Answer:
Chemical burns usually occur in industrial accidents and in laboratories. The substances most likely to be encountered are:
acid - sulphuric, hydrochloric, nitric and hydrofluoric.
alkali - caustic soda (sodium hydroxide), potassium hydroxide, lime (calcium oxide).
phenols - phenol, lysol.
phosphorous
The immediate treatment of all chemical burns is to remove the active substance as soon as possible by washing the affected part under running water. The only exception is with lime, where all solid material should be removed prior to washing. After washing, an antidote may be applied, which is sodium bicarbonate for acid burns, and vinegar or ammonium chloride for alkalis.
HYDROFLUORIC ACID BURNS:
Hydrofluoric acid is widely used in glass manufacture, pottery, glazing, and cleaning agents for tile and granite surfaces. Contact with skin results in a characteristic burn accompanied by intense pain where the skin is coagulated. Progressive destruction of deeper tissues occurs in the absence of treatment, and the burn extends subungually, restricting access for topical agents. The treatment is:
1. Immediate flushing with cold water for 20 min.
2. Application of iced water until the pain subsides.
3. IV infusion of calcium gluconate into the site of injury under tourniquet control to achieve better pain control.
4. If the area is large enough, excision of burned area with immediate skin grafting is the treatment of choice.
PHENOL BURNS:
Phenol penetrates deeply into the skin and unless the chemical is removed quickly, it can be absorbed to give systemic and local effects, the most concerning of which is renal damage. Early excision and grafting is recommended.
PHOSPHOROUS BURNS:
Commonly caused by bombs, and can therefore be present in the tissue as multiple particulate pieces, which continue to cause tissue damage until physically removed from the tissue. The wound can be rinsed with 1% copper sulfate which turns the phosphorous particles black and facilitate identification. Absorption of large amounts of copper sulfate will cause severe renal damage.