Chemical burns, also known as caustic burns, occur when the skin or eyes come into contact with an acid, base, or another irritant. Many of the substances that cause this type of burn can be easily found in and around the home and workplace. Chemical burns can cause reactions both on the skin and within the body.
If the chemical is swallowed, the burns can also affect the internal organs. Sometimes the effects are short-lived, but some caustic burn injuries can cause long-term or lifelong health problems. This is especially likely if they are not properly treated. Some chemical burns result in premature death. Infants, elderly people, and individuals with disabilities are at the highest risk for chemical burns.
Common Causes of Chemical Burns
Several substances can cause chemical burns. The most common are:
- Bases: Ammonia, calcium hydroxide, sodium and calcium hypochlorite, sodium carbonate, phosphates, silicates, lithium hydride, and sodium and potassium hydroxide
- Acids: Hydrochloric, sulfuric, nitric, hydrofluoric, acetic, formic, phosphoric, and chloroacetic acid as well as phenols
- Oxidants: Chromates, peroxides, magnates, and bleaches like chlorites used in the home
Other miscellaneous chemicals can cause burns such as hair coloring products, airbag chemicals, white phosphorus, metals, and vesicants like mustard gas.
Symptoms of Chemical Burns
The signs and symptoms associated with chemical burns vary depending on how the injury occurred. Swallowing a chemical will result in different symptoms than if the substance was spilled on the skin. For example, swallowing an alkaline chemical may result in burns inside the stomach. Symptoms also vary based on:
- Whether the chemical was in gas, liquid, or solid form
- The strength and amount of the chemical
- How long the skin was in contact with the irritant
- Whether the skin had open cuts or wounds during contact
- The area of the skin where contact occurred
Generally, chemical burns result in:
- Redness, irritation, and burning
- Dead or blackened skin (especially when the substance involved was an acid)
- Numbness or pain
- Vision changes or loss of vision if the chemical gets into the eyes
If the substance is swallowed, the patient may experience:
- Headache
- Low blood pressure
- Shortness of breath
- Irregular heartbeat
- Coughing
- Heart attack
- Muscle twitches
- Dizziness
- Seizures
Diagnosis of Chemical Burns
Medical professionals diagnose chemical burns based on:
- The depth of the burn
- The amount of damage
- The level of pain
- Signs of infection
- The amount of swelling present
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. Previously, this was called a first-degree burn. If the dermis (the second layer) of the skin is damaged, this is called a partial-thickness injury. Healthcare professionals formerly called this a second-degree burn. Injury to the deepest layer of the skin, called the hypodermis or subcutaneous tissue is known as a full-thickness injury. This was previously classified as a third-degree burn.
First Aid for Chemical Burns
It is important that first aid is rendered as soon as possible, and burns must be treated correctly to avoid further complications. If the substance went into the eyes, the individual should rinse their eyes continuously for at least 20 minutes and then seek emergency medical attention. Meanwhile, most external caustic burns are treated by rinsing the chemical off the body with lots of room temperature water. However, not all chemicals should be treated in this way.
For burns that can be rinsed with water, the affected area should be flushed for at least 20 minutes. This should be done gently since a strong spray can further damage the burned area. While the area is being flushed, any clothing or accessories that the chemical touched should be removed. If the injured person is still experiencing a burning sensation after 20 minutes, the burn should be flushed again for 10 to 15 minutes.
Some chemical burns will be aggravated if they’re rinsed with water. If the burn is caused by phenol or carbolic acid, the injured person or a bystander should flush the chemical with rubbing alcohol before using water. If there is no alcohol available, it’s acceptable to rinse with a large amount of water.
Meanwhile, sulfuric acid should be rinsed with a mild, soapy solution if the burns don’t appear severe. Dry lime and other dry powders should be brushed away before flushing with water for 20 minutes. If the powder isn’t brushed away, adding water can create a liquid that burns. Metal compounds should be covered in mineral oil.
After the burn is flushed, the area should be wrapped loosely in a clean cloth or a dry, sterile dressing. The victim can take over-the-counter pain medicine if the burn is superficial. However, serious burns require emergency treatment.
Hospital Treatment for Caustic Burns
People with burn injuries should get to the hospital immediately if:
- The burn is over a major joint
- The burn is bigger than three inches wide or long
- The burn is on the hands, feet, face, buttocks, or groin
- Pain medications aren’t controlling the pain
- The injured person is showing signs of shock, such as shallow breathing, low blood pressure, and dizziness.
Treatment will depend on the severity of the injured person’s condition. It may include:
- Cleaning the area and removing dirt and dead skin
- Administering antibiotics
- Administering intravenous fluids
- Prescribing anti-itch medications
- Skin grafting (attaching healthy skin from another area of the body to the wound)
Severe burns require burn rehabilitation, which includes a range of treatments, including:
- Pain management
- Skin replacement
- Cosmetic surgery
- Counseling
- Occupational therapy
Prognosis
The long-term outlook depends on how severe the burn is. Minor caustic burns usually heal relatively quickly if the patient gets appropriate treatment. However, more serious burns may require long-term medical attention in a specialized burn center. Some burn victims experience complications, including:
- Infection
- Scarring
- Muscle and tissue damage
- Limb loss
- Disfigurement
- Depression
- Flashbacks
- Nightmares
However, most individuals with severe chemical burns will recover over time if they get the right treatment and rehabilitation.
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