What is the treatment for chloroform burns?

Treatment for Chloroform Burns

Immediately irrigate chloroform burns with copious amounts of water for at least 15-20 minutes, then apply petrolatum-based ointment and cover with a non-adherent dressing, while monitoring for systemic toxicity including hepatotoxicity and CNS depression. 1, 2

Immediate Management

First Aid and Decontamination

• Begin copious water lavage immediately at the scene - this is the single most important intervention that significantly reduces full-thickness injury and shortens hospital stay by more than twofold compared to delayed irrigation 2
• Continue irrigation for 15-20 minutes minimum to ensure complete removal of the chemical agent 1, 3
• Remove all contaminated clothing and jewelry before swelling occurs to prevent constriction injury 4, 5
• Ensure clinician safety with appropriate personal protective equipment before initiating treatment 1

Wound Care After Irrigation

• After thorough irrigation, apply a thin layer of petrolatum or petrolatum-based antibiotic ointment (polymyxin B or bacitracin, avoiding sulfonamides) 4, 5
• Cover loosely with a clean, non-adherent dressing to promote healing and reduce infection risk 4, 5
• Do not break any blisters that form, as intact blisters improve healing and reduce pain 4

Pain Management

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs for mild to moderate pain 4, 5
• For severe pain, consider titrated intravenous opioids or ketamine, as burn pain can be intense and difficult to control 6
• Multimodal analgesia combining acetaminophen and NSAIDs may be used for significant pain 4

Monitoring for Systemic Toxicity

Critical Chloroform-Specific Complications

• Monitor closely for hepatotoxicity - chloroform causes free radical-induced oxidative liver damage with potential for significant transaminase elevation and hyperbilirubinemia 7
• Watch for CNS depression and respiratory compromise, as chloroform causes central nervous system depression that can lead to anoxia 7
• Monitor for cardiac arrhythmias, which are a known complication of halogenated hydrocarbon exposure 7
• Check baseline and serial liver function tests (AST, ALT, bilirubin), renal function, and electrolytes 7

Consider N-Acetylcysteine (NAC)

• Intravenous NAC may be beneficial for chloroform exposure with evidence of hepatotoxicity, as it has been successfully used to treat chloroform-induced liver injury 7
• NAC works by counteracting free radical-induced oxidative damage from chloroform metabolism 7

Mandatory Referral Criteria

Transfer to a burn center or seek specialist consultation if:

• Burns involve the face, hands, feet, or genitalia 4, 6, 5
• Partial-thickness burns cover >10% body surface area in adults or >5% in children 4, 6, 5
• Any full-thickness burns are present 5
• Signs of systemic toxicity develop (altered mental status, hepatotoxicity, cardiac arrhythmias) 7
• Signs of inhalation injury are present (difficulty breathing, soot around nose/mouth) 4, 5
• Severe pain unresponsive to first-line treatments 4

Common Pitfalls to Avoid

• Do not delay irrigation - prompt first-aid lavage at the scene dramatically improves outcomes compared to waiting until hospital arrival 2
• Do not apply ice directly to burns, as this can cause tissue ischemia 4
• Do not use butter, oil, or other home remedies 6
• Do not underestimate systemic toxicity risk - chloroform is absorbed cutaneously and can cause significant hepatic and CNS toxicity even from dermal exposure 7, 2
• Avoid prolonged cold exposure during cooling, especially in children, to prevent hypothermia 4

Ongoing Assessment

• Assess burn depth, though this is difficult with chemical burns as necrosis can continue despite cessation of exposure 1, 3
• Monitor urine output (target 0.5-1 mL/kg/hr) in more severe burns 5
• Reassess regularly for signs of infection (increased pain, erythema beyond burn margins, purulent discharge) 6
• Watch for compartment syndrome signs (blue, purple, or pale extremities indicating poor perfusion) 6