What is the management for a noncircumferential chemical burn to the heel caused by floor stripping chemical?

Management of Noncircumferential Chemical Burn to the Heel from Floor Stripping Chemical

Immediately irrigate the burn with copious running water for at least 15 minutes, remove all contaminated clothing and footwear, then cover with petrolatum-based ointment and a clean dressing. 1, 2

Immediate Decontamination (First Priority)

The cornerstone of chemical burn management is rapid removal of the caustic agent. The American Heart Association emphasizes that immediate first aid—defined as copious water irrigation within 3 minutes of exposure—significantly reduces full-thickness burns, hospital days, and delayed complications compared to delayed irrigation. 1

Step-by-step initial management:

• Remove all contaminated footwear, socks, and clothing immediately to prevent trapping chemicals against the skin during decontamination 1, 2

• If the floor stripping chemical is in powder form, brush it off first before water irrigation, as some dry chemicals (like sodium hydroxide) may react with water to cause additional caustic or thermal injury 1, 2

• Irrigate with copious running tap water for at least 15 minutes under moderate pressure—this is the most effective decontamination method for chemical burns of unknown composition 1, 2, 3

• Continue irrigation longer if pain persists or if the specific chemical is unknown, as some caustic agents require extended decontamination 1

Assessment of Burn Severity

After initial irrigation, evaluate whether the patient requires transfer to a burn center or emergency department:

Immediate medical attention is required if: 2

• The burn has blisters or broken skin 2
• The burn involves the foot (which this case does—heel burns may impair mobility and require specialized care) 2, 4
• There are signs of respiratory distress or systemic symptoms 2
• The burn appears full-thickness (white, leathery, or painless) 2

For this noncircumferential heel burn, if it appears superficial without blisters and the patient is stable, outpatient management may be appropriate. However, foot burns often require specialist evaluation due to functional implications. 2, 4

Wound Care After Irrigation

Once thorough decontamination is complete:

• Apply a thin layer of petrolatum or petrolatum-based antibiotic ointment (avoid sulfonamide-containing products initially) 4

• Alternative topical agents include medical-grade honey or aloe vera gel for small partial-thickness burns managed at home 4

• Cover loosely with a clean, non-adherent dressing to reduce pain, protect from contamination, and limit heat loss 1, 4

• Leave blisters intact if present, as this improves healing and reduces pain 4

• Avoid silver sulfadiazine for superficial burns, as it is associated with prolonged healing when used long-term on superficial injuries 1

Pain Management

• Administer oral acetaminophen or NSAIDs for pain control 4

• Cooling the burn site during initial irrigation helps reduce pain by affecting the inflammatory cascade 4

• Never apply ice directly to the burn, as this causes tissue ischemia and additional damage 2, 4

Special Considerations for Floor Stripping Chemicals

Floor stripping chemicals typically contain strong alkalis (sodium hydroxide, potassium hydroxide) or acids. These are critical points:

• Alkali burns tend to penetrate deeper than acid burns and may continue causing tissue damage even after initial exposure 5, 6

• Contact your regional poison control center for specific recommendations based on the exact chemical agent if known, as some chemicals require specialized decontamination 1, 2

• Certain chemicals like phenol or cresol should NOT be irrigated with water alone—however, floor stripping chemicals are generally safe to irrigate with water 1, 7

Common Pitfalls to Avoid

• Do not delay irrigation to search for neutralizing agents—water irrigation should begin immediately 1, 8

• Do not apply butter, oil, or other home remedies 2

• Do not break blisters, as this increases infection risk 2

• Do not use prolonged cold exposure on large burns, as this can cause hypothermia 9

Follow-up Care

• Monitor for signs of infection: increased pain, redness, swelling, or discharge 4

• Reassess burn depth at 24-48 hours, as chemical burns can progress and initial assessment may underestimate severity 8, 5

• Ensure tetanus prophylaxis is current 8

• Consider referral to burn specialist if the wound does not show improvement within 48-72 hours or if functional impairment of the heel is evident 2, 4