Chemical burn

Introduction to chemical burns The extent of chemical burns is closely related to the nature of the chemical, the dose, concentration, physical state (solid, liquid, gaseous), contact time and contact area, and first-aid measures at the time. The local damage of chemical substances is mainly cell dehydration and protein denaturation, and some heat production increases burns. Some chemicals can be poisoned after being absorbed. basic knowledge The proportion of illness: 0.0005% Susceptible people: no specific population Mode of infection: non-infectious Complications: hepatitis, acute renal failure, anemia, brain edema

Cause of chemical burn

Drug damage (55%):

Chemicals have oxidative effects, reductive effects, corrosive effects, protoplast toxicity, dehydration and blistering effects on local tissues. This is determined by the nature of the chemical. Some burns due to their own burning, such as phosphorus burns, and some do not damage healthy skin. Once the inflammation burns, causing skin burns, the drug can be absorbed into the body through the wound, causing a poisoning reaction.

Generally, acid burns, due to the coagulation of tissue proteins, forms a layer of clam shell, which can prevent further damage, form fat saponification after alkali burn, and can produce soluble basic protein, so there is a process of continuing damage to local wounds, and phosphoric acid is formed after phosphorus burns. Can continue to damage the organization.

Organ damage caused by poisoning (40%):

Chemical drugs can be absorbed from normal skin, wounds, respiratory tract, digestive tract, etc., causing poisoning and destruction of internal organs. The mortality of chemical burns is significantly higher than that of general burn patients, which is caused by poisoning caused by chemical poisons and its complications. Because most chemicals are excreted by the liver and kidneys, liver and kidney damage are more common. Common toxic hepatitis, acute liver necrosis, acute renal failure and tubular nephritis, etc., some chemical vapors directly stimulate the respiratory tract. Injury, many volatile biomass is excreted from the respiratory tract, which also stimulates the alveoli and respiratory tract. It can cause pulmonary edema and inhalation damage. Some chemicals can inhibit the discharge of substances from the respiratory tract, and also stimulate the alveoli and respiratory tract, which can cause pulmonary edema and inhalation injury. Some chemicals can inhibit bone marrow, destroy red blood cells, cause anemia or hemolysis, and some can cause toxic encephalopathy, cerebral edema, nerve damage, peptic ulcer and bleeding.

Chemical burn prevention

Chemical burns include strong acid burns, strong alkali burns and phosphorus burns, etc. Strong acids include sulfuric acid, nitric acid and hydrochloric acid, etc., strong acid corrosive, causing local pain, and forming acidic protein salts to form thick sputum of different colors; Including sodium hydroxide, potassium hydroxide, lime and ammonia, etc., due to the action of strong base on proteins, the formation of usable protein salts, the saponification of fat, which has greater destructive power, can cause alkali to erode deep and around, The bottom of the wound is deep and concave, and the healing is very slow. Phosphorus burns naturally cause heat in the surface of the body, causing local pain. The white smoke in the phosphorus burn is phosphorus pentoxide. When it forms water with water, it can be absorbed from the wound. Causes kidney and nervous system poisoning, phosphorus smoke inhaled into the respiratory tract, can cause pulmonary edema.

Chemical burn complications Complications, acute renal failure, anemia, cerebral edema

Common with toxic hepatitis, acute liver necrosis, acute renal failure and renal tubular nephritis, anemia, hemolysis, toxic encephalopathy, cerebral edema, nerve damage, peptic ulcer and bleeding.

Symptoms of chemical burns Common symptoms Weakness, shortness of breath, shortness of breath, coma, nausea, high heat, contracture scar, phosphorus burn, poisoning, palmar scar, deformed blisters

1, acid burn

Commonly used are sulfuric acid, hydrochloric acid, nitric acid burns, in addition to hydrofluoric acid, carbolic acid, oxalic acid, etc., which are characterized by dehydration of tissue, protein precipitation, and coagulation, so the wounds quickly become sputum after burns, and the boundaries are clear, thus limiting the continuation Erosion to the deep.

1 sulfuric acid, hydrochloric acid, nitric acid burns: sulfuric acid, hydrochloric acid, nitric acid burns a higher incidence, accounting for 80.6% of acid burns, sulfuric acid burn wounds are black or brownish black; hydrochloric acid is yellow; nitric acid is yellow brown, in addition, color change It is also related to the depth of the wound. The tidal red is the lightest, gray, brownish yellow or black. After the acid burns, the early judgment of the depth is more difficult than the general burn because of the scalp. It can not be judged as the concentration burn due to the waterless bubble.

Sulfuric acid, hydrochloric acid, nitric acid can cause skin burns in liquid state, and inhalation can cause inhalation injury in gaseous state. Compared with the three acids, at the same concentration, the sulfuric acid is the strongest in the liquid state, and the nitric acid is the strongest in the gaseous state. Pulmonary edema can occur in a few hours, and they can cause upper gastrointestinal burns, laryngeal edema and difficulty in breathing, and even ulcer perforation after oral administration.

It treats the principle of first-aid treatment with chemical burns. After washing, it can neutralize the hydrogen ions remaining on the skin with 5% sodium bicarbonate solution or magnesium oxide, soapy water, etc. After neutralization, it continues to rinse, and the wound is exposed. If it is determined to be III degree, cut the skin graft sooner or later, inhalation injury according to its routine treatment, after swallowing strong acid, can be oral milk, egg white, aluminum hydroxide gel, soy milk, magnesium milk, etc., forbidden gastric lavage or with emetic, avoid The use of fire-resistant sodium hydrogen hydride to avoid the production of gastrointestinal perforation, oral prednisone, to reduce fiber drugs.

2 Hydrofluoric acid burn: Hydrofluoric acid is an aqueous solution of hydrogen fluoride, which is colorless and transparent, has strong corrosiveness, and has the function of dissolving fat and decalcifying. After hydrofluoric acid burn, the wound may initially have only erythema or leather-like eschar. Then necrosis occurs, and the tissue is eroded to the surrounding and deep tissues, which can damage the bones and cause necrosis, forming ulcers that are difficult to heal. The wounded are heavier, 10% hydrofluoric acid has a greater wounding effect, and 40% is on the skin. The infiltration is slower.

After hydrofluoric acid burn, the key is early treatment, should be washed immediately with a large amount of running water, at least half an hour, there are also advocated to rinse for 1-3 hours, after washing, the wound can be coated with magnesium oxide glycerin (1:2) ointment, or Soaked in saturated calcium chloride or 25% magnesium sulfate solution to precipitate residual hydrofluoric acid on the surface into calcium fluoride or magnesium fluoride. Avoid using ammonia water to avoid the formation of corrosive ammonium difluoride (ammonium hydrogen fluoride), such as pain. In the drama, 5% to 10% calcium gluconate (0.5ml/cm2) can be added to 1% procaine for subcutaneous and intraperitoneal infiltration to reduce progressive damage. Beijing Jishuitan Hospital has prepared a cream and applied it. Wounds, every 2 to 4 hours dressing change, if necessary, can be bandaged until the pain disappears, and achieved satisfactory results. Hayashi reported that corticosteroids also have a certain effect on hydrofluoric acid. If there is blisters on the wound surface, burns should be removed. When the next, the finger (toe) should be removed, and the III degree wound should be cut early.

3 Carbolic acid burns: After the absorption of carbolic acid, it mainly causes damage to the kidneys. It has strong corrosion and penetrability, and has progressive infiltration damage to the tissues. Therefore, first use a large amount of flowing cold water to rinse, then rinse or dress with 70% alcohol. Deep wounds should be cut or cut early.

4 oxalic acid burn: skin, mucous membrane contact with oxalic acid is easy to form a powdery white intractable ulceration, and oxalic acid and calcium combined to reduce blood calcium, so when treatment with a large amount of cold water rinse, local and system should be timely application of calcium.

2, alkali burns

The common clinical alkali burns are caustic, lime and ammonia. The incidence is higher than that of acid burn. The alkali burn is characterized by binding with tissue proteins to form basic protein compounds, which are easy to dissolve and further deepen the wounds; saponified fat Tissue; dehydration of cells to death, and heat damage, so it causes damage more serious than acid burns, 1 caustic burn: caustic alkali refers to sodium hydroxide and potassium hydroxide, which is highly corrosive and irritating, After the burn, the wound surface is sticky bone or soapy eschar, the color is red, generally deep, usually above the deep II degree, the pain is severe, the wound blank is painful after the tissue is detached, the wound is sunken, the edge is sneak, and it often lasts for a long time.

The key to its treatment lies in the early and timely flow of cold water rinse. The washing time is long. Some people advocate flushing for 24 hours. It is not recommended to use neutralizing agent. Deep wounds should be cut early. After taking caustic soda, it is forbidden to gastric lavage and induce vomiting to prevent stomach. With the perforation of the esophagus, you can use a small dose of olive oil, 5% acetic acid or vinegar, lemon juice orally, and the gangrene will naturally fall off the gangrene to form a granulation wound. The granulation wound can be wetted with 1% citric acid solution for 24 hours to lower the pH. To improve the survival rate of skin grafting.

2 lime burn: quicklime (calcium oxide) and water form calcium hydroxide (slaked lime), and release a lot of heat. When the lime burns, the wound surface is dark and dark, and the lime powder should be wiped clean before washing. Heat production increases wounds.

3 ammonia water burn: ammonia water is very volatile to release ammonia, it is irritating. After inhalation, it can cause inhalation injury such as throat, laryngeal edema and pulmonary edema. The wounds in contact with ammonia water are blisters, and the depth is dry and black leather-like coke. scab.

The wound treatment is the same as general alkali burn, and those with inhalation injury should be treated according to the principle of inhalation injury.

3, phosphorus burn combined poisoning

Phosphorus burns ranks third in chemical burns, second only to acid and alkali burns. Phosphorus removal can cause injury when burned by air, and phosphorus pentoxide is formed after phosphorus oxidation, which has dehydration and oxygen scavenging effects on cells. Phosphorus oxide forms phosphoric acid in the presence of water and generates heat during the reaction process to further deepen the wound surface. Inhalation of phosphorus vapor can cause inhalation damage. Phosphorus and phosphide can cause phosphorus poisoning through inhalation of wounds and mucous membranes.

Phosphorus protoplasmic toxicity can inhibit the oxidation process of cells. Phosphorus absorption is more abundant in liver and kidney tissues, which may cause extensive damage to organs such as liver and kidney. After phosphorus burn, patients mainly present with headache, dizziness and fatigue. Nausea, severe cases can occur liver, renal insufficiency, hepatomegaly, liver pain, jaundice, oliguria or anuria, protein and cast in the urine, due to inhalation injury and phosphorus poisoning can cause shortness of breath, irritation Cough, lungs and dry and wet rales, severe pulmonary insufficiency and ARDS, chest radiographs suggest interstitial pulmonary edema, bronchial pneumonia, some patients may have low calcium, hyperphosphatemia, heart rhythm disorders, mental symptoms And cerebral edema, etc., the phosphorus burn wounds are deeper, can damage the bones, the wound surface is brown, and the III degree wound can be bronze or black when exposed.

After the phosphorus burn, immediately extinguish the flame, remove the contaminated clothes, rinse the surface with plenty of water or soak in the water, carefully remove the phosphorus particles on the wound surface to avoid contact with the air. If there is no large amount of water at the moment, cover the wound with a damp cloth. To avoid inhalation injury, patients and rescuers use a wet handkerchief or mask to cover the nose and mouth. After admission, the patient is washed with 1% copper sulfate to form black phosphating copper, which is easy to remove, and then rinsed or soaked in water with water. The amount of copper sulfate and the whiteness of the wound surface do not occur, the residual phosphide of the wound is carefully removed with scorpion, rinsed with water, wetted with 5% sodium bicarbonate solution, neutralized with phosphoric acid, 4-6 hours later. Switch to dressing, it is strictly forbidden to use oily dressing, deep wounds should be cut and planted sooner or later, denying the size of wound surface, phosphorus should be protected after visceral function, high sugar, high calorie, high protein diet, early infusion should be more Early alkaline medicine, early diuretic, energy-enhancing application, early application of calcium to avoid phosphorus poisoning, calcium poisoning has occurred , Can relieve symptoms, promote the excretion of phosphorus, and promote the recovery of injured organs.

4, cyanide burns and combined poisoning

Cyanide can be divided into inorganic cyanide and organic cyanide according to chemical structure. The latter is called nitrile compound. After cyanide enters the body, cyanide ion rapidly combines with ferric oxidase of oxidized cytochrome oxidase to hinder its cytochrome. Reducing to a type of cytochrome oxidase with ferrous iron, the cells can not get enough oxygen, resulting in "intracellular asphyxia", the acute venous blood oxygen difference can be reduced from normal 4% to 5% % ~ 1.5%, it is easy to cause respiratory center paralysis and cause death.

The main clinical manifestations of cyanide poisoning are fatigue, chest pain, chest tightness, dizziness, tinnitus, difficulty breathing, arrhythmia, dilated or enlarged pupil, aging or tonic convulsions, coma, last breath, heartbeat and death.

The treatment is to give isoamyl nitrite and sodium nitrite sooner or later. On the spot or in transit, the patient can inhale 0.2-0.4 ml of isoamyl nitrite every 15 to 30 seconds to several minutes, not more than 5 to 6 Branch, inhaled until intravenous sodium nitrite, 30% sodium nitrite 10 ~ 20ml (6 ~ 12mg / kg), intravenous injection at a rate of 2 ~ 3ml / minute, and then given 25% sodium thiosulfate under the same needle 50ml, if necessary, repeat injection once a day, the speed of injection is not fast, so as not to cause hypotension, local wounds should be washed with plenty of running water, then washed with 0.01% potassium permanganate, then 5% sodium thiosulfate Rinse, it should be noted that sodium nitrite and sodium thiosulfate have no detoxification effect on organic cyanide poisoning, and sodium nitrite itself has a detrimental effect on the body.

5, asphalt burns

Asphalt is called tar, which has high adhesion. It is widely used in house construction, engineering anti-corrosion and moisture-proof, paving road, etc. Liquid burns caused by liquid asphalt is purely thermal and has no chemical damage. It is characterized by difficulty in removing, high heat and heat dissipation. Slow, so the wound is often deep, and occurs mostly in exposed parts of the skin, such as hands, feet, face and so on.

Large-range asphalt burns should not be scrubbed with gasoline to avoid acute lead poisoning. After the asphalt burns, it can be immediately placed in cold water to cool it. After that, the olive oil or sesame oil can be used to remove the bitumen on the wound surface. It can also be wiped with turpentine, but its It is irritating, so it is suitable for small and medium area wounds.

Leaching evaporation produces a small amount of light-sensitive substances such as acridine, hydrazine, phenanthrene, etc., which increases pain after light irradiation. Therefore, patients should avoid sun exposure and avoid using light-sensitive drugs such as sulfonamide, chlorpromazine, promethazine, etc. Red mercury is banned, gentian violet.

Chemical burn inspection

Ask about the injury and the first aid on the scene. Carefully understand the composition, concentration and toxicity of the chemical substances, calculate the burn area and depth: the brownish red and soft touches are shallower, the brown is hard and sag or yellowish white and the softened is deep burn. Physical examination: should pay attention to whether there is shock, whether it is combined with eye burns, inhalation injury, jaundice, difficulty breathing, abdominal pain, hematuria, mental dizziness, sleepiness or coma. Auxiliary examination: same as thermal burns. Determine the blood levels of toxic chemicals as necessary.

Chemical burn diagnosis

Mainly differentiated from reflective burns and fire burns. The history of the contact with chemicals can be identified. Usually caused by high temperature liquid (water or oil) or gas (steam), usually when the skin is in contact with a hot faucet or hot drink on the skin during bathing, also known as immersion burns, usually the limbs are immersed under the hot water surface Occurs, the blisters on the surface of the skin are full of tissue fluid, which is the skin's response to heat.

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