What is the treatment for chemical burns?

Treatment of Chemical Burns

For chemical burns, immediate irrigation with copious amounts of clean running water for at least 15 minutes is the essential first step in treatment. 1

Immediate Management

First Aid Steps

1. Ensure safety first - protect yourself from chemical exposure

2. Remove contamination:

   • Brush off powdered chemicals from skin with a gloved hand or cloth 2
   • Remove all contaminated clothing, jewelry, and surrounding materials 1
   • Ensure you don't contaminate yourself during this process 2

3. Irrigation:

   • Immediately irrigate the affected area with copious amounts of water for at least 15 minutes 2, 1
   • Use tap water as the primary irrigation solution 1
   • Continue irrigation even if symptoms improve 1
   • For eye exposures, keep eyelids open during irrigation and direct water flow from inner corner outward 1

Special Chemical Considerations

• For hydrofluoric acid and phenol exposures, consult poison control for specific decontamination instructions 1
• Do not attempt to neutralize acids with bases as this can generate heat and worsen injury 1
• For cresol burns, note that water irrigation may not be effective and special care is needed 3

When to Activate Emergency Medical Services

Activate EMS immediately if:

• Respiratory symptoms are present
• Systemic symptoms develop
• Large areas are exposed to chemicals
• Burns involve face, hands, feet, or genitalia
• Full-thickness burns are suspected 1

Hospital Management

Assessment

• Rapidly assess the patient while continuing emergency management
• Determine the chemical agent involved and time of exposure
• Evaluate burn depth (though this can be difficult with chemical burns) 4
• Assess for systemic effects of chemical absorption 4

Wound Care

1. Continued decontamination if needed
2. Wound cleansing and debridement
3. Topical antimicrobial therapy:
   • Apply silver sulfadiazine cream 1% to a thickness of approximately 1/16 inch once to twice daily 5
   • Reapply after hydrotherapy or when removed by patient activity 5
   • Continue until satisfactory healing occurs or until the burn site is ready for grafting 5

Supportive Care

• Control pain and shock 5
• For severe burns, follow fluid resuscitation guidelines:
  • For adults with TBSA >20% and children with TBSA >10%, administer 20 mL/kg of intravenous balanced crystalloid solution within the first hour 2
• Consider escharotomy for circumferential third-degree burns causing compartment syndrome 2

Cooling Considerations

• Cool burns in adults with TBSA <20% and children with TBSA <10% in the absence of shock 2
• Avoid cooling large surface areas to prevent hypothermia

Common Pitfalls to Avoid

• Delaying irrigation to find "ideal" solutions - this significantly worsens outcomes 1
• Insufficient irrigation duration - the full 15 minutes is necessary regardless of symptom improvement 1
• Failing to remove contaminated clothing - this can trap chemicals against the skin 1
• Using high-pressure water streams - this can cause additional trauma 1
• Attempting to neutralize chemicals without expert guidance - can generate heat and worsen injury 1

Outcomes

Immediate irrigation within 10 minutes with a large volume of water for at least 15 minutes results in:

• Decreased degree of full-thickness burns
• Fewer full-thickness burns
• Shorter hospital stays 1, 6

For severe chemical burns with systemic effects, intensive supportive care including haemodialysis may be required in cases of toxicity 3.