Chemical Burn Treatment
Immediately irrigate chemical burns with copious amounts of running water for at least 15 minutes, starting at the scene and continuing until medical evaluation—this is the single most critical intervention that reduces tissue damage and improves outcomes. 1, 2
Immediate Decontamination (First Priority)
Initial Actions
- Remove all contaminated clothing, shoes, and jewelry immediately to prevent chemicals from being trapped against the skin and causing deeper injury 1
- For dry chemical powders, brush off the powder with a gloved hand or cloth BEFORE irrigation to avoid activating certain chemicals with water 1, 2
- Begin water irrigation immediately—do not delay to identify the specific chemical agent 1, 3
Irrigation Protocol
- Irrigate with copious amounts of clean running water for at least 15 minutes minimum 1, 2
- Continue irrigation for up to 24 hours for severe exposures like anhydrous ammonia burns 4
- Running water irrigation is superior to wet packs for achieving faster recovery 5
- For eye exposures, irrigate with large amounts of tap water immediately until pH normalizes 6
Special Chemical Exceptions
- Hydrofluoric acid and phenol require decontamination with substances other than water—consult poison control immediately for these specific agents 1
- For anhydrous ammonia burns, continue irrigation and monitor skin pH, targeting reduction from alkaline (pH 10) to near-normal (pH 6-8) 4
Post-Irrigation Wound Care
Dressing Application
- After thorough irrigation, apply a thin layer of petrolatum-based antibiotic ointment or silver sulfadiazine cream to prevent infection and maintain a moist wound environment 2, 7
- Cover with a clean, non-adherent occlusive dressing 6, 2
- Leave blisters intact—this improves healing and reduces pain 2
- Reapply topical antimicrobials once to twice daily, especially after wound cleaning 7
Pain Management
- Administer over-the-counter acetaminophen or NSAIDs for pain relief 2
- Cooling the burn site during initial irrigation helps reduce pain through effects on the inflammatory cascade 2
Critical Assessment for Transfer/Referral
Immediate Emergency Medical Attention Required For:
- Burns with blisters or broken skin 1
- Burns to face, hands, feet, or genitals—these require specialist evaluation to prevent permanent disability 1, 2, 8
- Partial-thickness burns >10% body surface area in adults (>5% in children) 1, 8
- All full-thickness (third-degree) burns 1
- Difficulty breathing or other respiratory symptoms—may indicate inhalation injury requiring intubation 1, 4
- Signs of systemic toxicity: sleepiness, seizures, vomiting 2
Special Pediatric Considerations
- All hand burns in children should be evaluated by a healthcare provider due to functional concerns 8
- Monitor children closely for hypothermia during cooling—avoid whole-body cooling methods 8
- Transfer to burn center for partial-thickness burns >5% TBSA in children 8
Common Pitfalls to Avoid
- Never apply ice directly to burns—this causes tissue ischemia and additional damage 1, 2, 8
- Never apply butter, oil, or other home remedies—these trap heat and worsen injury 1, 2, 8
- Do not break blisters—this increases infection risk 1
- Do not delay irrigation to identify the chemical—immediate water irrigation is appropriate for nearly all chemical burns 1, 3
- Do not apply anything by mouth for poisoning unless specifically advised by poison control 2
Ongoing Management
Monitoring
- Continue silver sulfadiazine cream application until satisfactory healing occurs or the site is ready for grafting 7
- Monitor for signs of infection: increased pain, redness, swelling, or discharge 2
- Consider early escharotomy for deep circular burns that may compromise circulation 1