Symptoms, diagnosis and treatment of chemical burns
Injuries from caustic substances usually occur in chemical industry, during transportation and handling of hazardous materials, at home, during job training and at school.
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Clinic for Hand-, Plastic & Reconstructive Surgery – Burn Center – Clinic for Plastic & Hand Surgery at Heidelberg University Hospital, BG Trauma Center Ludwigshafen, Germany 2 ETHIANUM, Clinic for Plastic, Aesthetic & Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany
Chemical burns Injuries from caustic substances usually occur in chemical industry, during transportation and handling of hazardous materials, at home, during job training and at school. Chemical burns are described as injuries to the skin or mucous membranes caused by chemical substances. Usually, strong acids or bases cause protein denaturation in tissues, resulting in cell damage and apoptosis with subsequent necrosis. In addition some substances may cause toxic as well as thermal damage. The extent of cutaneous damage depends on type, amount, and concentration of the caustic substances, but also on the duration of exposure. Disrupting the pathophysiological mechanism of the chemical reaction at an early stage is therefore the foremost goal of any medical treatment, before treating the actual damage.
▶ specific decontamination: transformation of the acid into its salt, cleavage/hydrolysis of toxic compounds, application of antidotes, etc. ▶ natural decontamination: vaporization of volatile substances First aid treatment, which has to be initiated immediately after exposure, should ensure in particular the protection of those providing first aid. The effects of hazardous substances must be reduced for the individual involved, for others at risk, and for rescue personnel. In this regard, caustic substances are labeled in the chemical industry with specific hazardous material declarations and accompanied by accident procedure sheets from which instructions can be gathered for administering first aid. Contamination with caustic substances in solid, liquid or gas form affects several organ systems in different ways depending on the concentration, the way of contact with the body, and the duration of exposure.
Decontamination As an initial procedure, decontamination of the affected patient is of utmost importance to reduce the contact time between the caustic substance and the tissue. The decontamination process has to be divided into specific procedures: ▶ unspecific decontamination: mechanical removal of toxic agents, when indicated extensive rinsing additionally provides for a desired diluting effect
Affection of different organ systems Respiratory tract Odor and irritation of breathing such as coughing following inhalation have a significant warning effect. If vapors are inhaled, symptoms such as burning, dryness of the nose and throat, coughing, dys-
453 Marc G. Jeschke et al. (eds.), Handbook of Burns © Springer-Verlag/Wien 2012
L. Kolios, G. Germann
pnoea, and angina pectoris symptoms may appear [4]. Increased production of secretion, raised capillary permeability, surfactant destruction, bronchoconstriction, and pulmonary hypertension are possible sequelae [12]. Inhalation of higher concentrations can lead to laryn
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