Chemical Burns in Emergency Medicine Medication

Medications have a limited role in the treatment of most chemical burns. Topical antibiotic therapy is usually recommended for dermal and ocular burns. Calcium or magnesium salts are used for hydrofluoric acid burns. Pain medications are important for subsequent burn care.

Steroid therapy is controversial for caustic ingestions but may be helpful for treating upper airway inflammation. No evidence indicates that steroid therapy decreases incidence of stricture formation. Steroids may predispose the patient to infection and may mask signs of perforation. There has been some use of aloe products on mild burns; however, currently, no definitive information on their use for chemical burns is available.^{[20, 18]}

Nonsteroidal anti-inflammatory agents do provide some degree of pain relief for mild burns by inhibition of prostaglandin mediators. These have not been evaluated for chemical burns and should be avoided in all cases of GI burns from ingestions.

After decontamination is performed on patients with chemical burns affecting a significant portion of the body, administer standard IV fluid and narcotic therapy as used for thermal burns. For additional information, see the Burns, Thermal article.

Class Summary

Topical and ophthalmic antibiotics are routinely used for dermal and ocular burns, respectively. The injured tissues lose many of their protective mechanisms and are at increased risk of infection.

Silver sulfadiazine (Silvadene)

Used topically for dermal burns and useful in the prevention of infections from second- or third-degree burns. Has bactericidal activity against many gram-positive and gram-negative bacteria, including yeast.

Erythromycin ophthalmic (E-Mycin)

Use prophylactically to prevent infections following ocular burns. Ointment has a very low incidence of allergic reactions. Other possible agents include polymyxin B, bacitracin, and ciprofloxacin solutions.

Neomycin/polymyxin B/bacitracin topical (Neosporin Topical)

Used topically for dermal burns and useful in prevention of infections from second- or third-degree burns. Has bactericidal activity against many gram-positive and gram-negative bacteria, including yeast. Preferable for face and visible areas.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained injuries to the eye.

Morphine is recommended in the ED. For outpatient treatment, combinations of hydrocodone or oxycodone and acetaminophen are usually sufficient. Codeine is not recommended.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used for the relief of mild to moderate pain. Although effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

DOC for narcotic analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Morphine sulfate administered IV may be dosed in a number of ways and is commonly titrated until the desired effect is obtained.

During the ED treatment of the acute burn, use IV (preferred) or IM for moderate or severe pain.

Acetaminophen with oxycodone (Tylox, Percocet)

Drug combination indicated for the relief of moderate to severe pain. DOC for aspirin-hypersensitive patients.

Formulations of oxycodone/acetaminophen are available as follows:

Tylox-5/500

Percocet-5/325

Percocet-7.5/500

Percocet-10/650

Acetaminophen with hydrocodone (Vicodin, Lorcet, Lortab, Norco)

Drug combination for outpatient use and indicated for the relief of moderate-to-severe pain.

Formulations of hydrocodone/acetaminophen are available as follows: Vicodin-5/500, ES-7.5/750, HP-10/600 Lorcet-10/650, Plus-7.5/650 Lortab-2.5/500, 5/500, 7.5/500, 10/500 Norco-10/325.

Typical elixirs contain 2.5 mg hydrocodone and 167 mg/mL acetaminophen.

Ibuprofen (Ibuprin, Advil, Motrin)

Usually the DOC for the treatment of mild to moderate pain, if no contraindications exist.

Inhibits inflammatory reactions and pain by decreasing activity of the enzyme cyclooxygenase, resulting in the inhibition of prostaglandin synthesis.

Useful for outpatient oral use where nonsedating drugs are preferred. Also has the advantage of an anti-inflammatory effect.

Ketoprofen (Oruvail, Orudis, Actron)

Used for the relief of mild to moderate pain and inflammation.

Initially administer small dosages to patients with a small body size, the elderly, and those with renal or liver disease.

When administering this medication, doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.

Naproxen (Anaprox, Naprelan, Naprosyn)

Used for relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, resulting in a decrease of prostaglandin synthesis.

Class Summary

These agents can help remove offending substances from the skin and minimize their caustic effects.

Polyethylene glycol

Used as an aid in removing phenol or cresols. Desired agent is PEG 400 mixed 50:50 in water. Most hospitals are not likely to have this product. If not available, use bowel-cleansing products containing PEG.