Chemical burn emergency care

Burns called damage caused by thermal, chemical, radiation energy. Among peacetime injuries, burns account for approximately 6%. The severity of burns is determined by the area and depth of tissue damage, the presence or absence of burns to the respiratory tract, poisoning by combustion products, and concomitant diseases. The greater the area and depth of tissue damage, the more severe the burn. Thermal burns can be caused by flames, hot gases, molten metal, hot liquids, steam, and sunlight.

In modern clinical practice, the classification of burns introduced by A.A. is most often used. Vishnevsky and M.I. Shreiberg, approved at the XXVII All-Union Congress of Surgeons.

Based on the depth of damage, burns are divided into four degrees:

• I degree - erythema and swelling of the affected area, accompanied by a feeling of pain and burning;

• II degree - against the background of erythema and edema, blisters appear filled with serous yellowish-transparent liquid;

• III degree - necrosis of the epidermis, the germinal layer of the skin is partially preserved, and the skin glands are partially preserved. Burn surfaces are represented by a scab, that is, dead, insensitive layers of skin. The scab retains pain sensitivity when pricked with a needle. When burned with a hot liquid or steam, the scab is whitish-gray; when burned by a flame or in contact with a hot object, the scab is dry, dark brown;

• SB degree - necrosis of all layers of the skin. The scab is denser than in grade III. All types of sensitivity are absent, including pain when pricked with a needle. When exposed to hot liquids, the scab is dirty gray; when burned by a flame, it is dark brown;

• IV degree - necrosis of the skin and underlying tissues: fascia, tendons, muscles, bones. The scab is dark brown and dense. Thrombosed saphenous veins are often visible. All types of sensitivity are absent in the scab.

Burns of I, II and III degrees are classified as superficial lesions, burns of III and IV degrees are deep.

Determination of the affected area

The severity of the victim’s general condition depends not only on the depth, but also on the volume of the affected tissue. In this regard, already at the pre-medical stage it is necessary to determine the area of ​​the burn.

To quickly approximately determine the affected area, you can use the “rule of nines.”

• Head and neck - 9%.

• Upper limb - 9% (each).

• Lower limb - 18% (each).

• Anterior surface of the body - 18%.

• Posterior surface of the body - 18%.

• Perineum and genitals - 1%.

You can use the “rule of the palm”: the area of ​​​​the palm of an adult is 1% of the total surface of the skin.

Depending on the area of ​​damage, burns are conventionally divided into limited and extensive. Extensive burns include burns covering more than 10% of the skin surface. Victims with extensive burns of any degree, as well as burns of the head and neck, palm, plantar surface of the foot, perineum, starting from the second degree, are subject to urgent hospitalization. This is explained by the fact that it is preferable to treat these groups of burns using the open method: the burn surface is evenly dried under the frame until a dry scab is formed, under which further epithelization of the affected surfaces occurs. All patients over 60 years of age and children are also hospitalized. Prognostically, first degree burns are very dangerous when more than 1 /₂ surface of the body, II degree with damage 1 /₃ body surface, III degree with damage less than 1/₃ body surface.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Chemical burns: causes of their occurrence, signs and symptoms, first aid measures and complex therapy
Almost all chemicals are endowed with the necessary strength, which can have a destructive effect on the tissues of the human body. Alkalis and concentrated acids are especially strong in this regard. As soon as they begin to affect the human body, they immediately arise chemical burns. First aid for such burns, it involves, first of all, thoroughly washing the affected area with running water, since this is the only way to get rid of the aggressive component. After this, it is recommended to apply a sterile bandage to the affected area. If a chemical component gets into the eyes or a person swallows it, then the first thing you should do is rinse the eye or stomach, and then consult an emergency physician.

Chemical burn is tissue damage resulting from exposure to salts of heavy metals, acids, caustic liquids, alkalis or any other chemically active components. These types of burns occur as a result of safety violations, domestic accidents, secondary injuries or suicide attempts. There are other factors that contribute to their development. The severity, as well as the depth of such burns, directly depends on the following factors:

1. concentration and amount of chemical
2. mechanism of action and strength of the chemical
3. degree of penetration and duration of exposure to the chemical

According to the depth and severity of tissue damage, four degrees of chemical burns are distinguished

First degree (damage to the upper layer of the skin, epidermis). In this case, there is slight swelling, redness, and mild pain at the site of the lesion.

Second degree (damage to the deeper layers of the skin). In this case, redness and swelling occur, as well as blisters filled with clear liquid.

Third degree (damage to the deeper layers of the skin, reaching the subcutaneous adipose tissue) is accompanied by the appearance of blisters that are filled with cloudy liquid or bloody contents. In this case, there is a violation of sensitivity, that is, the person does not experience pain in the affected area.

Fourth degree (damage to all tissues: skin, muscles, tendons).

In most cases, chemical burns occur third And fourth degrees.

If the burn occurs under the influence of alkalis and acids, then a so-called scab or crust appears at the site of the lesion. The crust that appears after exposure to alkalis is loose, whitish, soft and does not stand out among the whole tissue by any boundaries. If we compare alkaline liquids with acidic liquids, it is immediately worth noting that the former tend to penetrate much deeper into the tissue, therefore, they cause more significant harm.

In case of acid burns the crust is hard and dry. In addition, it has clearly defined boundaries that distinguish it from healthy areas of the skin. Plus, acid burns are most often superficial.
Color of the affected area skin in the case of a chemical burn is determined by the type of chemical substance. If the skin is exposed to sulfuric acid, then it initially turns white, and only then turns brown or gray. If the skin has been burned with nitric acid, then the affected area becomes yellow-brown or light yellow-green. Hydrochloric acid tends to leave yellowish burns, but acetic acid tends to leave a dirty white color. When burned with carbolic acid, the affected area first turns white and then brown. In the case of a burn with concentrated hydrogen peroxide, the affected area becomes gray.

It should be noted that the skin tissue continues to deteriorate even after the chemical component ceases to come into contact with it, and all because the process of absorption of the chemical substance in this case does not stop immediately. As a result, it is simply impossible to establish the exact degree of the burn during the first hours or days after the incident. It will be possible to make an accurate diagnosis only after seven to ten days, namely when the process of suppuration of the resulting crust begins. The danger and severity of this type of burn is determined by both its area and depth. The larger the affected area, the more dangerous the burn is for the patient’s life.

First aid for chemical burns of the skin

First aid in such cases involves: removing the chemical component from the affected area as quickly as possible, reducing the concentration of its residues on the skin by thoroughly rinsing with water, as well as cooling the affected area in order to reduce pain.

In case of a chemical burn to the skin, the following measures should be taken:

1. You should immediately remove clothing or jewelry that contains chemical components.
2. To get rid of the causes of the burn, it is necessary to wash off the chemicals from the skin, while holding the affected area under cold running water for at least a quarter of an hour. If it was not possible to rinse the affected area in a timely manner, then the rinsing time is increased to thirty to forty minutes. You should not try to get rid of chemicals using tampons or napkins moistened with water, as this will allow them to penetrate even more deeply into the skin. If the chemical component is in powder form, then first you need to remove its remnants from the skin and only then begin to wash the affected area. Exceptions to the rules are cases when there is a categorical contraindication for the interaction of a chemical component with water. This applies, for example, to aluminum, since organic compounds of this substance tend to ignite upon contact with water.
3. If after the first rinse a person begins to experience an even stronger burning sensation, then it is recommended to rinse the affected area again with running water for five to six minutes.
4. As soon as the affected area is washed, you should proceed to neutralize the chemical components. In case of an acid burn, you should use soapy water or a two percent solution of baking soda. This solution is easy to prepare: take two and a half glasses of water and dissolve one teaspoon of baking soda in it. In case of an alkali burn, a weak solution of vinegar or citric acid will come to the rescue. The chemical components of lime can be neutralized with a two percent sugar solution. Carbolic acid can be neutralized with milk of lime and glycerin.
5. You can reduce pain by applying a cold, damp cloth or towel to the affected area.
6. After this, apply a loose bandage made of clean dry cloth or a dry sterile bandage to the affected surface.

If the burn is not severe, then it will heal without any medications.

For a chemical burn, immediate medical attention is needed in the following cases:

1. If a person exhibits signs of shock such as pale skin, loss of consciousness, and shallow breathing.
2. If the diameter of the burn is more than seven and a half centimeters, and it has also penetrated deeper than the first layer of skin.
3. Chemical damage affected the groin area, legs, eyes, buttocks, face, arms or large joints, as well as the esophagus and oral cavity.
4. A person experiences very strong pain that cannot be relieved with painkillers such as ibuprofen or acetaminophen .

If you nevertheless decide to get advice from a specialist, then do not forget to take with you the container with the chemical substance that caused the burn, or its detailed description. This will make it possible to neutralize it much faster, which sometimes cannot be done under normal home conditions.

Chemical burns to the eyes

Chemical burns to the eyes are the result of lime, acids, ammonia, alkalis or other chemical components entering this area at work or at home. In fact, burns in this area are extremely dangerous, which is why they require timely consultation with a medical specialist. The severity of chemical eye burns is determined by the concentration, temperature, chemical composition, and the amount of the substance that caused the burn. In addition, the general reactivity of the patient’s body, the condition of his eyes, as well as the quality and timeliness of first aid are also taken into account. In most cases, with such burns, the patient experiences the following subjective sensations: lacrimation, fear of light, cutting pain in the eye area. In very severe cases, the patient may lose vision completely. We note right away that with such burns, not only the eyes are affected, but also the skin around them. It is very important to provide first aid to a person in a timely manner. First of all, he needs to rinse his eyes with plenty of running water as quickly as possible. Open your eyelids and rinse your eyes for ten to fifteen minutes. In this case, water is the main neutralizer of chemical components. If the burn is a consequence of exposure to alkali, then milk can be used instead of water. As soon as the eye is thoroughly washed, take a piece of gauze or bandage and apply a dry bandage. As soon as this is done, immediately take the patient to the doctor.

Chemical burns of the stomach and esophagus

Author: Pashkov M.K. Content Project Coordinator.

Surely you have a certain idea of ​​​​how to provide assistance for a household burn, meanwhile, not everyone knows what first aid is provided for chemical burns. It should be noted that this type of burn, due to the peculiarities of the effect of chemical components on the tissues of our body, in some cases is much more significant than the household burn we have already noted.

Before moving on to consider those features that are characteristic of chemical burns, we note that first aid for them, first of all, requires washing the affected area using ordinary running water - only it has the proper effect, allowing you to eliminate the aggressive component.

General features of a chemical burn

A chemical burn itself is tissue damage resulting from exposure to acids, heavy metal salts, alkalis and other types of active chemical components. Receiving such burns, as a rule, is a consequence of non-compliance with certain safety rules provided for working with these chemicals, as well as a consequence of domestic accidents, injuries in industrial conditions and suicide attempts. There are also a number of other factors that contribute to the development of chemical burns.

The depth of the resulting chemical burn, as well as the degree of its severity, is determined based on the factors listed below that characterize it in general:

1. the degree of concentration of the chemical substance and its quantity;
2. the strength and mechanism of action of the active chemical;
3. the current degree of penetration of the chemical substance, the duration of its effect.

Degrees of chemical burns

In accordance with the listed factors characterizing a chemical burn, its degree is determined. In particular, there are four of them.

1. I degree.Only the top layer of the skin is affected. Among the main manifestations that accompany this type of burn are slight swelling and redness of the skin. In addition, mild pain also occurs in the affected area.
2. II degree. In this case, the lesion affects, in addition to the upper layer of the skin, its deeper layers. A burn of this degree is characterized by manifestations in the form of swelling and redness, in addition, bubbles filled with a transparent liquid also appear.
3. III degree. Those layers of the skin that are located near the fatty subcutaneous tissue are affected. The characteristic features of a burn of this degree are the appearance of blisters with a cloudy liquid or mixed with blood. In the affected area, sensitivity is impaired, that is, the victim does not feel pain within it.
4. IV degree. The lesion affects all tissues, including skin, muscles and tendons.

As a rule, in practice one has to deal with burns corresponding to III and IV degrees.

Burns with acids and alkalis: characteristic signs and features

If the burn was caused by exposure to an acidic or alkaline liquid, a scab (crust) will form in the affected area. The scab itself is soft and loose, has a whitish tint, and does not stand out against the background of unaffected tissue by its borders. When comparing burns caused by alkaline liquids and burns caused by acidic liquids, it can be noted that alkaline liquids penetrate much deeper than acidic liquids, and accordingly, their degree of impact is more extensive.

An acid burn is characterized by the appearance of a dry and hard crust, which has clear boundaries of the affected area, which makes it stand out against the background of healthy areas of the skin. It is noteworthy that acid burns are mostly superficial.

As for the color of the skin lesion during a chemical burn, it is determined based on the type of the active substance. Thus, exposure to sulfuric acid makes the skin first white, then gray or brown. A nitric acid burn gives the skin a light yellow-green or brownish-yellow hue. A burn with hydrochloric acid makes the affected skin yellowish, a burn with acetic acid makes it dirty brown. If the burn was caused by exposure to carbolic acid, the affected area first becomes white, a little later - brown, and if we are talking about a type of burn such as a burn with concentrated hydrogen peroxide, then the affected area becomes gray.

Another important point is that the destruction of skin tissue occurs even after the connection with the chemical component is eliminated, that is, the absorption of the chemical continues to a certain point. For this reason, accuracy in determining the degree of burn during the first few hours (days) from the moment of injury is excluded as a possibility.

Accordingly, an accurate diagnosis can be made only after 7-10 days - that is, by the time the resulting crust begins to fester. The severity and danger of chemical burns is determined based on the area of ​​the lesion and its depth, therefore, the larger the area of ​​the lesion, the more dangerous this burn is for the health and life of the victim.

First aid for chemical burns

1. Clothing and jewelry in the affected area, which have also been exposed to chemical components, are removed.
2. To get rid of the causes of a chemical burn affecting the skin, you should, as we have already indicated, wash off the chemicals from it with running water. Note that if this is possible, the affected area must be kept under running water for about 15 minutes or more. If timely removal of the affecting component was not carried out, then the duration of subsequent washing should be half an hour or more.
3. It is impossible to get rid of the affecting chemical substance using napkins or cotton swabs moistened with water - this will only lead to increased penetration.
4. When the active chemical is in powder form, its residue is first removed from the skin, after which it is washed. The only exception in this situation is the categorical prohibition of interaction of such a substance with water. In particular, this is true for aluminum - an organic compound of this substance upon contact with water leads to ignition.
5. If the burning sensation intensifies after washing the affected area, you should rinse it again (about 5 minutes).
6. After washing the affected area, they begin to neutralize the affecting chemical components. If we are talking about an acid burn, then use a 2% solution of baking soda (2.5 cups of water + 1 teaspoon of baking soda) or soapy water. In case of alkali burn, use a weak solution of citric acid or vinegar. When exposed to the chemical components of lime, a 2% sugar solution is used. Neutralization of carbolic acid is carried out using lime milk and glycerin.
7. Reducing pain is achieved by using a damp, cold cloth/towel applied to the affected area.
8. Finally, a loose bandage (without the possibility of squeezing) made of dry, clean cloth or dry bandage/gauze is applied to the area affected by the chemical attack.

When does a chemical burn require emergency medical care?

Undoubtedly, first aid for chemical burns immediately after injury is more than important, but in some cases it is still impossible to do without qualified assistance. It is necessary in the following situations:

1. the appearance of signs of shock in the victim (loss of consciousness, shallow breathing, pale skin);
2. the total diameter of the lesion exceeds 7.5 cm and its penetration is noted deeper than the first layer of skin;
3. in case of chemical damage, the areas of the legs, groin, face, buttocks, arms, large joints, mouth or esophagus were exposed;
4. the appearance of significant pain in the victim that is not eliminated by the use of painkillers.