From the Guidelines
Immediate irrigation of the affected area with running water for at least 15 minutes is crucial in the emergency department management of a 25-year-old male with a chemical burn from battery acid on his left arm. This is based on the recommendations from the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The guidelines emphasize the importance of immediate skin decontamination after a chemical exposure, and unless otherwise recommended by local guidelines or chemical-specific information, skin exposed to caustic chemicals like battery acid should be irrigated with running water for at least 15 minutes 1.
Key steps in the management of this patient include:
- Removal of contaminated clothing and jewelry to avoid trapping chemicals against the skin during decontamination 1
- Irrigation of the affected area with copious amounts of water or normal saline for at least 15-20 minutes to dilute and remove the acid
- Assessment of the burn for depth, extent, and severity after irrigation
- Pain management with medications such as morphine or hydromorphone
- Gentle cleansing of the wound with mild soap and water, avoiding aggressive scrubbing
- Application of a topical antimicrobial agent and coverage with a non-adherent dressing for superficial or partial-thickness burns
It is also essential to monitor the patient for signs of compartment syndrome, particularly if the burn encircles the arm, and to provide tetanus prophylaxis if the patient's immunization status is not up-to-date. Follow-up within 24-48 hours is necessary to reassess the wound and adjust treatment as needed. Personal protective equipment should be worn by healthcare providers during decontamination to prevent exposure to the caustic agent 1.
From the Research
Emergency Department Management
For a 25-year-old male with a chemical burn from battery acid on his left arm, the following steps should be taken in the emergency department:
- Immediate removal of contaminated clothing and jewelry
- Decontamination of the affected area with large amounts of water and neutral soap
- Application of a topical antibiotic, such as silver sulfadiazine, although its effectiveness is still a topic of debate 2, 3, 4
- Consideration of systemic antibiotics, but only if there is a high risk of infection or if the patient shows signs of sepsis 2
- Pain management with analgesics
- Wound care, including dressing and debridement as necessary
- Monitoring for signs of infection, such as increased redness, swelling, or purulent discharge
Specific Considerations
- The use of silver sulfadiazine is controversial, with some studies suggesting it may increase the risk of burn wound infection and prolong hospital stay 2, 4
- Other treatment options, such as natural rubber dressing loaded with silver sulfadiazine, have shown promise in treating burn wounds infected with Candida spp. 5
- The management of chemical burns may involve a multidisciplinary approach, including surgery, infectious disease specialists, and wound care specialists
Additional Treatments
- Sodium thiosulfate infusion may be considered for patients with severe chemical burns, although its effectiveness is still being researched 6
- N-acetylcysteine (NAC) may be used as a mucolytic agent and to reduce the risk of pulmonary complications 6
- Humidified oxygen, bronchodilators, and mechanical ventilation may be necessary for patients with respiratory complications 6