eMedicine Specialties > Emergency Medicine > Environmental
Burns, Chemical: Follow-up
Updated: Jan 10, 2008
Follow-up
Further Inpatient Care
- Admission is recommended for large surface area or circumferential dermal burns, for burns by substances with systemic toxicity, or for pain control.
- Following caustic ingestions, admission is recommended for any patient with oral burns; any patient who is symptomatic; or any patient who ingested a strong acid, or base, hydrofluoric acid, or other highly caustic substance.
Further Outpatient Care
- Dermal burns treated on an outpatient basis should be rechecked every 2-3 days.
- Any ocular burns treated as on an outpatient basis should be rechecked in 24 hours.
- Endoscopic examination of all transmucosal or transmural esophageal burns should be repeated in 2-3 weeks.
Inpatient & Outpatient Medications
- Significant dermal burns require adequate IV fluid resuscitation and analgesics (eg, morphine sulphate). Consider the use of patient-controlled analgesia pumps.
Transfer
- Transfer all significant dermal burns that cannot be handled locally to a regional burn center. Always decontaminate the burn area, initiate fluid resuscitation, and administer analgesic agents prior to transfer.
- Patients with any significant scleral or corneal injury should be transferred to a facility where ophthalmologic care is available. Always irrigate the eyes prior to transfer.
- If endoscopy is not available and the patient is symptomatic, has oral burns, or has ingested a potentially caustic substance, transfer the patient to a facility that can perform endoscopy. Since endoscopy does not need to be performed on an emergent basis, observation of asymptomatic patients is acceptable.
Deterrence/Prevention
- For cases of pediatric exposure, counsel the family on keeping dangerous substances out of the reach of children.
- For suicide attempts, consult a psychiatrist.
- In many states, the Occupational Safety and Health Administration (OSHA) requires reporting of industrial injuries. Employers should provide the necessary training and protective equipment for employees working with potentially hazardous materials.
Complications
- Scarring, infection, and poor healing may occur with dermal burns. Skin grafting may be required.
- Ocular burns, especially from alkali substances and hydrofluoric acid, can result in cataract formation and/or complete vision loss.
- Perforation and/or bleeding and respiratory compromise from upper airway edema are the short-term complications of caustic ingestions. Stricture formation is the main long-term complication associated with caustic burns to the esophagus.
Prognosis
- The prognosis depends entirely on the extent of tissue injury. Small lesions heal well, whether dermal or esophageal. Larger dermal burns can produce significant scarring. Extensive esophageal lesions can result in future stricture formation. Hydrofluoric acid burns can cause progressive tissue injury and may result in loss of digits.
- Even moderate corneal burns can result in scarring and loss of vision. Sometimes this can be remedied by corneal transplantation.
Patient Education
- For cases of occupational exposure, educate the patient on the proper safety precautions that should be taken when working with hazardous materials. All industries are required to inform employees of any dangerous materials they may come into contact with in the workplace and must provide them with adequate training and protective equipment.
- When children experience chemical burns, counsel the parents on how to keep medications and chemicals out of the reach of children. Parents may not think that something like automatic dishwashing detergent can be a danger to children. Inform them of the various substances in the home that are potentially dangerous. Consultation with the local social services agency may be indicated to evaluate the child's home situation.
- For excellent patient education resources, visit eMedicine's Burns Center. Also, see eMedicine's patient education articles Chemical Burns and Thermal (Heat or Fire) Burns.
Miscellaneous
Medicolegal Pitfalls
- Failure to further evaluate a patient with a caustic ingestion because no oropharyngeal lesions are seen
- Failure to evaluate and treat a burn
- Failure to obtain psychiatric evaluation in a suicide attempt
- Treatment of a hydrofluoric acid burn as a general acid burn
- Failure to adequately irrigate a chemical exposure
- Delay in irrigating a chemical exposure (particularly important when giving prehospital instructions)
- Irrigating metallic sodium, potassium, lithium, or magnesium with water
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References
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Further Reading
Keywords
acid burns, base burns, corrosive ingestion, caustic burn, caustic chemical burn, esophageal burn, sulfuric acid, nitric acid, hydrofluoric acid, hydrochloric acid, muriatic acid, phosphoric acid, acetic acid, formic acid, chloroacetic acid, monochloroacetic acid, dichloroacetic acid, trichloroacetic acid, phenol, cresol, sodium hydroxide, potassium hydroxide, calcium hydroxide, calcium oxide, lime, ammonia, phosphate, chlorate, white phosphorus, vesicants, chromate, potassium dichromate, chromic acid, peroxides, hydrogen peroxide, bleach, potassium permanganate
