Chemical Burn Treatment
Immediately irrigate the affected area with copious running water for at least 15 minutes—this is the single most critical intervention that reduces full-thickness burns, hospital length of stay, and long-term complications. 1
Immediate First Aid (Within 3 Minutes)
Time is tissue. Irrigation within 3 minutes of exposure significantly reduces the number of full-thickness burns, mean hospital days, and delayed complications compared to delayed irrigation. 1
Step 1: Safety and Decontamination
- Remove all contaminated clothing, shoes, and jewelry immediately to prevent chemicals from being trapped against the skin and causing continued injury. 1, 2
- Wear personal protective equipment to avoid contaminating yourself or others during decontamination. 1
- For dry chemical powders (sodium hydroxide, elemental sodium, elemental potassium): brush off as much powder as possible BEFORE water irrigation, as these chemicals may react with water to cause additional caustic or thermal injury. 1, 2
Step 2: Water Irrigation
- Irrigate with running tap water for at least 15 minutes as the primary decontamination method. 1
- Continue irrigation longer if pain persists or if the specific chemical is unknown, as some caustic agents require extended decontamination. 2
- Do not delay irrigation to search for neutralizing agents—water irrigation should begin immediately. 2
Step 3: Chemical-Specific Exceptions
Critical pitfall: Some chemicals require specialized decontamination agents rather than water. 1
- Hydrofluoric acid and phenol require decontamination with substances other than water and may need treatment beyond simple decontamination. 1, 2
- Contact your regional poison control center immediately for chemical-specific treatment recommendations, including duration of irrigation and specialized decontamination strategies. 1, 2
When to Activate Emergency Medical Services
Seek immediate medical attention for: 2
- Burns with blisters or broken skin
- Difficulty breathing or any respiratory symptoms
- Burns to the face, hands, feet, or genitals
- Partial-thickness burns covering >10% body surface area (>5% in children)
- Full-thickness (third-degree) burns
- Infected or very painful burns
Post-Irrigation Wound Care
- Cover loosely with a clean, non-adherent dressing to reduce pain, protect from contamination, and limit heat loss. 2
- Avoid silver sulfadiazine for superficial burns, as it is associated with prolonged healing when used long-term on superficial injuries. 2
- For deeper burns requiring topical antimicrobial therapy, silver sulfadiazine cream 1% may be applied once to twice daily to a thickness of approximately 1/16 inch until satisfactory healing occurs or the burn site is ready for grafting. 3
Pain Management
- Use multimodal analgesia with all medications titrated based on validated comfort and analgesia assessment scales. 1
- Titrated intravenous ketamine can be combined with other analgesics to treat severe burn-induced pain. 1
- Non-pharmacological techniques (cooling limited burned surfaces, covering burns with fatty substances like Vaseline, virtual reality, or hypnosis) should be combined with analgesic drugs when the patient is stable. 1
Special Considerations for Chemical Eye Exposure
- Decontamination by irrigation should be performed immediately after chemical exposure to the eyes. 1
- Irrigate with copious tap water for 15 minutes unless otherwise recommended by local guidelines. 1
Common Pitfalls to Avoid
- Never apply ice directly to burns—this causes additional tissue damage. 2
- Never apply butter, oil, or other home remedies to burns. 2
- Never delay medical attention for burns with blisters or broken skin. 2
- Never break blisters—this increases infection risk. 2
- Never assume absence of symptoms means absence of injury—clinical presentation does not correlate with injury severity, particularly with caustic ingestions. 4