What is the treatment for a gasoline burn?

Treatment for Gasoline Burns

Immediately remove all gasoline-soaked clothing and begin extensive water lavage or soaking of the affected area, continuing for at least 5-20 minutes, followed by wound care similar to partial-thickness thermal burns including debridement, topical antimicrobials, and appropriate dressings. 1, 2

Immediate First Aid and Decontamination

The priority with gasoline burns is rapid decontamination to prevent continued tissue damage and systemic absorption of toxic hydrocarbons:

• Remove all clothing containing gasoline immediately to stop ongoing chemical exposure 1
• Lavage extensively with clean running water for 5-20 minutes or consider prolonged soaking to ensure complete removal of the hydrocarbon 1, 2
• Remove jewelry before swelling occurs to prevent constriction and vascular ischemia 2, 3
• Monitor for signs of hypothermia during prolonged cooling, especially in children or when treating large surface areas 2, 3

Critical Pitfall: Gasoline burns are chemical burns that can cause full-thickness injury

Unlike simple thermal burns, gasoline contact can produce significant full-thickness skin loss even without flame involvement, and the hydrocarbon continues causing damage until completely removed 1, 4. This is why extensive lavage is more critical than with thermal burns alone.

Wound Care After Decontamination

Once gasoline is completely removed, treat the wound similarly to partial-thickness thermal burns:

• Cleanse and debride the wound under sterile conditions after initial lavage 1
• Apply topical antimicrobial agents such as silver sulfadiazine cream 1% to a thickness of approximately one-sixteenth inch, once to twice daily 5, 1
• Cover with clean, non-adherent dressings and change based on wound condition 1, 2
• Alternative topical agents include petrolatum-based antibiotic ointment (polymyxin B or bacitracin), honey, or aloe vera for smaller superficial burns 2, 3

Pain Management

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs for pain relief 2
• Consider multimodal analgesia with titrated medications based on validated pain assessment scales for severe burns 2
• Titrated intravenous ketamine can be combined with other analgesics for severe burn-induced pain 2

Assessment for Systemic Complications

Gasoline burns carry unique risks beyond the cutaneous injury:

• Monitor for systemic toxicity including pulmonary, cardiovascular, neurologic, renal, and hepatic complications from hydrocarbon absorption through the skin 1, 4
• Assess for regional neuromuscular impairment which may be transient or permanent from local absorption 4
• Consider immediate surgical debridement if there is suspicion of continued absorption of toxic compounds from the wound 1
• Evaluate for inhalation injury if gasoline ignited, looking for facial burns, difficulty breathing, singed nasal hairs, or soot around nose/mouth 2, 6

Critical Decision Point: When to Transfer to Burn Center

Transfer immediately to a specialized burn center for: 2, 3

• Burns involving face, hands, feet, or genitals (high risk of permanent disability)
• Second or third-degree burns >10% total body surface area in adults (>5% in children)
• Signs of inhalation injury or systemic toxicity
• Suspicion of ongoing hydrocarbon absorption requiring surgical intervention 1

Special Considerations for Gasoline Burns

Gasoline burns differ from standard thermal burns in several important ways:

• Full-thickness injury is common even without flame involvement due to the chemical properties of hydrocarbons 1, 4
• Systemic absorption through intact or burned skin can cause life-threatening complications, particularly with leaded gasolines 1
• Continued tissue damage occurs until complete decontamination is achieved 1
• Higher mortality risk when gasoline is used as an accelerant in flame burns 7, 8

Common Pitfall: Underestimating Depth and Systemic Risk

Do not treat gasoline burns as simple thermal injuries. The chemical component causes deeper tissue damage than initially apparent, and systemic toxicity can develop even from cutaneous exposure alone 1, 4. Maintain high suspicion for complications and lower threshold for specialist referral.