What is the treatment for a chemical burn?

Treatment for Chemical Burns

Immediate skin decontamination with running water for at least 15 minutes is the recommended first-line treatment for chemical burns to minimize tissue damage and reduce morbidity and mortality. 1

Immediate First Aid Steps

1. For dry chemicals:

   • Brush off any dry chemical before irrigation with water 1
   • This prevents potential exothermic reactions when certain chemicals (like sodium hydroxide, elemental sodium, or potassium) contact water

2. For all chemical burns:

   • Remove contaminated clothing, jewelry, and surrounding materials immediately 1
   • Irrigate the affected area with clean running water for at least 15 minutes 1
   • Continue irrigation even if pain subsides, as chemical damage may continue

3. When to call emergency services:

   • Presence of respiratory symptoms
   • Systemic symptoms
   • Large chemical exposures
   • Burns involving face, hands, feet, or genitals
   • Burns with >10% body surface area (>5% in children) 1

Special Considerations

• Monitor for hypothermia: Particularly in children and when cooling large surface areas 1

• Pain management:

  • Consider over-the-counter pain medications for pain control 1
  • For severe pain, multimodal analgesia including ketamine may be beneficial in hospital settings 1

• Consult poison control: Follow chemical-specific procedures or consult a regional poison center for specific chemical exposures 1

Wound Care After Initial Decontamination

1. For small partial-thickness burns managed at home:

   • After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
   • Cover with a clean non-adherent dressing 1

2. For larger or deeper burns requiring medical care:

   • Cover with a clean cloth or non-adherent dry dressing while awaiting medical evaluation 1
   • In medical settings, silver sulfadiazine cream 1% may be applied to a thickness of approximately 1/16 inch once to twice daily 2

Common Pitfalls to Avoid

• Delayed irrigation: Studies show that immediate irrigation (within 3-10 minutes) significantly reduces full-thickness burns, hospital stays, and complications compared to delayed irrigation 1, 3

• Inadequate irrigation time: A minimum of 15 minutes is necessary for most chemicals 1

• Using neutralizing agents: Generally avoid attempting to neutralize chemicals, as these reactions can generate heat and cause additional thermal injury

• Ignoring specific chemical properties: Some chemicals like hydrofluoric acid and phenol require special treatment beyond water irrigation 1

Remember that rapid removal of the caustic agent is the key to minimizing tissue damage. Personal protective equipment should be worn when assisting someone with a chemical burn to prevent secondary contamination.