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Chemical Burns

Chemical Burns. Burn Symposium STATION 1. Isaac Tawil, MD UNM Burn Center Adults & Pediatrics. from tragedy… hope!. UNM Burn Center from tragedy… hope!. Chemical Burns. Isaac Tawil MD UNM Emergency Medicine &Trauma-Critical Care. Chemical Burns…. Ubiquitous: Petroleum distillates

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Chemical Burns

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  1. Chemical Burns Burn Symposium STATION 1 Isaac Tawil, MD UNM Burn Center Adults & Pediatrics from tragedy… hope!

  2. UNM Burn Center from tragedy… hope! Chemical Burns Isaac Tawil MD UNM Emergency Medicine &Trauma-Critical Care

  3. Chemical Burns… • Ubiquitous: • Petroleum distillates • fertilizers • House cleaners • Industrial applications • Chemical Warfare

  4. Are chemical burns important? • 3% of all burn patients • 30% of all burn deaths

  5. Severity of chemical burns • Strength = concentration • Quantity • Duration of contact • Penetration of agent • Mechanism of action adult & pediatric injury…

  6. Mechanisms of action • Reduction: HCL, Nitric acid • Oxidation: NA Hypochlorite (Clorox, Dakin’s) • Corrosiveagents: phenols, cresols, lyes • Protoplasmic poisons: HF, acetic, formic acid • Vesicants: DMSO, mustard gas, lewisite • Desiccants: sulfuric acid, muriatic acid

  7. Acids vs. Alkali • Acids: Coagulation Necrosis • Alkali: Liquefactive Necrosis

  8. Treatment • Removal of offending agent from patient • Removal of clothing • Brush off powders/ solids • Wash off liquids • Copious irrigation • Protection of Health Care Providers • Irrigate to the floor / No tubs

  9. Treatment • Monitor pH of irrigation effluent • Neutralizing solutions…?? • Be aware of antidotes • HF calcium gluconate • Chromic acid Na hyposulfite wash • Lewisite/ Phosgene Dimercaprol

  10. Case #1 • Construction worker presents with burns • He was pouring a slab of concrete

  11. Case #1: Cement burns • Cement: Alkali & Dessicant • Calcium Oxide +H2O Calcium Hydroxide Treatment…?

  12. Case #2 • 35 M presents w/ 16% TBSA burns from meth lab explosion. • Complains of shortness of breath and burn pain • Which of the following may cause a chemical inhalational injury, and how might this chemical contribute to tissue injury? • Ammonia • Chlorine • Ozone • Phosgene • Mustard gas

  13. Case #2: Ammonia burns • Key ingredient in methamphetamine production • Causes serious lung injury (particularly upper airways) • Ammonium + H2O = ammonium hydroxide Treatment…?

  14. Case #3 • 42 M present 24 hours after chemical exposure during glass etching • Patient also c/o heart fluttering • ECG: prolonged QT

  15. Case #3: Hydrofluoric Acid Burn • Lethal acid & metabolic poison • Serum electrolytes & ECG monitoring are key. • Treatment focus on neutralizing Fluoride ion • Calcium gluconate gel • Calcium gluconate SQ injections • Intra-arterial calcium • Patient’s pain guides treatment

  16. How can these help you?

  17. Questions… one child burned, is one child too many! Isaac Tawil, MD UNM Burn Center Adults & Pediatrics from tragedy… hope!

  18. The New Mexico Burn Corps Call 1-888-UNM-PALS to join our TEAM! We need active VOLUNTEERS from all ages to help us meet the needs of New Mexico! Isaac Tawil, MD itawil@salud.unm.edu

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