How should a chemical burn be managed?

Treatment for Chemical Burns

Immediately irrigate the affected area with copious amounts of running water for at least 15 minutes, starting within 3 minutes of exposure to significantly reduce tissue damage and complications. 1, 2, 3

Immediate Decontamination (First Priority)

Remove all contaminated clothing, shoes, and jewelry immediately before they trap chemicals against the skin and cause deeper injury. 2, 3

For dry chemical powders, brush off the powder first before beginning water irrigation to prevent activation of certain chemicals. 2

Begin copious water irrigation immediately:

• Start within 3 minutes of exposure for optimal outcomes 2, 3
• Continue for at least 15 minutes minimum 1, 2, 3
• Extend irrigation longer if pain persists or the chemical agent is unknown 2
• The American Heart Association emphasizes that immediate irrigation (within 3 minutes) significantly reduces full-thickness burns, hospital days, and delayed complications compared to delayed treatment 2, 3

Critical caveat: Do not delay irrigation to search for neutralizing agents—water should begin immediately. 2 However, certain specific chemicals like hydrofluoric acid and phenol require decontamination with substances other than water, so consult poison control if the agent is known. 2

Wound Care After Irrigation

After thorough irrigation:

• Apply petrolatum-based products or topical antibiotic ointment (such as polymyxin) to keep the wound moist 1, 2, 3
• Cover loosely with a clean, non-adherent dressing to reduce pain, protect from contamination, and limit heat loss 1, 2, 3
• Leave blisters intact as this improves healing and reduces pain 3

Avoid silver sulfadiazine for superficial burns, as it is associated with prolonged healing when used long-term on superficial injuries. 1, 2, 3

Pain Management

Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain relief. 1, 3

For severe burns requiring hospitalization:

• Use multimodal analgesia with titrated medications based on validated pain assessment scales 1, 3
• Titrated IV ketamine combined with short-acting opioids is effective for severe burn pain 1
• The cooling effect of water irrigation itself reduces pain by affecting the inflammatory cascade 3

When to Seek Immediate Medical Attention

Transfer to emergency care or burn center if any of the following:

• Burns with blisters or broken skin 2, 3
• Difficulty breathing or respiratory symptoms 1, 2, 3
• Burns to the face, hands, feet, or genitals 1, 2, 3
• Partial-thickness burns covering >10% body surface area in adults (>5% in children) 1, 2, 3
• Full-thickness (third-degree) burns 1, 2, 3
• Exposure in enclosed spaces suggesting possible inhalation injury 3

Hospital-Level Management

Upon hospital arrival:

• Continue irrigation if necessary 2, 3
• Consider early escharotomy if deep circular burns compromise circulation 2, 3
• Initiate fluid resuscitation using balanced crystalloid solution (Ringer's Lactate preferred) for burns ≥10% TBSA in adults or ≥5% in children 4
• Monitor for compartment syndrome in circumferential burns 3
• Assess for inhalation injury by checking for circumoral burns, oropharyngeal burns, and carbonaceous sputum 3

Special Considerations

Contact your regional poison control center for specific recommendations if the exact chemical agent is known, as some chemicals require specialized decontamination protocols. 2, 3

In remote environments with no immediate medical access, applying topical honey as an antimicrobial agent may be reasonable. 2

Critical Pitfalls to Avoid

• Never apply ice directly to burns—this causes additional tissue damage through ischemia 2, 3
• Never apply butter, oil, or other home remedies 2, 3
• Never break blisters intentionally—this increases infection risk 2, 3
• Never delay irrigation to search for neutralizing agents—water should begin immediately 2