Magnesium and Thermite Poisoning Treatment & Management

  • Author: Jayson Tappan, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

Prehospital Care

  • Remove patients from the burning environment, with appropriate attention to personal safety.
  • Flush thermite burns with copious amounts of water and brush or debride them to remove contaminating particles.
  • Initial care for magnesium burn wounds should include removal of all unburned particles by mechanical means, including wound debridement, if needed. If particles are present, do not flush with water until particles have been removed.  If water irrigation is needed for burn treatment or other decontamination, use copious amounts to rapidly flush away residual magnesium before the resulting chemical reaction can cause harm. To stop burning particles that cannot be easily removed, the area can be submersed or coated in mineral oil to stop the oxidizing reaction.[9]
  • Treat burns with standard thermal burn treatment techniques. Undertake standard support of the ABCs, including intubation and fluid resuscitation if needed.[4, 5, 10]
  • Cover burned areas with dry, sterile dressings or burn-specific dressings. Avoid large areas of wet dressings due to the risk of hypothermia.
  • Narcotic analgesia may be useful if the patient's hemodynamic status permits.
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Emergency Department Care

  • Institute airway support.
  • Start fluid resuscitation, guided by formulas for similar thermal burns.[4, 5]
  • Perform wound debridement to remove residual particles of magnesium or iron if not already performed in prehospital setting.
  • Aggressively seek and treat associated traumatic injuries (eg, from blast).
  • Assess and start initial treatment of any ocular injuries.[7]
  • Institute analgesia.
  • Consider all incendiary burns tetanus prone and administer appropriate tetanus prophylaxis.
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Consultations

  • A burn surgeon or other appropriate surgeon (eg, plastic, trauma) should be involved in care.
  • Consult an ophthalmologist if eye injury has occurred.
  • Continuing critical care expertise may be required if injury severity is high.
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Contributor Information and Disclosures
Author

Jayson Tappan, MD  Staff Physician, Department of Emergency Medicine, National Naval Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Robin A C Marshall, MD  Core Staff Physician, Assistant Residency Director, Civil Service Advocate, Department of Emergency Medicine, Naval Medical Center Portsmouth; Consulting Staff, Department of Emergency Medicine, Riverside Emergency Physicians, Riverside Regional Medical Center

Robin A C Marshall, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD  Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jonathan L Burstein, MD, to the development and writing of this article.

References

  1. Chemical casualties. Smokes, fuels, and incendiary materials. J R Army Med Corps. Dec 2002;148(4):395-7. [Medline].

  2. Stewart CE, Sullivan JB, eds. Military munitions and antipersonnel agents. In: Hazardous Materials Toxicology. 1992:1007-1008.

  3. Mendelson JA. Some principles of protection against burns from flame and incendiary munitions. J Trauma. Apr 1971;11(4):286-94. [Medline].

  4. Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia: Mosby Elsevier; 2006.

  5. Tintinalli, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw-Hill; 2004.

  6. Kaye P, Young H, O'Sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. May 2002;19(3):268-9. [Medline].

  7. Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am. Feb 2008;26(1):125-36, vii. [Medline].

  8. Warden CR. Respiratory agents: irritant gases, riot control agents, incapacitants, and caustics. Crit Care Clin. Oct 2005;21(4):719-37, vi. [Medline].

  9. Curreri PW, Asch MJ, Pruitt BA. The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations. J Trauma. Aug 1970;10(8):634-42. [Medline].

  10. US Department of Transportation. Emergency Response Guidebook. 2004.

  11. Schwartz SI, ed. Principles of Surgery. 8th ed. New York: McGraw Hill; 2004.

 
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