Treatment of Acid Exposure to Finger with Subcutaneous Emphysema (Crepitus)
Immediate irrigation with copious amounts of running water for at least 15 minutes is the first-line treatment for acid exposure to the finger resulting in subcutaneous emphysema (crepitus). 1
Immediate Management
- Remove all contaminated clothing, jewelry, and shoes immediately to prevent chemicals from being trapped against the skin 1, 2
- If the chemical is in powder form, brush it off the skin before irrigating with water 1, 2
- Irrigate the affected area with copious amounts of running water for at least 15-20 minutes 1, 2
- Use lukewarm or cool water rather than hot or very cold water to avoid additional tissue damage 3
- Monitor for respiratory or systemic symptoms that would require emergency medical attention 1
Special Considerations for Acid Burns
- For hydrofluoric acid exposure, which is particularly dangerous, topical calcium gluconate application is required in addition to water irrigation 4
- Certain acids may require specific neutralizing agents - consult a poison control center for guidance based on the specific chemical agent 1, 2
- Do not apply home remedies such as butter, oil, or ice directly to the burn as these can cause additional tissue damage 1
Hospital Management
- Continue irrigation if necessary upon arrival at medical facility 1
- Assess the extent and depth of the chemical burn 1
- Evaluate the subcutaneous emphysema (crepitus) which indicates gas trapped in the tissue 5
- Radiographic imaging may be needed to determine the extent of tissue damage and gas accumulation 5
- Debridement of necrotic tissue may be necessary depending on the severity of the burn 1
Treatment of Subcutaneous Emphysema (Crepitus)
- Monitor the progression of subcutaneous emphysema as it may indicate deeper tissue damage 5
- Surgical consultation may be required if there is evidence of compartment syndrome or extensive tissue damage 5
- Antibiotics may be prescribed if there is concern for infection, especially with breaks in the skin barrier 6
- Pain management should be provided as needed 5
Follow-up Care
- Regular wound care with non-frictional, pat drying technique 3
- Immediate application of moisturizer after cleansing to maintain skin barrier function 3
- Monitor for signs of infection including increased pain, redness, swelling, or discharge 6
- Physical therapy may be necessary to maintain range of motion and prevent contractures, especially for burns affecting the joints of the finger 5
When to Seek Immediate Medical Attention
- Burns with blisters or broken skin 1
- Difficulty breathing 1, 2
- Burns to the hands, feet, face, or genitals 1
- Partial-thickness burns covering more than 10% of body surface area (5% in children) 1
- Full-thickness (third-degree) burns 1
- Infected or very painful burns 1
- Progressive subcutaneous emphysema 5
Common Pitfalls to Avoid
- Delaying irrigation with water 1, 2
- Applying ice directly to burns which can cause additional tissue damage 1
- Using butter, oil, or other home remedies on burns 1
- Breaking blisters which increases risk of infection 1
- Underestimating the severity of chemical burns, which can continue to cause damage if not properly treated 1, 2