There are two primary groups of chemical burns: acid and alkali. When assessing a chemical burn it is important to know both the causing agent (acid or alkali) and the concentration of the solution. It is important to know if an acid or an alkali caused the burn because they cause injury by different mechanisms.
Acids produce coagulation necrosis upon contact with the skin and acids rapidly penetrate the skin, which can lead to life-threatening burns. Chemical burns cause 20 deaths per year. Bleach and drain cleaners are two common chemical burn agents.
Inadequate childproofing can lead to accidental chemical burns in the home. Older children and young adults are exposed to chemical burns through carelessness and impetuous behavior or from experimenting with chemicals in school or at home.
When accessing a chemical burn it is important to know what type of chemical exposure occurred, what the offending substance was, the container if possible can be helpful. The medical staff will need to determine if the chemical is acid, alkali, or a chemical composition and also the concentration of the solution. Next, the medical staff will need to find out if the chemical exposure was by skin contact, oral, gastrointestinal, eye or by inhalation. They will also need to know the time and duration of exposure and any symptoms the involved individuals are complaining of such as pain, burning, any numbness, unconsciousness, what the vital signs have been, any signs of respiratory distress, oral or eye discomfort, swelling of skin, or changes in vision or breathing.
It may also be helpful to know of any decontamination or life-saving measures that were done at the accident scene.
Other injuries or medical conditions should be noted and an immediate physical assessment taken that includes the airway, breathing pattern, circulation, disability, and temperature. The extremities should be inspected to assess for additional injuries.
While monitoring the airway, special attention should be paid to the presence of drooling, stridor, and hoarseness, any swelling in the mouth or around the mouth.
Classify the burns as superficial partial thickness, deep partial thickness, or full thickness. Color, sensation, and texture are important when trying to determine the depth of the burn. To determine the extent of the burn injury regarding percentage of body part covered by burns it is important to observe all body parts including the face, hands, feet, back, head, chest area and genitals.
Kids who refuse to swallow may be suffering from mouth burns.
When eye involvement from chemicals is suspected, check for foreign bodies that may be involved.
Use pH testing and a stain with fluorescein to check for corneal abrasion.
Causes of chemical burns in the home include inadequate child-proofing, leaving cleaning or caustic products out, and when cleaning agents are stored in bottles or containers that are not the original bottles or containers, as well as using chemicals with total disregard for instructions.
Sources of acid burns are toilet bowl cleaners, drain cleaners, automotive tire or metal cleansers, rust removers, engraving solution, tile and glass cleaners and also battery fluid.
Sources of alkalis (bases) burns are oven cleaners, detergents that contain ammonia, sodium or potassium polyphosphates, household bleach, pool chlorination, cement, mortar, or plaster that contains calcium hydroxide or oxide, denture cleaners, dishwashing cleaners and also toilet bowl cleaners that contain lye.