Advanced Trauma Life Support ATLS Student Course Manual 2018

UNIQUE BURN INJURIES 179
consideration, including chemical, electrical, and tar
burns, as well as burn patterns that indicate abuse.
Chemical Burns
Chemical injury can result from exposure to acids,
alkalies, and petroleum products. Acidic burns cause a
coagulation necrosis of the surrounding tissue, which
impedes the penetration of the acid to some extent.
Alkali burns are generally more serious than acid burns,
as the alkali penetrates more deeply by liquefaction
necrosis of the tissue.
Rapid removal of the chemical and immediate
attention to wound care are essential. Chemical
burns are influenced by the duration of contact,
concentration of the chemical, and amount of the agent.
If dry powder is still present on the skin, brush it away
before irrigating with water. Otherwise, immediately
flush away the chemical with large amounts of warmed
water, for at least 20 to 30 minutes, using a shower
or hose (n FIGURE 9-6). Alkali burns require longer
irrigation. Neutralizing agents offer no advantage over
water lavage, because reaction with the neutralizing
agent can itself produce heat and cause further tissue
damage. Alkali burns to the eye require continuous
irrigation during the first 8 hours after the burn. A
Pitfall
Patient presents with
chemical burn and
exposure to unfamiliar
compound.
prevention
• Obtain the manufacturer’s
Material Safety
Data Sheet or contact a
poison center to identify
potential toxicities.
small-caliber cannula can be fixed in the palpebral
sulcus for irrigation. Certain chemical burns (such as
hydrofluoric acid burns) require specialized burn unit
consultation. It is important to ascertain the nature
of the chemical and if possible obtain a copy of the
Material Safety Data Sheet to address any systemic
toxicity that may result. Providers must also take care to
protect themselves from inadvertent exposure during
the decontamination process.
Electrical Burns
Electrical burns result when a source of electrical
power makes contact with a patient, and current is
transmitted through the body. The body can also serve
as a volume conductor of electrical energy, and the
heat generated results in thermal injury to tissue.
Different rates of heat loss from superficial and deep
tissues allow for relatively normal overlying skin to
coexist with deep-muscle necrosis. Therefore, electrical
burns frequently are more serious than they appear on
the body surface, and extremities, particularly digits,
are especially at risk. In addition, the current travels
inside blood vessels and nerves and can cause local
thrombosis and nerve injury. Severe electrical injuries
usually result in contracture of the affected extremity.
A clenched hand with a small electrical entrance
wound should alert the clinician that a deep soft-tissue
injury is likely much more extensive than is visible
to the naked eye (n FIGURE 9-7). Patients with severe
electrical injuries frequently require fasciotomies and
should be transferred to burn centers early in their
course of treatment.
n FIGURE 9-6 Chemical Burn. Immediately flush away the chemical
with large amounts of water, continuing for at least 20 to 30 minutes.
n FIGURE 9-7 Electrical Burn. A clenched hand with a small
electrical entrance wound should alert the clinician that a deep
soft-tissue injury is likely much more extensive than is visible to the
naked eye. This patient has received a volar forearm fasciotomy to
decompress the muscle.
n BACK TO TABLE OF CONTENTS