Chemical Trauma
Transcript of Chemical Trauma
-
7/26/2019 Chemical Trauma
1/44
Chemical Burn
-
7/26/2019 Chemical Trauma
2/44
Chemical Burn
First aid to rescue in time
To disengage chemical contact immediately and rinse inlocale as soon as possible mass of water long time
Neutralization acid 2 Sodium bicarbonate,sulfadiazine base Vitamin C
nfection pre!ention antibiotic To promote healing epidermal growth factor Vitamin C
pre!ention and cure symblepharon and other complication
mydriasis " #tropine
glucocorticoid
Collagenase inhibitor
Tear Substitute contact lens
Complication Treatment $peration
-
7/26/2019 Chemical Trauma
3/44
-
7/26/2019 Chemical Trauma
4/44
#cid and %asesn&ury
-
7/26/2019 Chemical Trauma
5/44
Introduction
Ch
emica
l%ur
n
-
7/26/2019 Chemical Trauma
6/44
Pathophysiology
Ch
emica
l%ur
n
-
7/26/2019 Chemical Trauma
7/44
-
7/26/2019 Chemical Trauma
8/44
Multiple factors influence tissue damage and percutaneous
absorption of chemicals (severity)
-
7/26/2019 Chemical Trauma
9/44
-
7/26/2019 Chemical Trauma
10/44
eneral (pproach4 5he goal of treatment is to minimize any area of
irreversible in6ury and maximize salvage in thezone of reversible damage.
4 aggressive irrigation with water is the cornerstone
of initial treatment for chemical burns.
4 7mmediate removal from the offending chemical,debridement, ry chemical particles such as lime
should be brushed away before irrigation.
4 !odium metal and related compounds should be
initially covered with mineral oil or excised,
because water can cause a severe exothermic
reaction.
-
7/26/2019 Chemical Trauma
11/44
4 however, use of water or saline to
irrigate a chemical burn should not be
delayed while searching for other
treatment agents and should begin
immediately at the scene of the
accident. (lmost universally, earlierirrigation means a better prognosis.
-
7/26/2019 Chemical Trauma
12/44
Specifc Chemicals
-
7/26/2019 Chemical Trauma
13/44
Acid Burns
4 (cetic (cid4 Carbolic (cid 8Phenol3
4 Chromic (cid
4 9ormic (cid
4 0ydrochloric and!ulfuric (cids
4 0ydrofluoric (cid
4 -ethacrylic (cid
4 1itric (cid4 Oxalic (cid
Alali4'yes 8ammonium,barium, calcium, lithium,
potassium (caustic
potash), and sodium
(caustic soda) hydroxides4'ime4Portland Cement4 -etals
-
7/26/2019 Chemical Trauma
14/44
Acid
4 p0 :+ ) strong corrosives.
4 !everity ) physical characteristics of the acid.
include concentration, molarity, andcomplexing affinity for hydroxyl ions.
4 Contact time with the s$in is the most
important chemical burn feature
4 penetrate s$in deeper and longer
4 ;ounds may initially loo$ superficial only tobecome full/thic$ness burns in + to < days.
4 !trong al$alis have a p0 =+.
Alali
-
7/26/2019 Chemical Trauma
15/44
Alali
-
7/26/2019 Chemical Trauma
16/44
Acetic Acid
4 in hair/wave neutralizer solutions 8chemical burns to the scalp in women3,4 can cause a partial/thic$ness burn.
Carbolic Acid (Phenol)4 ( corrosive organic acid used widely in industry and medicine,
4 denatures proteins and causes chemical burns characterized by arelatively painless white or brown coagulum.
4 !ystemic absorption may result in life/threatening complications.
4 5he unpleasant, acrid odor of phenol
4 econtamination is gentle wash with a combination of P"# mixture 8?/ to >/minute3 , or
by a gentle wash with isopropyl alcohol.
-
7/26/2019 Chemical Trauma
17/44
Chromic Acid
4 Powerful oxidizers.
4 chronic penetrating ulcerating lesion of the s$in.
4 !ystemic chromium toxicity can cause liver or renalfailure, 7 bleeding, coagulopathy, and centralnervous system disturbances.
4 (ggressive excision has been shown to be the bestmethod
4 5opical agents such as ?@ thiosulfate and ascorbicacidpreventing toxicity while preparing for surgical
excision.
-
7/26/2019 Chemical Trauma
18/44
$ormic Acid
4 9ormic acid in A@ solution is used by acrylate glue
ma$ers, cellulose formate wor$ers, and tanning wor$ers.4 produces coagulation necrosis of the s$in.
4 !ystemic effects,
B decreased respiration,
B anion gap metabolic acidosis
4 5reatment
B ebridement,
B prevention of further damage and infection, and
B s$in grafting if the defect is full thic$ness and of a sizereuiring coverage.
-
7/26/2019 Chemical Trauma
19/44
%ydrochloric and !ulfuric Acids
4 5hese acids can burn the s$in dar$ brown or
blac$.4 5here are 5oilet bowl cleaners acid, rain
cleaners, -unitions, chemical, and fertilizermanufacturers, (utomobile battery fluid 8+?@3
sulfuric acid, 0ousehold bleaches are only
-
7/26/2019 Chemical Trauma
20/44
%ydrofluoric Acid
4 0ydrofluoric acid is uniue among the corrosives in its mechanism
of action and degree of toxicity, its acts li$e al$alis and will cause
progressive tissue loss, including bony destruction
4 0ydrofluoric acid is used in the production of high/octane fuel, veryeffective rust remover
4 0ydrofluoric acid rapidly penetrates the s$in and causes both local
and potentially lethal systemic toxicity. 7ts systemic effects include
hypocalcemia, hypomagnesemia, and hyper$alemia.
-
7/26/2019 Chemical Trauma
21/44
4 5he treatment of hydrofluoric acid burns consists of two
phases.
>. immediate phase is copious water irrigation of the
affected s$in for >? to
-
7/26/2019 Chemical Trauma
22/44
-
7/26/2019 Chemical Trauma
23/44
Methacrylic Acid
4 -ethacrylic acid found in many artificial nail cosmeticproducts can produce severe dermal burns,
*itric Acid
4 1itric acid is used in industry for casting iron and steel,electroplating, engraving, and fertilizer manufacturing.
+,alic Acid
4 Oxalic acid is used for leather tanning and blueprintpaper. 'i$e hydrofluoric acid, it poisons enzymaticprocesses. Oxalic acid binds calcium and preventsmuscle contraction..
-
7/26/2019 Chemical Trauma
24/44
-reatment of !elect Chemical Burns
-
7/26/2019 Chemical Trauma
25/44
.yes4 !trong, corrosive al$alis 8DlyesD3 include ammonium, barium,
calcium, lithium, potassium 8caustic potash3, and sodium 8causticsoda3 hydroxides.
4 'yes are widely used in industry and are found in home products8drain and toilet cleaners, detergents, and paint removers3.
4 .yes are e,tremely corrosive and penetrating& and burns
re/uire copious irrigation for long periods4 !uicidal ingestion of lye may result in rapid death from upper
airway occlusion. 'ate morbidity related to esophageal andgastric necrosis may be minimized by early surgical interventionwith esophagogastrectomy.
4 (mmonium hydroxide is used in the production of synthetic fibers
and extensively in agriculture.
-
7/26/2019 Chemical Trauma
26/44
'ime
4 'ime 8calcium oxide3 is found in agricultural
products and cements.
4'ime is converted by water to the al$alicalcium hydroxide.
4 pon s$in contact, lime draws water out of the
s$in. (ll dry lime particles should be brushed
away before irrigation.
-
7/26/2019 Chemical Trauma
27/44
Portland Cement
4 Portland cement, which accounts for a
ma6or proportion of the cement used in
the .!., is a mixture of sand, lime, and
other metal oxides.
-
7/26/2019 Chemical Trauma
28/44
4 #urning metal may be extinguished with a
class fire extinguisher or smothered with
sand. #urning metal fragments can also be
covered with mineral oil.4 ;ound debridement should include excision
-
7/26/2019 Chemical Trauma
29/44
+cular Burns
Acid injury
!igns and symptoms )
4 Early ) tearing, rubbing, redness, pain, and blepharospasm.
4 Con6unctiva ) pale due to ischemia and destruction of vascular
supply.
4 !welling of the corneal epithelium,
4 clouding of the anterior chamber,
4 pupillary dilatation4 corneal ulceration
-
7/26/2019 Chemical Trauma
30/44
4 p0 paper should be used to determine the presence of
acid or al$ali
4 (cid uic$ly precipitates the superficial tissue proteins of
the eye, producing the typical Dground glassD appearanceof the cornea.
4 Damage sustained secondary to acid burns in most
cases is immediate and limited to the area of contact
(no late effects such as cell disruption or tissuesoftening3.
-
7/26/2019 Chemical Trauma
31/44
-
7/26/2019 Chemical Trauma
32/44
Alali injury
4 (l$ali burns are more severe
4 In a short period& strong alali can penetrate the cornea&
anterior chamber& and the retina& ith destruction of all sensoryelements& thus causing complete blindness
4 !evere chemosis, blanched con6unctiva, and an opacified corneaobscuring view of the iris or lens
-
7/26/2019 Chemical Trauma
33/44
-
7/26/2019 Chemical Trauma
34/44
-
7/26/2019 Chemical Trauma
35/44
-
7/26/2019 Chemical Trauma
36/44
-
7/26/2019 Chemical Trauma
37/44
-
7/26/2019 Chemical Trauma
38/44
4 "mergency ophthalmology consultation is needed for
corneal burns
4 9or severe corneal in6ury, a collagenase inhibitor such as
cysteine or acetylcysteine is used to prevent loss ofcorneal stroma,
4 5opical steroids may reduce iridocyclitis but may also
exacerbate collagenase/induced corneal ulceration.
4 ( scleral contact lens may reduce adhesions and scarring.4 7ntraocular pressure should be chec$ed
4 Corneal transplantation, blepharoplasty, $eratoplasty, or
$eratoprosthesis may be eventually reuired.
-
7/26/2019 Chemical Trauma
39/44
-
7/26/2019 Chemical Trauma
40/44
4 ry eyes4 7ris and ciliary body 8iridocyclitis3 and4 posterior synechiae 8(dhesions between lens and
iris3
4 Ectropion 8lid deformity3,4 Cataract4 #laucoma (>?@/??@ in patients with severe burns34 !carring of the cornea,4 symblepharon.
Complication
-
7/26/2019 Chemical Trauma
41/44
THANK YOU!
-
7/26/2019 Chemical Trauma
42/44
-
7/26/2019 Chemical Trauma
43/44
http)%%eyewi$i.aao.org%ChemicalF@+G(l$aliFandF(cid
@+HF7n6uryFofFtheFCon6unctivaFandFCorneaI7nternationalFClassificationFofFiseases
-
7/26/2019 Chemical Trauma
44/44
Epidemiology4 = +?, products are capable of producing chemical
burns
4 9reuensy of Chemical in6uries occur
B J@ of wor$/related eye in6uries
B = A@ of wor$place accidents,B @ are the result of an assault
4 +%< young men.
4 Mortality0MorbidityB +@ visual and cosmetic disabilityL
B only >?@ of patients with severe chemical in6uries
achieve functional visual rehabilitation.