chemical trauma

7/26/2019 Chemical Trauma

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Chemical Burn


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Chemical Burn

First aid to rescue in time

To disengage chemical contact immediately and rinse inlocale as soon as possible mass of water long time

Neutralization acid 2 Sodium bicarbonate,sulfadiazine base Vitamin C

nfection pre!ention antibiotic To promote healing epidermal growth factor Vitamin C

pre!ention and cure symblepharon and other complication

mydriasis " #tropine

glucocorticoid

Collagenase inhibitor

Tear Substitute contact lens

Complication Treatment $peration


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#cid and %asesn&ury


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Introduction

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Pathophysiology

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Multiple factors influence tissue damage and percutaneous

absorption of chemicals (severity)


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eneral (pproach4 5he goal of treatment is to minimize any area of

irreversible in6ury and maximize salvage in thezone of reversible damage.

4 aggressive irrigation with water is the cornerstone

of initial treatment for chemical burns.

4 7mmediate removal from the offending chemical,debridement, ry chemical particles such as lime

should be brushed away before irrigation.

4 !odium metal and related compounds should be

initially covered with mineral oil or excised,

because water can cause a severe exothermic

reaction.


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4 however, use of water or saline to

irrigate a chemical burn should not be

delayed while searching for other

treatment agents and should begin

immediately at the scene of the

accident. (lmost universally, earlierirrigation means a better prognosis.


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Specifc Chemicals


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Acid Burns

4 (cetic (cid4 Carbolic (cid 8Phenol3

4 Chromic (cid

4 9ormic (cid

4 0ydrochloric and!ulfuric (cids

4 0ydrofluoric (cid

4 -ethacrylic (cid

4 1itric (cid4 Oxalic (cid

Alali4'yes 8ammonium,barium, calcium, lithium,

potassium (caustic

potash), and sodium

(caustic soda) hydroxides4'ime4Portland Cement4 -etals


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Acid

4 p0 :+ ) strong corrosives.

4 !everity ) physical characteristics of the acid.

include concentration, molarity, andcomplexing affinity for hydroxyl ions.

4 Contact time with the s$in is the most

important chemical burn feature

4 penetrate s$in deeper and longer

4 ;ounds may initially loo$ superficial only tobecome full/thic$ness burns in + to < days.

4 !trong al$alis have a p0 =+.

Alali


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Alali


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Acetic Acid

4 in hair/wave neutralizer solutions 8chemical burns to the scalp in women3,4 can cause a partial/thic$ness burn.

Carbolic Acid (Phenol)4 ( corrosive organic acid used widely in industry and medicine,

4 denatures proteins and causes chemical burns characterized by arelatively painless white or brown coagulum.

4 !ystemic absorption may result in life/threatening complications.

4 5he unpleasant, acrid odor of phenol

4 econtamination is gentle wash with a combination of P"# mixture 8?/ to >/minute3 , or

by a gentle wash with isopropyl alcohol.


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Chromic Acid

4 Powerful oxidizers.

4 chronic penetrating ulcerating lesion of the s$in.

4 !ystemic chromium toxicity can cause liver or renalfailure, 7 bleeding, coagulopathy, and centralnervous system disturbances.

4 (ggressive excision has been shown to be the bestmethod

4 5opical agents such as ?@ thiosulfate and ascorbicacidpreventing toxicity while preparing for surgical

excision.


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$ormic Acid

4 9ormic acid in A@ solution is used by acrylate glue

ma$ers, cellulose formate wor$ers, and tanning wor$ers.4 produces coagulation necrosis of the s$in.

4 !ystemic effects,

B decreased respiration,

B anion gap metabolic acidosis

4 5reatment

B ebridement,

B prevention of further damage and infection, and

B s$in grafting if the defect is full thic$ness and of a sizereuiring coverage.


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%ydrochloric and !ulfuric Acids

4 5hese acids can burn the s$in dar$ brown or

blac$.4 5here are 5oilet bowl cleaners acid, rain

cleaners, -unitions, chemical, and fertilizermanufacturers, (utomobile battery fluid 8+?@3

sulfuric acid, 0ousehold bleaches are only


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%ydrofluoric Acid

4 0ydrofluoric acid is uniue among the corrosives in its mechanism

of action and degree of toxicity, its acts li$e al$alis and will cause

progressive tissue loss, including bony destruction

4 0ydrofluoric acid is used in the production of high/octane fuel, veryeffective rust remover

4 0ydrofluoric acid rapidly penetrates the s$in and causes both local

and potentially lethal systemic toxicity. 7ts systemic effects include

hypocalcemia, hypomagnesemia, and hyper$alemia.


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4 5he treatment of hydrofluoric acid burns consists of two

phases.

>. immediate phase is copious water irrigation of the

affected s$in for >? to


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Methacrylic Acid

4 -ethacrylic acid found in many artificial nail cosmeticproducts can produce severe dermal burns,

*itric Acid

4 1itric acid is used in industry for casting iron and steel,electroplating, engraving, and fertilizer manufacturing.

+,alic Acid

4 Oxalic acid is used for leather tanning and blueprintpaper. 'i$e hydrofluoric acid, it poisons enzymaticprocesses. Oxalic acid binds calcium and preventsmuscle contraction..


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-reatment of !elect Chemical Burns


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.yes4 !trong, corrosive al$alis 8DlyesD3 include ammonium, barium,

calcium, lithium, potassium 8caustic potash3, and sodium 8causticsoda3 hydroxides.

4 'yes are widely used in industry and are found in home products8drain and toilet cleaners, detergents, and paint removers3.

4 .yes are e,tremely corrosive and penetrating& and burns

re/uire copious irrigation for long periods4 !uicidal ingestion of lye may result in rapid death from upper

airway occlusion. 'ate morbidity related to esophageal andgastric necrosis may be minimized by early surgical interventionwith esophagogastrectomy.

4 (mmonium hydroxide is used in the production of synthetic fibers

and extensively in agriculture.


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'ime

4 'ime 8calcium oxide3 is found in agricultural

products and cements.

4'ime is converted by water to the al$alicalcium hydroxide.

4 pon s$in contact, lime draws water out of the

s$in. (ll dry lime particles should be brushed

away before irrigation.


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Portland Cement

4 Portland cement, which accounts for a

ma6or proportion of the cement used in

the .!., is a mixture of sand, lime, and

other metal oxides.


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4 #urning metal may be extinguished with a

class fire extinguisher or smothered with

sand. #urning metal fragments can also be

covered with mineral oil.4 ;ound debridement should include excision


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+cular Burns

Acid injury

!igns and symptoms )

4 Early ) tearing, rubbing, redness, pain, and blepharospasm.

4 Con6unctiva ) pale due to ischemia and destruction of vascular

supply.

4 !welling of the corneal epithelium,

4 clouding of the anterior chamber,

4 pupillary dilatation4 corneal ulceration


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4 p0 paper should be used to determine the presence of

acid or al$ali

4 (cid uic$ly precipitates the superficial tissue proteins of

the eye, producing the typical Dground glassD appearanceof the cornea.

4 Damage sustained secondary to acid burns in most

cases is immediate and limited to the area of contact

(no late effects such as cell disruption or tissuesoftening3.


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Alali injury

4 (l$ali burns are more severe

4 In a short period& strong alali can penetrate the cornea&

anterior chamber& and the retina& ith destruction of all sensoryelements& thus causing complete blindness

4 !evere chemosis, blanched con6unctiva, and an opacified corneaobscuring view of the iris or lens


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4 "mergency ophthalmology consultation is needed for

corneal burns

4 9or severe corneal in6ury, a collagenase inhibitor such as

cysteine or acetylcysteine is used to prevent loss ofcorneal stroma,

4 5opical steroids may reduce iridocyclitis but may also

exacerbate collagenase/induced corneal ulceration.

4 ( scleral contact lens may reduce adhesions and scarring.4 7ntraocular pressure should be chec$ed

4 Corneal transplantation, blepharoplasty, $eratoplasty, or

$eratoprosthesis may be eventually reuired.


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4 ry eyes4 7ris and ciliary body 8iridocyclitis3 and4 posterior synechiae 8(dhesions between lens and

iris3

4 Ectropion 8lid deformity3,4 Cataract4 #laucoma (>?@/??@ in patients with severe burns34 !carring of the cornea,4 symblepharon.

Complication


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THANK YOU!


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@+HF7n6uryFofFtheFCon6unctivaFandFCorneaI7nternationalFClassificationFofFiseases


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Epidemiology4 = +?, products are capable of producing chemical

burns

4 9reuensy of Chemical in6uries occur

B J@ of wor$/related eye in6uries

B = A@ of wor$place accidents,B @ are the result of an assault

4 +%< young men.

4 Mortality0MorbidityB +@ visual and cosmetic disabilityL

B only >?@ of patients with severe chemical in6uries

achieve functional visual rehabilitation.

chemical trauma

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