but) Ingestion of hydrofluoric acid. The ingestion of even diluted hydrofluoric acid is fraught with the death of the patient after 1-7 hours. One large sip of rust remover in 90 minutes led to severe hypocalcemia, acidosis and lethal asystole.
At affected bloody vomiting, hypovolemic tetanic convulsions, upper airway obstruction, severe hypocalcemia, acidosis, shock and coma were observed. The electrical instability of the myocardium and the resulting life-threatening cardiac arrhythmias are probably due to the binding of potassium, magnesium and calcium ions,
Significant risk of hypocalcemia observed in the following cases (general rules):
(a) an exposure of at least 1% of the surface of the body with intact skin (for example, a single brush) to hydrofluoric acid with a concentration of 50% or higher,
(b) exposure to acid of any concentration over 5% of the body surface,
(c) inhalation of the vapor of its solution with a concentration of 60% or higher,
(g) ingestion of acid.
Fluoride ions can cause direct intoxication of the central nervous system, leading to stupor, coma and respiratory failure. They also lead to hemorrhagic gastritis, hypocalcemia, pulmonary edema, and metabolic acidosis. One patient survived by ingesting about 60 ml of rust remover containing 12% hydrofluoric acid. He developed lidocaine-resistant ventricular fibrillation in combination with hypocalcemia and hypomagnesemia.
b) Local action of hydrofluoric acid. Skin burns with hydrofluoric acid require rinsing immediately with plenty of water, preferably under a shower or faucet, for at least 15 to 30 minutes. Then the wound is treated. When exposed to an acid concentration below 20%, the preferred option is probably frequent and plentiful gel lubrication with 2.5% calcium gluconate. It is obtained by mixing 3.5 g of calcium gluconate powder (see United States Pharmacopeia) with 150 ml of a water-soluble ointment base, for example K-Y Jelly.
The gel can be fixed in place with a film that is impervious to it (vinyl glove, plastic dressing, etc.) and updated at a frequency necessary to relieve pain. Medical use of this product is not officially approved by the FDA.
at) Hydrofluoric Acid Infiltration. Skin lesions arising from hydrofluoric acid concentrations above 20% usually require I intradermal injection of 10% calcium gluconate (0.5 ml / cm2 of skin with a 30 gauge needle). The introduction of 10% magnesium salts was not effective in all experimental animals, so the final conclusion about their applicability for such burns can be made only after additional clinical trials. Calcium chloride for infiltration is contraindicated: this substance is caustic, and its use is fraught with even greater tissue damage.
d) Intraarterial calcium infusion for hydrofluoric acid poisoning. Burns with hydrofluoric acid are often on the fingers, where it is dangerous to use intradermal calcium injections. In such cases, an intra-arterial infusion of 10 ml of a 20% solution of its gluconate (180 mg of calcium) diluted in 40 ml of isotonic saline is recommended for 4 hours. Blood flow in the affected area is examined first using arteriography.
Effective method finger burn treatment concentrated hydrofluoric acid is also an infusion of calcium chloride: a mixture of 10 ml of its 10% preparation with 40-50 ml of 5% glucose solution. In experimental animals, the use of an ointment with calcium gluconate after such burns reduces the extent of tissue necrotization caused by them.
One of calcium arterial infusion regimens suggested by Siegel and Heard:
1. Determine at least the following laboratory parameters: the level of calcium, magnesium and phosphorus, prothrombin (PV) and partial thromboplastin (PTT) time.
2. A suitable vessel is cannulated with an arterial catheter of caliber 20 type 4 French or 5 French.
3. If only the thumb and forefinger are affected, cannula of the brachial artery, if the leg or foot is femoral.
4. The patient is in the intensive care unit, where the blood pressure curve is monitored.
5. The infusion is carried out for 4 hours: 10 ml of 10% calcium chloride diluted in 40 ml of isotonic saline is injected.
6. Every hour, check the shape of the blood pressure waves and rinse the catheter with heparinized saline.
7. After infusion of all calcium chloride, the catheter is washed with 10 ml of isotonic saline for 15 minutes.
8. When 500 IU of heparin is added to the infusion mixture, coagulation in the catheter is significantly slowed down.
9. A clot formed in it (visible by a flattened pressure waveform or by difficulty pushing blood out of a tube) lyses 5000 IU of urokinase.
10. After completion of the infusion, continuous monitoring of the waveform is carried out, washing the catheter with heparinized saline 1 time per 1 hour and according to indications.
11. The patient is observed for 48 hours.
12. After 4 hours, the affected limb is examined for residual pain and tenderness on palpation. If soreness persists, repeat the infusion.
13. One hour after the infusion, serum levels of calcium, magnesium and phosphorus, as well as PV and PTT, are determined.
14. If the magnesium level drops by 0.3 mg / 100 ml or below 1.7 mg / 100 ml, an intravenous infusion of magnesium sulfate is started at a rate of 1.015 - 4.06 meq / h. It is regulated depending on the increase in the level of magnesium and the number of injections of calcium.
15. The scheme with alternating 4 hours of infusion and 4 hours of rest is repeated until the residual soreness with a slight pressure disappears. 16. After completing the procedure, the catheter is removed and the patient is transferred to the surgical department for observation for 16 to 24 hours, after which it can be discharged.
e) Intravenous regional perfusion with calcium gluconate. Henry observed immediate relief of limb pain after regional intravenous perfusion with a mixture of 5 ml of 10% calcium gluconate with 20 ml of isotonic saline.
All symptomatic patients (persistent cough, shortness of breath) are shown hospitalization, since pulmonary edema can develop only after 24 hours.
- Burns. All victims with a total burn area of more than 2 - 3% of the body surface or significant respiratory failure must be hospitalized in the burn department or intensive care unit. If serum calcium levels cannot be determined immediately, and the lesion is extensive (more than 5% of the skin area), 1 g of calcium gluconate (10 ml of 10% solution) is administered intravenously.
- Acidosis. Systemic acidosis is eliminated by sodium bicarbonate, focusing on the gas composition of arterial blood. It is necessary to identify and stop cardiac arrhythmias caused by electrolyte imbalance, acidosis or hypoxia. As often as possible determine the levels of calcium, magnesium, phosphorus and potassium. The appearance of electrocardiographic signs of hypocalcemia (prolongation of the Q-T interval) and fluoride-induced hyperkalemia (the cause of arrhythmias) is monitored. Dialysis may be required to remove excess potassium and fluoride from serum. Hypotension is treated with infusion therapy and, if indicated, by vasoconstrictor agents.
- Eyes. Affected eyes should be flushed with plenty of water immediately within 30 minutes after exposure. Anesthetizing eye drops will increase the comfort of this procedure for the patient and facilitate its implementation for a long time. Periodically, it is necessary to check the pH of the eye fluid with a litmus test, continuing to rinse until this indicator normalizes. After washing, check visual acuity. An ophthalmologist is invited to consult. With corneal erosion caused by hydrofluoric acid, recovery can accelerate periodic installations of eye drops with 1% calcium gluconate in combination with standard treatment for acidic eye burns.
- Inhalation. Inhalation damage is treated by removing the victim from a source of hydrogen fluoride (preferably in fresh air) and at the same time by degassing his clothes and skin. It is necessary to monitor the signs of laryngeal and pulmonary edema, pneumonitis, pulmonary hemorrhage and systemic intoxication.
- Ingestion. After ingestion of hydrofluoric acid at home, the patient can be treated immediately with milk, which dilutes caustic liquid and possibly binds part of the fluoride ions. If spontaneous vomiting does not occur and less than 90 minutes have elapsed since administration, gastric lavage is recommended. The addition of 10% calcium gluconate to the wash liquid will help to bind part of the fluoride ions. There are no data or rules regarding the amount of fluid needed to clean the stomach. Ipecac syrup is contraindicated.
After cleaning the digestive tract, the patient is examined for signs of respiratory tract damage, perforation of the stomach, gastric bleeding, and systemic intoxication.
- Calcium and magnesium. After ingestion of hydrofluoric acid, which caused hypocalcemia (prolongation of the Q-T interval, Trusso or Hvostek symptoms) and hypomagnesemia, several intravenous administrations of calcium gluconate (for example, 9 and 10 ampoules to a patient who received 2 oral doses) and magnesium sulfate (2 and 5 g) for 6 to 7 hours in combination with repeated cardioversion (due to ventricular fibrillation), until the levels of calcium and magnesium in the blood normalize and the activity of the heart stabilizes.
The first step in helping the victim is to eliminate the burning effect. If something flows, drips or pours, then the victim must be moved away from the affected area, observing his own safety. Further assistance is provided in a certain sequence:
- Clothes and accessories stained with chemicals are removed from the victim.
- The skin at the lesion site is washed with water for about 20 minutes. If help is late, then flushing continues longer (up to 40 minutes).
- Dry and powder chemicals are shaken off first and only after that they start washing.
- With an acid burn, the substance is neutralized by washing with a soda solution. And with alkaline damage, they are washed with a weak solution of acid (vinegar).
- The site of lime damage is treated with a sugar solution, the concentration of which should not exceed 20%. It is impossible to rinse with running water, otherwise the chemical burn of the skin will become stronger.
- The damaged area is protected with a sterile cloth or a bandage.
Next, the victim is taken to the hospital. This can be done on your own or by calling an ambulance.
Chemical burn treatment: first aid
First aid in the treatment of chemical burns is to remove the chemical compound that caused the burn from the skin as quickly as possible. In this case, the main thing to remember about the principle: “do no harm”!
Sometimes, having received a burn, say acid, people try to fill the wound with alkali. As a result, a new burn is superimposed on one chemical burn, which seriously complicates the treatment.
In addition, valuable time is wasted searching for the “necessary ingredient”. Meanwhile, the effectiveness of the treatment of chemical burns directly depends on how quickly the substance was removed.
Naturally, safety precautions require that in rooms where chemical-active substances are used that can cause chemical burns, solutions with decontaminating substances are present, but if these are not clearly detected, chemical burns must be immediately rinsed with water (except in rare cases about which below).
Rinse a chemical burn with water for at least 10 minutes: in addition to actually removing the substance that caused the burn, washing with water cools the affected area of the skin, which reduces the depth of tissue damage.
After the burn is washed, a clean dressing should be applied and the victim should be taken to a medical facility. Treating chemical burns without consulting a doctor is quite risky - in the case of chemical burns, the external manifestations of the injury can be subtle and it is difficult for an amateur to assess the real depth of tissue damage.
What it is
By chemical burn is meant violation of the integrity of tissues or damage resulting from the action of chemical agents on them. Among them, the most common culprits are:
- acids (sulfuric, hydrofluoric, nitric)
Long-term effects of these substances on integumentary tissues are dangerous for the body. The extent of the lesion will be directly proportional to the concentration of the chemical and the time spent on the skin of the victim. Even a weak solution of a chemical compound with prolonged contact can cause skin burns..
Causes of Chemical Burns
As a result of the ingress of aggressive substances on the surface of the epithelium, a local chemical reaction occurs, leading to the destruction of skin proteins, membrane phospholipids.
Morphological changes are complemented by ulceration of wounds and the development of the inflammatory process. All this together gives an overall picture of a chemical burn, which manifests itself in one of four degrees.
Severity, depth of lesion, symptoms
- First degree characterized by redness of the skin, burning sensation and pain at the site of contact, and swelling or swelling of the tissues.
- Second degree arises as a result of deep lesions. In addition to hyperemia, surface vesicles filled with a transparent serous fluid are visualized.
- Third degree characterized by a violation of the tactile sensitivity of the burned area, which is covered with blisters with a cloudy or bloody contents.
- Fourth degree chemical burn - the most severe. Such damage penetrates through all skin layers, muscles, connective tissue, reaching the bone skeleton.
The site of exposure to the burn agent is gradually covered with a crust or coating. With alkaline types of chemical burns, the crust has a whitish hue. Alkali is the greatest threat to humans.. They are able to penetrate quite deeply, causing irreversible changes.
Sulphuric acid stains the burned area in white, and then gray. Nitric acid stains the epithelium in yellowish-greenish tones. Yellow burn is inherent hydrochloric acid. Hydrogen peroxide in high concentrations burns the skin with the formation of gray plaque.
Read also: How to use Panthenol in the form of a spray, ointment, cream, foam for various burns.
Before starting treatment, it is necessary to stop the effect of an aggressive substance on the epithelium.
Reducing the reactivity of a chemical can be achieved by conventional water rinsing of the affected area.
Cold compresses reduce pain and prevent the development of edema.
- Remove jewelry and clothing contaminated with chemicals.
- Rinse with running water for 20 minutes or up to 40 minutes if the events start late.
- Powder chemicals are previously shaken off the skin and only then the residues are washed off.
- Neutralization is carried out by exposure to a soapy or weak soda solution for acid burns, weak vinegar for alkaline burns.
- Lime burns are recommended to be treated with a 20% sugar solution.
- The damaged area is best lightly bandaged with a sterile bandage.
Medication for burns can be carried out in a hospital or at home, depending on the degree of burn and the condition of the patient. The skin around the wounds is treated with a 3% solution of boric acid. The wound cavity is washed with 3% hydrogen peroxide. Antiseptic irrigation in the presence of wounds is carried out with a solution of Chlorhexidine, Lavasept, Miramistin.
The second degree of burns allows treatment with ointments and emulsions. A good effect in the treatment of chemical burns occurs after the use of synthomycin emulsion, furatsilinovoy and Gentamicin ointment. Dermazin, Levomekol contributes to the rapid healing of wounds.
Traditional medicine has in its arsenal many recipes for the treatment of chemical burns:
- Flax oil compressesmixed with chopped boiled onion are shown for third degree burns. The bulb is pre-boiled and brought to a mushy state in the mixer, adding a small amount of flax oil. Change the dressing twice a day, continuing treatment until the epithelial layer is restored.
- Applying Fresh Cabbage Leaf Helps to eliminate pain and have an astringent effect. A sheet of fresh white cabbage is washed with boiled water and fixed with a bandage to the burn site with light rounds.
- Fresh grated potato applications help with minor burns, using them in the first minutes after an injury. The potatoes are rubbed and squeezed through several layers of gauze. Compresses are repeated 2-3 times a day. At night, a fresh portion of the plant mass is necessarily applied.
- Treatment of the burn site with starch solution with soda reduces the likelihood of blistering. Dry starch is mixed with baking soda in equal amounts and sprinkle on the damaged surface.
- 100 g green Hypericum sprouts mixed with 300 ml sunflower oil. Ожоги смазывают после тридцатиминутного кипячения, охлаждения и фильтрации смеси.
- Пихтовое масло так же эффективно при волдырях, как и облепиховое. Для повязки используют стерильную марлевую салфетку, смоченную в масле. The napkin is fixed with a bandage and changed several times a day.
- Milk decoction of black elderberry leaves prepared from 2 tablespoons of plant material and 0.5 l of milk. The crushed grass after adding milk is kept for 10 minutes in a water bath. Filter the solution after the mixture has completely cooled. For treatment, it is better to choose napkins made from natural linen. They are moistened with cooked broth. Steamed leaves are spread on a moistened napkin. The application for a burn is applied for several hours, followed by a change in bandage.
- A decoction of garden roses, elderberries, chamomiles, root crops of beets and bulbs You can cook quickly and get a good therapeutic effect. It is enough to peel one onion and cut it into several parts. To it add a few tablespoons of chopped elderberry roots and grated beets. Petals of garden roses will be enough about 100 g. Pharmacy chamomile will need only a pinch. The mixture is poured into 1 liter of water for subsequent boiling. Of chilled broth make lotions.
Complications of chemical burns
As a result of severe chemical burns, the regenerative function of the skin may be impaired. Especially often it occurs when deep layers are damaged. As a result, healing occurs with the formation of scar tissue.
In addition to a violation of the aesthetic state, coarse connective tissue disrupts the motor and excretory function of the skin.
Read also: An excellent bandage for the treatment of burns Branolind N with Peruvian balm
The best preventive measure is the proper storage of chemicals, in particular acids and alkalis. Subject to the instructions in the workplace and safety regulations, it is possible to completely eliminate the possibility of contact of aggressive substances with the skin.
To do this, there is a special working protective clothing and shoes. Before working with an unknown substance, it is necessary to study the instructions for use in detail. Work with reagents is carried out using protective shields, glasses and gloves. If necessary, use masks or respirators.
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Before using any means and prescriptions, we recommend that you consult with your doctor!
What substances are most often burned
Chemical skin burns most often occur through negligence. People do not follow safety precautions when working with various acids, alkalis, gasoline, kerosene, phosphorus, bitumen and other hazardous substances. Among acid burns, sulfuric, nitric, and hydrofluoric acids are leading.
Kerosene and gasoline are burned when working in a garage or when trying to remove a stain from paint, tar or wax. Bitumen can get on the skin during construction or repair work. The substance has a high temperature and adheres tightly to tissue or skin. This complicates a chemical burn with thermal damage.
Determination of the degree of damage
A section of medicine called "combustiology" deals with the treatment of burns. Experts in this field argue that if first aid was performed correctly, the degree of damage is reduced by one, and if it is wrong, the degree of burn increases.
The degree of damage is distinguished as follows:
- Chemical burn of the skin of the I degree is an edematous and reddened area of the skin, painful to the touch.
- Grade II is characterized by the appearance of blisters (vesicles) containing a clear liquid. Affected skin looks swollen, they are painful to the touch.
- With the III degree, the burn penetrates the skin up to the subcutaneous tissue. Partial tissue necrosis occurs, the reaction is impaired, since the nerve endings are melted.
- At the IV degree of a chemical burn, the destruction of the deep layers occurs. A burn affects not only the skin, but also the muscles, ligaments, bones, internal organs.
It is not always possible to understand on the spot how much a person has suffered from chemical exposure. The exact extent of the problem is clarified only after 1-2 weeks, when suppuration of the scab area occurs. In addition, the burn area is important.
Medical Area Definition
Doctors determine the size of a burn in several ways. The first is called the "rule of nines." In this case, the surface of the skin of an adult patient is divided into conditional 11 sites, each of which is considered as 9% of the surface:
- chemical burn of the skin of the face, head and neck - 9%,
- damage to the upper extremities - 9% * 2,
- damage to the lower extremities - 18% * 2, that is, each leg 2 times 9%,
- skin of the front side of the body - 18%,
- skin of the back of the body - 18%.
There remains 1 percent, which conditionally falls on the skin of the perineum.
The second method is based on the statement that the palm area of an adult is about 1% of the skin surface. With limited exposures to the palm of the hand, the area of the lesion is measured, with extensive burns, the size of the uninjured areas of the skin. With deep chemical lesions, the victim develops a burn disease. The course of the disease directly depends on the area and depth of exposure.
In which cases self-treatment is acceptable
If there is a chemical burn of the skin, treatment at home is permissible only with I degree of damage. But this is provided that the first aid was provided correctly and the consequences of the defeat are minimal. If an extensive burn of I degree is received, then it is necessary to consult a doctor.
With second-degree burns, independent treatment can be tried only with a small lesion area. If the blister is more than 5 cm, then you can not postpone the visit to the doctor. After contacting the burn center with lesions of the first or second degree, hospitalization is not necessary.
A chemical burn of the III and IV degree may require surgical intervention, since self-repair of tissues is slowed down or does not occur at all. You should not take risks if a person has a severe chemical burn of the skin. Treatment at home will still not give a result. It follows that with deep burns, going to the doctor is a matter of life and death for the victim.
At the hospital, doctors evaluate the condition of the victim and only after that decide how to treat a chemical skin burn. The affected area is additionally washed, treated with antiseptics. The patient is prescribed a course of antibiotics and painkillers. Using droppers, restore the body's water balance. Depending on the degree and area of the lesion, a skin transplant is performed from intact parts of the body.
Doctors have two goals:
- Achieve tissue regeneration.
- Prevent infection of the affected areas or minimize the negative impact on the body.
Recovery from severe chemical burns is slow. Even after tissue healing, doctors observe their patients for years to help them recover as much as possible.
How to treat a chemical burn at home
Chemical burns of the I and II degrees (up to 5 cm) can be treated at home. But even with small foci that are localized in the face, hands, feet or perineum, it is necessary to consult a doctor.
If home treatment showed signs of secondary infection of the wound, that is, the edges became red and swollen, purulent discharge appeared, body temperature increased and pain intensified, then the treatment does not help and professional help is needed.
For home treatment, an ointment for chemical burns of the skin on a gel or water basis is used. These include the following drugs:
It is acceptable to use sprays containing panthenol. When processing use sterile bandages, wipes and gloves. Hands must be treated with special means so as not to infect.
Despite the advice of grandmothers and neighbors, who are well-known experts in all areas, remember that many actions do significant harm:
- Never open blisters on burns at home; this opens the way for infection.
- Do not lubricate affected areas with oil, protein, sour cream or alcohol.
- Do not wash the chemical burn with urine, otherwise infection is guaranteed.
- Do not touch the wound surface with your hands, but only with sterile swabs or a napkin.
- Do not apply medicinal plants to a burn.
- Do not use cotton wool and bandage when dressing.
The best option for home treatment is to first get a specialist consultation and identify health risks.
Acid burn treatment
Contrary to the widespread stereotype, burns with diluted rather than concentrated acids are most dangerous. Concentrated acid instantly causes protein coagulation, resulting in the formation of a dense scab that prevents the burn from deepening.
Treatment of acid burns should begin with washing the burned surface with a 1-2% solution of soda, and then with a 0.5% solution of ammonia.
Treatment of burns with hydrofluoric acid
Burns with hydrofluoric acid (which is used, for example, for etching glass) are one of the most severe due to the general toxic effect of the compound. In this case, burns with hydrofluoric acid leave virtually no residue!
If hydrofluoric acid gets on the skin, wash the affected area with an emulsion of magnesium oxide in glycerol (if at hand), or with running water, and immediately deliver the victim to the hospital.
Alkali burn treatment
Burns with alkali are one of the most dangerous. Alkali quickly penetrates deep into the skin and causes saponification of fats in the subcutaneous tissue, therefore alkali burns are very “loose”, with a large amount of tissue infiltrate, accompanied by severe edema and purulent complications.
Alkali burns should be treated with a 1-2% solution of citric or acetic acid.
Phosphorus Burn Treatment
The place of the burn should ideally be submerged under water (to stop air from reaching phosphorus and spontaneous combustion), or kept under a strong stream of water.
You should try to remove all phosphorus particles, and then cover the burn with a dressing that is richly moistened with 5% potassium permanganate solution (it prevents the ignition of phosphorus)
Treatment for Quicklime Burns
Quicklime burns are the only case when it is strictly forbidden to rinse the burn site with water. The affected surface should be greased with a copious layer of fat and delivered to the hospital.
However, no matter what the chemical burn is caused, and whatever antidotes are introduced to neutralize the active substance, the actual treatment of chemical burns is reduced to drying the wound in order to remove excess infiltrate, treating with antiseptics and using drugs that improve blood microcirculation in the affected area and accelerate processes tissue regeneration.
Treating Chemical Burns: Healing Medicines
As for drugs that accelerate regenerative processes and improve blood microcirculation in burned tissues, Solcoseryl has been considered the standard for such drugs for more than fifty years. The Swiss drug is made on the basis of deproteinized components from the blood of dairy calves. Solcoseryl contains a complete set of amino acids, nucleotides and other biologically active compounds necessary for tissue repair. Since during the healing of burns, the need for “building material” increases significantly, the use of Solcoseryl significantly reduces the treatment time for a burn.
For the treatment of chemical burns, the gel form of the drug on a fat-free basis is best suited. In addition to the fact that Solcoseryl gel allows you to quickly bring biologically active substances deep into the burn, the gel base of the drug dries the wound, preventing excessive accumulation of exudate.