What is the appropriate treatment for a patient presenting with chemical burns to one hand and the nose, 6 hours post-exposure to an unknown paint solvent, with symptoms including blisters, swelling, erythema, and nasal erosion, but no signs of systemic toxicity or respiratory distress?

Management of Chemical Burns to Hand and Nose

Immediate decontamination with running water for at least 15 minutes is the recommended first-line treatment for this patient with chemical burns to the hand and nose from an unknown paint solvent. 1

Initial Assessment and Management

1. Decontamination

   • Remove any contaminated clothing, jewelry, or material from the affected areas 1
   • Irrigate the affected areas (hand and nose) with running water for at least 15 minutes 1
   • Since the patient presented 6 hours after exposure, immediate decontamination is still beneficial but the chemical injury has likely already occurred

2. Wound Assessment

   • The patient presents with:
     • Right hand: Blisters, swelling, and erythema with normal pulses and capillary refill
     • Nose: Erosion on tip with clear yellow discharge
   • These findings suggest second-degree burns (partial thickness) to the hand and superficial burns to the nose

Wound Care

1. For the Hand Burns

   • Clean the wound area gently 2
   • Leave burn blisters intact as this improves healing and reduces pain 2
   • Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream to the affected areas 2, 3
   • Cover with sterile, non-adherent dressings applied loosely 2
   • Elevate the hand to reduce edema

2. For the Nasal Burns

   • Gently clean the area with sterile saline
   • Apply antibiotic ointment for this superficial injury 2
   • Consider a non-adherent dressing if practical

Pain Management

Implement a multimodal approach to pain management:

• First-line: Acetaminophen 1g every 4-6 hours 2
• Second-line: Add NSAIDs for inflammatory pain if not contraindicated 2
• For severe pain: Consider short-acting opioids 2

Follow-up and Monitoring

1. Monitor for complications:

   • Signs of infection (increasing pain, redness, purulent discharge)
   • Signs of compartment syndrome in the hand (progressive pain, pallor, paresthesia, pulselessness, paralysis) 2
   • Respiratory symptoms that may develop later

2. Wound reassessment:

   • Daily wound checks for the first few days
   • Reapply silver sulfadiazine cream once to twice daily 3
   • Continue treatment until satisfactory healing has occurred 3

3. Early mobilization:

   • Begin range of motion exercises for the hand as soon as pain allows to prevent contractures 2

Special Considerations

• Chemical-specific treatment: Since the exact solvent is unknown, consult with a regional poison center for any specific treatment recommendations 1
• Potential for delayed manifestation: Some chemical burns may worsen over 24-72 hours, requiring close follow-up
• Silver sulfadiazine cautions: Be aware of potential side effects including allergic reactions and silver staining of the treated burn wound 4

Indications for Hospital Admission

Consider hospital admission if:

• Signs of systemic toxicity develop
• Significant deterioration of the wounds occurs
• Pain cannot be adequately controlled
• Hand function is compromised

Pitfalls to Avoid

• Do not apply ice directly to burns as this can worsen tissue damage 2
• Do not underestimate chemical burns - they can continue to cause damage even after initial decontamination
• Do not delay treatment of potential compartment syndrome in the hand
• Do not discontinue silver sulfadiazine if early leukopenia occurs, as this is no longer considered a reason to stop therapy 4

This patient requires close follow-up within 24-48 hours to reassess the burns and adjust treatment as needed.