Burn Injury, Chemical

From 1999 to 2008, 3% of all reported burn injuries.

Risk increases with age: 1% of burn injuries from birth to age 16; 3.7% from 20–30; and 5% from 30–50, according to the National Burn Repository Report on Data from 1999 to 2008.

Majority of chemical exposures occupational, occurring in men of working age, whereas assaults with caustic chemicals are more likely to occur against women.

American Association of Poison Control Centers reports approximately 130,000 exposures to caustic substances in 2007.

Morbidity varies by exposure type and substance. Surface burns may be regarded like thermal burns after decontamination.

Caustic ingestion may result in perforation and/or bleeding, and respiratory compromise from upper-airway edema.

Identify injury setting, chemical(s) involved, areas of exposure, and duration before decontamination.

Airway compromise may arise from face/ingestion exposures; develop an airway management plan early.

Occupational exposures may have associated traumatic injuries (from explosions, fire, falls, etc.).

Chemical burns may produce more tissue necrosis than their initial appearance would suggest.

A large number of different chemicals can potentially cause injury, including acids, bases, and organic and inorganic compounds.

Acid burns generally produce coagulative necrosis; depth may be limited by formation of coagulated proteins at base of burn.

Bases typically generate liquefactive necrosis; depth often much deeper than in acid burns.

Organic compounds cause direct heat production and chemical reactions that disrupt skin.

Inorganic compounds bind directly to the skin and create salts that damage skin integrity.

Severity of burn is related to a variety of factors including the pH, concentration, volume, physical form, and contact-time duration of the offending agent.