Do you irrigate first with caustic splash injuries?

Management of Caustic Splash Injuries

For caustic splash injuries, immediate irrigation should be performed first, without delay, using running water for at least 15 minutes. 1, 2

Initial Management Algorithm

1. Immediate Irrigation

   • Begin irrigation immediately with copious amounts of running water 1
   • Continue irrigation for at least 15 minutes 1, 2
   • For eye injuries, keep eyelids open during irrigation and direct water flow from inner corner (near nose) outward 2

2. Dry Chemical Considerations

   • For dry chemicals (e.g., sodium hydroxide, elemental sodium/potassium), brush off as much powder as possible before irrigation 1
   • Avoid spreading contaminant to other areas during brushing 1

3. During Irrigation

   • Remove contaminated clothing, jewelry, and surrounding materials 1
   • For eye injuries, ensure thorough irrigation under eyelids and across entire ocular surface 2

Evidence and Rationale

The 2024 American Heart Association guidelines strongly recommend immediate skin decontamination after chemical exposure (Class 1, Level B-NR) 1. Observational studies have shown that patients who received immediate irrigation within 10 minutes with a large volume of water for at least 15 minutes had:

• Decreased degree of full-thickness burns
• Reduced number of full-thickness burns
• Shorter mean hospital stays 1

A study of 83 patients demonstrated that those who received copious water irrigation within 3 minutes of exposure had:

• Lower likelihood of progression to full-thickness burns (13.5% vs 60.8%)
• Fewer delayed complications (5.4% vs 30.4%)
• Shorter hospital stays (6.2 vs 22 days) 3

Special Considerations

• Chemical-Specific Protocols: Some chemicals require specific decontamination approaches:

  • Hydrofluoric acid and phenol may need decontamination with substances other than water 1
  • Follow local guidelines or consult poison control centers for chemical-specific instructions 1, 2

• Eye Injuries: For chemical splashes to the eyes:

  • Irrigation should be performed immediately with tap water 2
  • Alternative solutions like normal saline, Ringer's lactate, or commercial eye wash solutions can be used if immediately available 2
  • Keep eyelids open during irrigation to ensure thorough cleansing 2

• When to Seek Advanced Care: Call emergency medical services when:

  • Patient has respiratory symptoms
  • Patient has systemic symptoms
  • Exposure involves large areas 1

Common Pitfalls to Avoid

• Delaying irrigation to find "ideal" solutions can significantly worsen outcomes 2
• Insufficient irrigation duration - the full 15 minutes is necessary regardless of symptom improvement 2
• Failing to remove contaminated clothing which can trap chemicals against skin 1
• Attempting to neutralize acids with bases can generate heat and worsen injury 2
• Using high-pressure water streams can cause additional trauma, especially for eye injuries 2

Remember that rapid removal of the caustic agent is the key to first aid, and running water is a readily available and effective decontamination agent for most chemical exposures 1, 3.