Materiały źródłowe

• #1 Chemical Burns – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499888/

  Healthcare professionals should be knowledgeable about chemical burns from exposure to acids (pH less than 7), alkalis (pH greater than 7), and irritants to recognize, manage and care for these common types of injury. […] This activity reviews the pathophysiology and presentation of chemical burns and highlights the role of the interprofessional team in its management. […] Describe the physical exam of a patient with a suspected chemical burn. […] Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in prompt diagnosis of chemical burns and improving outcomes in patients diagnosed with the condition. […] Direct examination of external exposure sites is mandatory, and if there is ingestion, endoscopic evaluation is necessary.

• #2 Chemical Burns: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/chemical-burn-or-reaction

  A chemical burn occurs when your skin or eyes come into contact with an irritant, such as an acid or a base. […] Your healthcare provider will make a diagnosis based on several factors. These may include: the level of pain in the affected area, the amount of damage to the area, the depth of the burn, signs of possible infection, the amount of swelling present. […] The outlook depends on the severity of the burn. Minor chemical burns tend to heal fairly quickly with the appropriate treatment. More severe burns, however, may require long-term treatment. In this case, your doctor may recommend that you receive care at a specialized burn center.

• #3 Chemical burns

  https://dermnetnz.org/topics/chemical-burn

  Chemical burn is a burn to internal or external organs of the body caused by a corrosive or caustic chemical substance that is a strong acid or base (also known as alkali). […] The main cause of chemical burn is contact with strong acids or bases. […] The signs and symptoms of a chemical burn depend on several factors, including: pH of the agent, concentration of the agent, length of contact time, amount of agent involved, physical form of the agent (ie: solid, liquid, gas), site of contact (e.g. eye, skin, mucous membrane), whether swallowed or inhaled, whether or not skin is intact. […] Some signs and symptoms of chemical burns include: Redness, irritation, or burning at the site of contact; Pain or numbness at the site of contact; Formation of black dead skin (eschar) this occurs particularly with acid chemical burns as they produce a coagulation necrosis by denaturing proteins; Deep tissue injury to the skin is caused by alkali chemical burns, as they produce a liquefaction necrosis that involves denaturing of proteins as well as saponification of fats; Vision changes or complete loss of vision if chemicals get into the eyes.

• #4 Chemical Burns: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/769336-overview

  Chemical burns can be caused by acids or bases that come into contact with tissue. […] The severity of the burn is related to a number of factors, including the pH of the agent, the concentration of the agent, the length of the contact time, the volume of the offending agent, and the physical form of the agent. […] The long-term effect of caustic dermal burns is scarring, and, depending on the site of the burn, scarring can be significant. […] 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. […] Even moderate corneal burns can result in scarring and loss of vision.

• #5 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Chemical burns are unique injuries that require individualized evaluation and management depending upon the causative agent. They are often occupational exposures and account for 4 percent and up to 14 percent of admissions to burn units in resource-abundant and resource-limited settings, respectively. […] The evaluation and management of common topical chemical burns will be reviewed here, with a focus on the basic principles of management. […] Chemical burns require immediate treatment because the duration of contact, in addition to the potency and concentration of the toxic agent, determines the degree of tissue destruction. In most cases, the management of topical chemical burns consists of the following: Ensure protection of rescuers and health care workers from exposure, Remove the patient from the exposure scene, Remove all clothing and jewelry, Brush off any dry chemicals, Copious water irrigation.

• #6 Chemical Burns – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499888/

  Healthcare professionals should be knowledgeable about chemical burns from exposure to acids (pH less than 7), alkalis (pH greater than 7), and irritants to recognize, manage and care for these common types of injury. […] This activity reviews the pathophysiology and presentation of chemical burns and highlights the role of the interprofessional team in its management. […] Describe the physical exam of a patient with a suspected chemical burn. […] Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in prompt diagnosis of chemical burns and improving outcomes in patients diagnosed with the condition. […] Direct examination of external exposure sites is mandatory, and if there is ingestion, endoscopic evaluation is necessary.

• #7 Chemical Burns: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/chemical-burn-or-reaction

  A chemical burn occurs when your skin or eyes come into contact with an irritant, such as an acid or a base. […] Your healthcare provider will make a diagnosis based on several factors. These may include: the level of pain in the affected area, the amount of damage to the area, the depth of the burn, signs of possible infection, the amount of swelling present. […] The outlook depends on the severity of the burn. Minor chemical burns tend to heal fairly quickly with the appropriate treatment. More severe burns, however, may require long-term treatment. In this case, your doctor may recommend that you receive care at a specialized burn center.

• #8 Chemical Burns: Causes, Symptoms, Treatment, Prevention, Care

  https://www.webmd.com/first-aid/chemical-burns

  Chemical Burn Diagnosis […] In the emergency room, you can expect the following: […] – Initial evaluation and stabilization […] – Rapid evaluation of the chemical […] – Determination of the extent of injury […] – Blood tests and other studies to determine if you should be admitted to the hospital […] Most people with chemical burns do not need to be admitted. Most can go home after arranging follow-up care with their doctor. In severe cases, however, they may need to be admitted to a hospital.

• #9 Chemical burns

  https://dermnetnz.org/topics/chemical-burn

  Chemical burn is a burn to internal or external organs of the body caused by a corrosive or caustic chemical substance that is a strong acid or base (also known as alkali). […] The main cause of chemical burn is contact with strong acids or bases. […] The signs and symptoms of a chemical burn depend on several factors, including: pH of the agent, concentration of the agent, length of contact time, amount of agent involved, physical form of the agent (ie: solid, liquid, gas), site of contact (e.g. eye, skin, mucous membrane), whether swallowed or inhaled, whether or not skin is intact. […] Some signs and symptoms of chemical burns include: Redness, irritation, or burning at the site of contact; Pain or numbness at the site of contact; Formation of black dead skin (eschar) this occurs particularly with acid chemical burns as they produce a coagulation necrosis by denaturing proteins; Deep tissue injury to the skin is caused by alkali chemical burns, as they produce a liquefaction necrosis that involves denaturing of proteins as well as saponification of fats; Vision changes or complete loss of vision if chemicals get into the eyes.

• #10 Chemical Burns: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/chemical-burn-or-reaction

  A chemical burn occurs when your skin or eyes come into contact with an irritant, such as an acid or a base. […] Your healthcare provider will make a diagnosis based on several factors. These may include: the level of pain in the affected area, the amount of damage to the area, the depth of the burn, signs of possible infection, the amount of swelling present. […] The outlook depends on the severity of the burn. Minor chemical burns tend to heal fairly quickly with the appropriate treatment. More severe burns, however, may require long-term treatment. In this case, your doctor may recommend that you receive care at a specialized burn center.

• #11 Emergency Management of Chemical Burns

  https://www.heraldopenaccess.us/openaccess/emergency-management-of-chemical-burns

  Chemical burns can be caused by acids, bases, organic and inorganic solutions. […] The recognition of the causes, types and mechanisms of tissue destruction of the chemical agents can help in the management of this type of burns. […] Knowing the cause of the burn is of paramount importance in the management. […] The history should also include the duration of contact with the chemical agent, change of voice or difficulty in breathing in cases of inhalation of a chemical agent, the medical condition of the patient and past history of previous experience with chemical burns as in industrial workers. […] The chemical burn can take the shape of patches of skin burns in cases of immersion of part of the body in contact with a chemical agent. […] Most acids produce a coagulation necrosis by denaturing proteins, forming a coagulum (eschar) that limits the penetration of the acid.

• #12

  https://journals.lww.com/em-news/fulltext/2002/02000/the_diagnosis__nitric_acid_burn.20.aspx

  The diagnostic key here is the yellowing of the skin at the injury site. This yellowing is characteristic for chemical injury secondary to nitric acid exposure. […] Nitric acid is corrosive, and can cause severe burns. […] These burns usually take on a characteristic yellowish hue. […] Following ocular contact, serious damage to the eyes may result. Following ingestion, nitric acid may cause immediate corrosion of and damage to the gastrointestinal tract. […] Pulmonary edema may result, may occur up to 48 hours after exposure, and could prove fatal.

• #13 Chemical (Alkali and Acid) Injury of the Conjunctiva and Cornea – EyeWiki

  https://eyewiki.org/Chemical_(Alkali_and_Acid)_Injury_of_the_Conjunctiva_and_Cornea

  Chemical (alkali and acid) injury of the conjunctiva and cornea is a true ocular emergency and requires immediate intervention. Early recognition and treatment ensures the best possible outcome for this potentially blinding condition. […] The severity of ocular injury depends on 4 factors: the toxicity of the chemical, how long the chemical is in contact with the eye, the depth of penetration, and the area of involvement. It is therefore critical to take a careful history to document these factors. […] Prior to a full ophthalmic exam, the pH of both eyes should be checked. If the pH is not in physiologic range, then the eye must be irrigated to bring the pH to an appropriate range (between 7 and 7.2). […] The physical exam should be used to assess the extent and depth of injury. Specifically, the degree of corneal, conjunctival, and limbal involvement should be documented, as it can be used to predict ultimate visual outcome.

• #14 Eye injuries – chemical burns | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eye-injuries-chemical-burns

  A chemical burn occurs when a liquid or powder chemical contacts the eye. […] Rinse the eye and seek urgent medical attention. […] Professional care for chemical burns to the eye may include: irrigation the doctor or ophthalmologist will first flush your eyes, even if you’ve already flushed them yourself. […] Seek immediate medical advice. Medical staff will need to know what chemical was involved, particularly whether it was acid or alkaline, liquid or powder. […] Diagnostic tests may include a fluorescein evaluation, which involves the use of a special dye that colours damaged or dead eye tissue yellow-green when viewed under ultraviolet light.

• #15 Chemical Eye Burns

  https://www.webmd.com/eye-health/chemical-eye-burns

  Chemical exposure to any part of the eye or eyelid may result in a chemical eye burn. Chemical burns represent 7%-10% of eye injuries. About 15%-20% of burns to the face involve at least one eye. Although many burns result in only minor discomfort, every chemical exposure or burn should be taken seriously. Permanent damage is possible and can be blinding and life-altering. […] The severity of a burn depends on what substance caused it, how long the substance had contact with the eye, and how the injury is treated. […] Chemical burns to the eye can be divided into three categories: alkali burns, acid burns, and irritants. […] Acid burns result from chemicals with a low pH and are usually less severe than alkali burns, because they do not penetrate into the eye as readily as alkaline substances. The exception is a hydrofluoric acid burn, which is as dangerous as an alkali burn. Acids usually damage only the very front of the eye; however, they can cause serious damage to the cornea and also may result in blindness.

• #16 Eye injuries – chemical burns | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eye-injuries-chemical-burns

  A chemical burn occurs when a liquid or powder chemical contacts the eye. […] Rinse the eye and seek urgent medical attention. […] Professional care for chemical burns to the eye may include: irrigation the doctor or ophthalmologist will first flush your eyes, even if you’ve already flushed them yourself. […] Seek immediate medical advice. Medical staff will need to know what chemical was involved, particularly whether it was acid or alkaline, liquid or powder. […] Diagnostic tests may include a fluorescein evaluation, which involves the use of a special dye that colours damaged or dead eye tissue yellow-green when viewed under ultraviolet light.

• #17 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Accidental or suicidal ingestion of a chemical corrosive substance can result in gastrointestinal and respiratory burns. The initial period after a chemical burn is associated with the possibility of laryngeal oedema, perforation of the oesophagus, stomach and intestine, gastrointestinal bleeding and pancreatitis. Severe upper gastrointestinal burns affect 10-33% of adult patients, with mortality rates of up to 10%. Patients requiring either an emergency oesophageal resection due to mediastinitis or a gastrointestinal resection due to peritonitis have a more severe course of illness, with a higher risk of death. The most common late complication of endoscopically confirmed chemical oesophageal burns is stricture formation, which occurs in approximately a quarter of hospitalised patients. Oesophageal strictures resulting from chemical burns are considered more difficult to treat both endoscopically and surgically than post-reflux or neoplastic strictures.

• #18 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Ingestion of a corrosive substance in small amounts may be asymptomatic and may not have any significant sequelae. Among patients hospitalised with endoscopically confirmed oesophageal burns, oesophageal stenosis is the most common complication, affecting 24% of patients. It can be difficult to estimate the severity of burns based on clinical symptoms; therefore, patients often require advanced diagnostics. In general, there is no correlation between the results of laboratory tests and the severity of oesophageal burns. […] An overview chest X-ray and abdominal X-ray on admission are used as part of the initial assessment. Chest X-ray may reveal oesophageal perforation, pneumomediastinum, pleural fluid or pneumothorax, and abdominal X-ray may show free air under the diaphragm, indicating gastroesophageal perforation. Neck, chest and abdominal CT are standard examinations in patients with upper gastrointestinal burns to investigate for perforation or partial oesophageal wall damage, which can have severe consequences.

• #19 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Laboratory studies depend on the burn type and extent of exposure. […] For severe burns, consider the following: Electrolytes, Creatinine, BUN, Glucose, Urinalysis, CBC count, Creatine phosphokinase, Coagulation profile. […] For hydrofluoric acid burns, consider the following: Calcium, Magnesium, Potassium. […] For ingestions of caustics, consider the following: Hemoglobin/hematocrit, Pulse-oximetry or ABG if respiratory symptoms. […] For oxalic acid burns, check calcium. […] For chromic acid burns, consider the following: BUN, Creatinine. […] For monofluoroacetic acid burns, consider the following: Electrolytes, ABG. […] For phenol burns, consider the following: Electrolytes, CBC count, Urinalysis, Creatinine, Liver function tests. […] Endoscopy for ingestions is as follows: Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.

• #20 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Findings on esophagoscopy do not correlate well with physical signs and symptoms. […] Burn findings are classified as superficial, transmucosal, or transmural. […] Esophagoscopy findings are used to guide further treatment. The presence of full-thickness or circumferential burns is associated with future stricture formation. […] Endotracheal intubation is required for severe respiratory symptoms. Direct visualization is recommended to assess the degree of injury. […] Bullae resulting from chemical burns should be decompressed and debrided.

• #21 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Considering the pathophysiology of oesophageal burns, it is deemed safe to perform oesophagogastroduodenoscopy (OGD) up to 48 or even 96 hours after the burn in order to perform an early assessment. Endoscopic assessment of the injury makes it possible to predict the severity of the course and the risk of complications, including the development of stenosis. The guidelines currently available are based on the results of a small number of studies, usually retrospective, without randomisation, or a case series. […] Early endoscopy (up to 48 hours, but preferably within 6-12 hours) combined with CT scanning allows assessment of the extent of the burn, the need for emergency surgical treatment and the risk of oesophageal stenosis. Patients with CT findings consistent with grade 3 or 4 oesophageal burns are at greater risk of developing oesophageal stenosis.

• #22 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Laboratory studies depend on the burn type and extent of exposure. […] For severe burns, consider the following: Electrolytes, Creatinine, BUN, Glucose, Urinalysis, CBC count, Creatine phosphokinase, Coagulation profile. […] For hydrofluoric acid burns, consider the following: Calcium, Magnesium, Potassium. […] For ingestions of caustics, consider the following: Hemoglobin/hematocrit, Pulse-oximetry or ABG if respiratory symptoms. […] For oxalic acid burns, check calcium. […] For chromic acid burns, consider the following: BUN, Creatinine. […] For monofluoroacetic acid burns, consider the following: Electrolytes, ABG. […] For phenol burns, consider the following: Electrolytes, CBC count, Urinalysis, Creatinine, Liver function tests. […] Endoscopy for ingestions is as follows: Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.

• #23 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Laboratory studies depend on the burn type and extent of exposure. […] For severe burns, consider the following: Electrolytes, Creatinine, BUN, Glucose, Urinalysis, CBC count, Creatine phosphokinase, Coagulation profile. […] For hydrofluoric acid burns, consider the following: Calcium, Magnesium, Potassium. […] For ingestions of caustics, consider the following: Hemoglobin/hematocrit, Pulse-oximetry or ABG if respiratory symptoms. […] For oxalic acid burns, check calcium. […] For chromic acid burns, consider the following: BUN, Creatinine. […] For monofluoroacetic acid burns, consider the following: Electrolytes, ABG. […] For phenol burns, consider the following: Electrolytes, CBC count, Urinalysis, Creatinine, Liver function tests. […] Endoscopy for ingestions is as follows: Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.

• #24 Chemical Burns – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499888/

  With ingestions, especially when concerned about systemic absorption, laboratory evaluation (complete blood count [CBC], platelets, electrolytes, calcium, magnesium, arterial/venous blood gas, liver and kidney studies, lactic acid level, and, occasionally, coagulation studies) may be indicated. […] Eye exposure, either acid or alkali, represents a significant acute injury. […] Copious irrigation of affected external areas is mandated. […] Endoscopic examination best explores internal injuries after ingestion. […] The prognosis depends on the type of chemical and extent of the injury. […] The most common complications are pain and scarring. […] For those who suffer a burn to the esophagus, endoscopy has to be repeated in 14-21 days to ensure that there is no stricture formation.

• #25 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Laboratory studies depend on the burn type and extent of exposure. […] For severe burns, consider the following: Electrolytes, Creatinine, BUN, Glucose, Urinalysis, CBC count, Creatine phosphokinase, Coagulation profile. […] For hydrofluoric acid burns, consider the following: Calcium, Magnesium, Potassium. […] For ingestions of caustics, consider the following: Hemoglobin/hematocrit, Pulse-oximetry or ABG if respiratory symptoms. […] For oxalic acid burns, check calcium. […] For chromic acid burns, consider the following: BUN, Creatinine. […] For monofluoroacetic acid burns, consider the following: Electrolytes, ABG. […] For phenol burns, consider the following: Electrolytes, CBC count, Urinalysis, Creatinine, Liver function tests. […] Endoscopy for ingestions is as follows: Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.

• #26 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Hydrofluoric acid: QTc prolongation, ventricular dysrhythmia, hypocalcemia, hyperkalemia, hypomagnesemia. […] Phenol causes dermal burns. Severe dermal burns can cause systemic toxicity, such as central nervous system and cardiac abnormalities, and death. […] White phosphorus produces a combined chemical and thermal burn. […] Alkali burns are notable for their degree of edema and fluid loss. […] Initial treatment in the majority of cases consists of extensive irrigation with water.

• #27 Hydrofluoric acid burn – Wikipedia

  https://en.wikipedia.org/wiki/Hydrofluoric_acid_burn

  A hydrofluoric acid burn is a chemical burn from hydrofluoric acid. […] Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram. […] Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram (ECG). ECG changes may include QRS widening and a prolonged QT interval.

• #28 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Laboratory studies depend on the burn type and extent of exposure. […] For severe burns, consider the following: Electrolytes, Creatinine, BUN, Glucose, Urinalysis, CBC count, Creatine phosphokinase, Coagulation profile. […] For hydrofluoric acid burns, consider the following: Calcium, Magnesium, Potassium. […] For ingestions of caustics, consider the following: Hemoglobin/hematocrit, Pulse-oximetry or ABG if respiratory symptoms. […] For oxalic acid burns, check calcium. […] For chromic acid burns, consider the following: BUN, Creatinine. […] For monofluoroacetic acid burns, consider the following: Electrolytes, ABG. […] For phenol burns, consider the following: Electrolytes, CBC count, Urinalysis, Creatinine, Liver function tests. […] Endoscopy for ingestions is as follows: Perform esophagoscopy and gastroscopy on all patients with symptomatic ingestions and on patients who are asymptomatic but have a history of a significant ingestion of a substance with the potential to cause major injury.

• #29 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Ingestion of a corrosive substance in small amounts may be asymptomatic and may not have any significant sequelae. Among patients hospitalised with endoscopically confirmed oesophageal burns, oesophageal stenosis is the most common complication, affecting 24% of patients. It can be difficult to estimate the severity of burns based on clinical symptoms; therefore, patients often require advanced diagnostics. In general, there is no correlation between the results of laboratory tests and the severity of oesophageal burns. […] An overview chest X-ray and abdominal X-ray on admission are used as part of the initial assessment. Chest X-ray may reveal oesophageal perforation, pneumomediastinum, pleural fluid or pneumothorax, and abdominal X-ray may show free air under the diaphragm, indicating gastroesophageal perforation. Neck, chest and abdominal CT are standard examinations in patients with upper gastrointestinal burns to investigate for perforation or partial oesophageal wall damage, which can have severe consequences.

• #30 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Ingestion of a corrosive substance in small amounts may be asymptomatic and may not have any significant sequelae. Among patients hospitalised with endoscopically confirmed oesophageal burns, oesophageal stenosis is the most common complication, affecting 24% of patients. It can be difficult to estimate the severity of burns based on clinical symptoms; therefore, patients often require advanced diagnostics. In general, there is no correlation between the results of laboratory tests and the severity of oesophageal burns. […] An overview chest X-ray and abdominal X-ray on admission are used as part of the initial assessment. Chest X-ray may reveal oesophageal perforation, pneumomediastinum, pleural fluid or pneumothorax, and abdominal X-ray may show free air under the diaphragm, indicating gastroesophageal perforation. Neck, chest and abdominal CT are standard examinations in patients with upper gastrointestinal burns to investigate for perforation or partial oesophageal wall damage, which can have severe consequences.

• #31 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Ingestion of a corrosive substance in small amounts may be asymptomatic and may not have any significant sequelae. Among patients hospitalised with endoscopically confirmed oesophageal burns, oesophageal stenosis is the most common complication, affecting 24% of patients. It can be difficult to estimate the severity of burns based on clinical symptoms; therefore, patients often require advanced diagnostics. In general, there is no correlation between the results of laboratory tests and the severity of oesophageal burns. […] An overview chest X-ray and abdominal X-ray on admission are used as part of the initial assessment. Chest X-ray may reveal oesophageal perforation, pneumomediastinum, pleural fluid or pneumothorax, and abdominal X-ray may show free air under the diaphragm, indicating gastroesophageal perforation. Neck, chest and abdominal CT are standard examinations in patients with upper gastrointestinal burns to investigate for perforation or partial oesophageal wall damage, which can have severe consequences.

• #32 Caustic Substances Poisoning – Injuries and Poisoning – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/injuries-and-poisoning/poisoning/caustic-substances-poisoning

  A doctor inserts a flexible viewing tube down the esophagus to look for burns and determine the severity of the injury. […] The mouth is examined for chemical burns. Because the esophagus and stomach may be burned without the mouth being burned, the doctor may insert a flexible viewing tube (endoscope) down the esophagus to look for burns, particularly if the person drools or has difficulty swallowing. Directly inspecting the area allows the doctor to determine the severity of the injury and possibly to predict the risk of subsequent narrowing and the possible need for surgical repair of the esophagus. Endoscopy can be delayed if the person is too sick for the procedure. […] X-rays and computed tomographic (CT) scans may be necessary to evaluate the extent of the injury.

• #33 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  The most important component of active therapy is thorough irrigation of all wounds and areas of exposure with copious amounts of water. […] Ideally, water irrigation is started immediately at the scene of exposure since pre-hospital irrigation reduces burn severity and the length of hospitalization. […] The principles of management of chemical burns are similar to those for thermal injuries (with the addition of clinician protection, immediate decontamination, and extensive irrigation). […] Assess for inhalational injury or systemic toxicity—Some chemicals are absorbed through the skin or produce vapors, fumes, or aerosols absorbed through the lungs and cause systemic toxicity and/or cause airway/lung injury from these inhaled toxicants. […] The presence of dyspnea, cough, hoarseness, drooling, stridor, tachypnea, decreased breath sounds, wheezing, rales, rhonchi, or use of accessory respiratory muscles suggests a caustic chemical inhalation with upper airway or lung parenchymal edema or injury.

• #34 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  The most important component of active therapy is thorough irrigation of all wounds and areas of exposure with copious amounts of water. […] Ideally, water irrigation is started immediately at the scene of exposure since pre-hospital irrigation reduces burn severity and the length of hospitalization. […] The principles of management of chemical burns are similar to those for thermal injuries (with the addition of clinician protection, immediate decontamination, and extensive irrigation). […] Assess for inhalational injury or systemic toxicity—Some chemicals are absorbed through the skin or produce vapors, fumes, or aerosols absorbed through the lungs and cause systemic toxicity and/or cause airway/lung injury from these inhaled toxicants. […] The presence of dyspnea, cough, hoarseness, drooling, stridor, tachypnea, decreased breath sounds, wheezing, rales, rhonchi, or use of accessory respiratory muscles suggests a caustic chemical inhalation with upper airway or lung parenchymal edema or injury.

• #35 Chemical Burns Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/769336-workup

  Findings on esophagoscopy do not correlate well with physical signs and symptoms. […] Burn findings are classified as superficial, transmucosal, or transmural. […] Esophagoscopy findings are used to guide further treatment. The presence of full-thickness or circumferential burns is associated with future stricture formation. […] Endotracheal intubation is required for severe respiratory symptoms. Direct visualization is recommended to assess the degree of injury. […] Bullae resulting from chemical burns should be decompressed and debrided.

• #36 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Hydrofluoric acid: QTc prolongation, ventricular dysrhythmia, hypocalcemia, hyperkalemia, hypomagnesemia. […] Phenol causes dermal burns. Severe dermal burns can cause systemic toxicity, such as central nervous system and cardiac abnormalities, and death. […] White phosphorus produces a combined chemical and thermal burn. […] Alkali burns are notable for their degree of edema and fluid loss. […] Initial treatment in the majority of cases consists of extensive irrigation with water.

• #37 Hydrofluoric acid burn – Wikipedia

  https://en.wikipedia.org/wiki/Hydrofluoric_acid_burn

  A hydrofluoric acid burn is a chemical burn from hydrofluoric acid. […] Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram. […] Diagnosis should include blood tests for calcium, potassium, and magnesium along with an electrocardiogram (ECG). ECG changes may include QRS widening and a prolonged QT interval.

• #38 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Hydrofluoric acid: QTc prolongation, ventricular dysrhythmia, hypocalcemia, hyperkalemia, hypomagnesemia. […] Phenol causes dermal burns. Severe dermal burns can cause systemic toxicity, such as central nervous system and cardiac abnormalities, and death. […] White phosphorus produces a combined chemical and thermal burn. […] Alkali burns are notable for their degree of edema and fluid loss. […] Initial treatment in the majority of cases consists of extensive irrigation with water.

• #39 Chemical Burns | Burns Caused By Chemicals | TORKLAW

  https://www.torklaw.com/practice-areas/burns/chemical-burns/

  Medical professionals diagnose chemical burns based on: […] Burns are classified according to the extent of the injury and the depth of the burn. […] If only the top layer of the skin is affected, this is known as a superficial burn. […] If the dermis (the second layer) of the skin is damaged, this is called a partial-thickness injury. […] Injury to the deepest layer of the skin, called the hypodermis or subcutaneous tissue is known as a full-thickness injury.

• #40 Cutaneous chemical burns: assessment and early management

  https://www.racgp.org.au/afp/2015/march/cutaneous-chemical-burns-assessment-and-early-mana

  Assessment of the patient should be rapid and occur in conjunction with early emergency management. […] Early management should be conducted with consideration of clinicians safety, and appropriate precautions should be taken. […] Excluding specific situations and chemical exposure, copious irrigation with water remains the mainstay of early management. […] The duration of skin contact is the key determinant of injury severity. […] Thus, prompt removal of chemical contact is mandatory. […] Early irrigation dilutes the chemical concentration and has been shown to reduce the severity of the burn and hospital stay. […] Monitoring blood gases through venous sampling may be necessary to ensure metabolic stability. […] Chemical burns should be treated as full-thickness burns until proven otherwise.

• #41 Chemical eye burn causes and symptoms | Burn and Reconstructive Centers of America

  https://burncenters.com/community/chemical-eye-burn-causes-and-symptoms/

  A chemical eye burn occurs when the eye or eyelid is exposed to a corrosive chemical agent, such as a acid or alkaline. […] Chemical eye burns are considered ophthalmological emergencies, and medical treatment should be sought immediately. […] Chemical eye burns are classified similarly to all other burn typesin degrees. […] First-degree chemical eye burns: Considered a minor eye injury but emergent nonetheless, this degree of chemical eye burn injury is characterized by a clear cornea with an absence of limbal ischemia or a white film over the eye. […] Second-degree chemical eye burns: A moderate injury, second-degree chemical eye burn injuries are characterized by a cloudy cornea where the details of the iris are still visible. […] Third-degree chemical eye burns: A severe injury, third-degree chemical eye burn injuries are characterized by complete loss of the outer layer of tissue on the cornea and near-complete opacity of the iris where details are not readily visible.

• #42 Chemical burns acid or alkali, what’s the difference? | Eye

  https://www.nature.com/articles/s41433-019-0735-1

  Two prognostic classifications are in vogue, the Roper-Hall and the Duas classification. […] Control of inflammation involves the judicious use of steroids, antiproteases like tetracycline, sodium citrate (10%) and application of amniotic membrane. […] A host of ocular surface reconstructive measures come into play in the late stage of chemical burns, of which limbal stem cell transplantation and the current availability of HOLOCLAR, approved by NICE for unilateral chemical burns are key interventions.

• #43 EyeRounds.org: Chemical Eye Injury: A Case Report and Tutorial

  http://eyerounds.org/cases/307-chemical-eye-injury.htm

  INITIAL PRESENTATION […] 52-year-old male who presented emergently after an alkali chemical injury to his eyes. […] When initially evaluated at an outside hospital, the reported pH was 9.0 in his right eye and 8.5 in his left eye. […] Differential Diagnosis: […] Alkali burn […] Acid burn […] Chemical injuries to the eye are ophthalmic emergencies that require immediate management. Delay in care can result in deeper penetration of the chemical agent resulting in more widespread injury. Long term sequelae of chemical ocular burns include secondary glaucoma, limbal stem cell deficiency, and permanent vision loss. […] Immediate and copious irrigation (at least 30 minutes) with any non caustic liquid to neutralize pH is critical. […] Grade degree of injury using a schema such as Roper-Hall or Dua to help prognosticate and guide treatment.

• #44 Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis

  https://www.termedia.pl/Diagnosis-and-management-of-gastrointestinal-chemical-burns-and-post-burn-oesophageal-stenosis,40,46010,1,1.html

  Zargar grade IIa-IIIb burns are likely to lead to oesophageal or gastric strictures, which require endoscopic treatment as a first step. Post-burn stenosis is estimated to develop a minimum of six months after the burn, after which time surgical treatment can be considered. Oesophageal resection may be preferred due to the increased risk of tumour development in the burn scar. All patients with oesophageal burns, including those undergoing surgery or endoscopic treatment, require long-term follow-up due to the increased risk of cancer development in the burn scar and anastomotic area.

• #45 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Chemical burns are unique injuries that require individualized evaluation and management depending upon the causative agent. They are often occupational exposures and account for 4 percent and up to 14 percent of admissions to burn units in resource-abundant and resource-limited settings, respectively. […] The evaluation and management of common topical chemical burns will be reviewed here, with a focus on the basic principles of management. […] Chemical burns require immediate treatment because the duration of contact, in addition to the potency and concentration of the toxic agent, determines the degree of tissue destruction. In most cases, the management of topical chemical burns consists of the following: Ensure protection of rescuers and health care workers from exposure, Remove the patient from the exposure scene, Remove all clothing and jewelry, Brush off any dry chemicals, Copious water irrigation.

• #46 Topical chemical burns: Initial evaluation and management – UpToDateChemical_burns.htm

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management/print

  Chemical burns are unique injuries that require individualized evaluation and management depending upon the causative agent. […] The evaluation and management of common topical chemical burns will be reviewed here, with a focus on the basic principles of management. […] Chemical burns require immediate treatment because the duration of contact, in addition to the potency and concentration of the toxic agent, determines the degree of tissue destruction. […] The most important component of active therapy is thorough irrigation of all wounds and areas of exposure with copious amounts of water. […] Ideally, water irrigation is started immediately at the scene of exposure since pre-hospital irrigation reduces burn severity and the length of hospitalization. […] The principles of management of chemical burns are similar to those for thermal injuries (with the addition of clinician protection, immediate decontamination, and extensive irrigation).

• #47 Chemical burns — first aid and treatment | healthdirect

  https://www.healthdirect.gov.au/chemical-burns

  If you think someone has a chemical burn, call triple zero (000). Ask for an ambulance. If you can, let them know what chemical caused the burn. For help and advice about poison, call the Poisons information Hotline on 13 11 26. […] Your doctor will examine you. They will want to know as much as possible about the chemical. This includes how much chemical there was. It also includes how long the chemical was on your skin. […] See a doctor if you have chemical burns. […] Call triple zero (000) if someone has collapsed, stopped breathing, or is having a seizure. Ask for an ambulance. If you can, let them know what chemical caused the burn. […] If the chemical is on your skin, wash it off straight away with cool running water. Keep the affected area under water for at least 20 minutes. Continue washing even after the chemical seems to have been removed. This helps to reduce tissue damage.

• #48 Chemical burns — first aid and treatment | healthdirect

  https://www.healthdirect.gov.au/chemical-burns

  Your doctor may advise you to keep your wound clean and stop it from drying out. […] For a minor chemical burn, you probably won’t need to stay in hospital. More serious burns will need treatment in hospital. The wound will be carefully watched and treated at the hospital. This is important to control your pain and prevent infection. […] Most small chemical burns heal within a couple of weeks. They usually don’t leave a scar, even if your skin has blistered. […] You can help prevent chemical burns by always reading and following the instructions when using chemical products.

• #49 Cutaneous chemical burns: assessment and early management

  https://www.racgp.org.au/afp/2015/march/cutaneous-chemical-burns-assessment-and-early-mana

  Referral to secondary or tertiary centres is required for formal assessment by specialist services. […] Complete rapid assessment of the cutaneous injury and clinical status of the patient is essential in establishing the need for prompt referral to centres of higher acuity. […] Appropriate early management is crucial in reducing the period of patient morbidity. […] Current guidelines suggest water irrigation is the safest, most efficacious and readily available treatment option in the early stages of care of chemical burns.

• #50 Chemical burns: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/318084

  A chemical burn can occur when a person comes in direct contact with a chemical or its fumes. […] Severe chemical burns do require immediate emergency care to prevent complications and, in some cases, death. […] Knowing the type of chemical that caused the burn is important. Symptoms will vary based on how the chemical responds once in contact with the skin, eyes, or inside of the body. […] Chemical burns often require some kind of medical treatment or a trip to the hospital. […] In the emergency room, the person will be evaluated rapidly to determine how much tissue has been affected and the extent of the injury. After evaluation, they will be stabilized. […] Doctors may carry out further lab work and other diagnostic tests to determine any further health concerns. A treatment plan will then be prepared based on the persons overall condition, the type of exposure, and the likelihood that the persons symptoms may worsen.

• #51 Chemical Burns: Causes, Symptoms, Treatment, Prevention, Care

  https://www.webmd.com/first-aid/chemical-burns

  Chemical Burn Diagnosis […] In the emergency room, you can expect the following: […] – Initial evaluation and stabilization […] – Rapid evaluation of the chemical […] – Determination of the extent of injury […] – Blood tests and other studies to determine if you should be admitted to the hospital […] Most people with chemical burns do not need to be admitted. Most can go home after arranging follow-up care with their doctor. In severe cases, however, they may need to be admitted to a hospital.

• #52 Topical chemical burns: Initial evaluation and management – UpToDate

  https://www.uptodate.com/contents/topical-chemical-burns-initial-evaluation-and-management

  Chemical burns are unique injuries that require individualized evaluation and management depending upon the causative agent. They are often occupational exposures and account for 4 percent and up to 14 percent of admissions to burn units in resource-abundant and resource-limited settings, respectively. […] The evaluation and management of common topical chemical burns will be reviewed here, with a focus on the basic principles of management. […] Chemical burns require immediate treatment because the duration of contact, in addition to the potency and concentration of the toxic agent, determines the degree of tissue destruction. In most cases, the management of topical chemical burns consists of the following: Ensure protection of rescuers and health care workers from exposure, Remove the patient from the exposure scene, Remove all clothing and jewelry, Brush off any dry chemicals, Copious water irrigation.

• #53

  https://111.wales.nhs.uk/encyclopaedia/a/article/acidandchemicalburns

  Get medical advice as soon as possible if you think you have an acid or chemical burn. You’ll need to be treated as soon as possible. […] An acid or chemical burn needs immediate first aid. […] Acid and chemical burns need to be checked and treated in hospital.

• #54 Acid and chemical burns | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/injuries/skin-injuries/acid-and-chemical-burns/

  Burns caused by acid, alkaline or caustic chemicals can be very damaging and need immediate medical attention. […] Immediate treatment for chemical burns in hospital includes: continuing to wash off the corrosive substance with water until its completely removed, cleaning the burn and covering it with an appropriate dressing, pain relief, a tetanus jab if necessary. […] If the burn is severe, you may be referred to a specialist burns unit, which may be in a different hospital. You may stay in hospital for a number of days. […] For chemical burns affecting the eyes, you’re also likely to be urgently assessed by an eye specialist to help minimise the risk of lasting vision loss.

• #55 Chemical burns – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8640619/

  Objectives: To report a burn unit’s experience with chemical burns and to discuss the fundamental principles in managing chemical burns. […] Conclusions: The key principles in the management of chemical burns include removal of the chemical, copious irrigation, limited use of antidotes, correct estimation of the extent of injury, identification of systemic toxicity, treatment of ocular contacts and management of chemical inhalation injury. Individualized treatment is emphasized.

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