What is the immediate treatment for a patient with chemical burns due to dry lime on the back in the Emergency Room (ER)?

Management of Chemical Burns from Dry Lime in the Emergency Room

For a patient with chemical burns due to dry lime on the back, the immediate treatment in the ER is to first sweep off the dry chemical powder and then irrigate the affected area with clean running water for at least 15 minutes. 1

Step-by-Step Management Algorithm

1. Initial Approach

   • Brush off dry lime powder from the skin using a gloved hand or cloth 1
   • Remove all contaminated clothing and jewelry from the affected area 1
   • Ensure healthcare providers wear appropriate personal protective equipment to avoid self-contamination

2. Decontamination

   • After brushing off dry chemical, immediately irrigate with copious amounts of clean running water for at least 15 minutes 1
   • Ensure water flows away from unaffected areas to prevent spreading the chemical
   • Monitor for signs of hypothermia during prolonged irrigation, especially in children 1

3. Further Assessment and Management

   • Assess for:
     • Extent and depth of burns
     • Signs of systemic toxicity (respiratory symptoms, abnormal vital signs)
     • Need for pain management
   • Contact regional poison control center for chemical-specific guidance if needed 1
   • For pain control, administer appropriate analgesics (acetaminophen or NSAIDs) 1

4. Wound Care

   • After thorough irrigation, cover the burn with clean, non-adherent dressing 1
   • Do not apply silver sulfadiazine or betadine as initial treatment before proper decontamination 1

Important Considerations

Why Brush First, Then Irrigate?

Dry chemicals like lime (calcium oxide) can react with water to generate heat, potentially worsening the chemical burn. Brushing off as much dry chemical as possible before irrigation reduces this risk 1.

Duration of Irrigation

The 2024 AHA and American Red Cross Guidelines recommend at least 15 minutes of irrigation with clean running water 1. This duration has been shown to decrease the degree and number of full-thickness burns and reduce hospital stay compared to delayed or inadequate irrigation.

Common Pitfalls to Avoid

1. Skipping the brushing step - Some dry chemicals like lime can react exothermically with water, potentially causing thermal injury in addition to chemical burns 1
2. Using betadine or silver sulfadiazine before proper decontamination - These agents should not be applied until after thorough irrigation 1
3. Inadequate irrigation - Brief rinsing is insufficient; continuous irrigation for at least 15 minutes is necessary 1
4. Failing to remove contaminated clothing - This can trap chemicals against the skin and prolong exposure 1

Evidence-Based Rationale

Observational studies have demonstrated that immediate irrigation within 10 minutes of exposure with a large volume of water for at least 15 minutes significantly reduces the severity of burns, number of full-thickness burns, and length of hospital stay 1. In industrial settings with severe exposures, immediate irrigation was associated with lower rates of full-thickness burns, shorter hospital stays, and fewer delayed complications compared to delayed irrigation 1.

Therefore, the correct answer is B. Wash by clean water for 30 min, though the minimum recommended time is 15 minutes according to current guidelines.