History
Clinical signs and symptoms vary depending on the route of exposure and the particular substances involved. Because of the variety of presentations, emergency clinicians must be prepared to handle all possibilities. Some exposures, such as hydrofluoric acid, may present without immediate pain and should be considered in patients with complaints of slow-onset deep pain occurring after exposure to an appropriate product.
Patient history should include the following:
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Offending agent, concentration, physical form, pH
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Route of exposure
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Time of exposure
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Volume of exposure
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Possibility of coexisting injury
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The timing and extent of irrigation
For children presenting with chemical burns a thorough history of the situation should be obtained, considering possible neglect and/or abuse. Children may be exposed to caustic substances in methamphetamine labs.
Physical Examination
If the exposure was by ingestion, the immediate concern is to protect the patient's airway. If there is evidence of airway compromise (eg, oropharyngeal edema, stridor, use of accessory muscles), consider establishing a definitive airway.
In dermal exposures, consider the following:
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Size
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Depth
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Location
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Circumferential burns
In ocular exposures, consider the following:
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Visual acuity
In the presence of periorbital dermal lesions, consider the following:
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Scleral and corneal lesions (eg, ulcerations, fluorescein uptake)
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Leakage of vitreous humor
For ingestions, consider the following:
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Presence of oral burns or edema, drooling
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Dysphagia, stridor, wheezing, dyspnea, tachypnea
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Abdominal tenderness, guarding, crepitus, subcutaneous air (Hamman crunch)
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.
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Caustic oral burns.
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Caustic burns of tongue.
