|Monthly Tech-Tip |
Tissue damage is caused by two mechanisms. A corrosive burn from the free hydrogen ions and a chemical burn from tissue penetration of the fluoride ions. Fluoride ions penetrate and form insoluble salts with calcium and magnesium. Soluble salts are also formed with other cations but dissociate rapidly, releasing the fluoride ion allowing further tissue destruction.
CXR, if pulmonary edema is suspected; to look for pulmonary edema
Digital - if burns to the fingers to evaluate bone integrity.C. Other Tests :
ECG - Cardiac monitoring is necessary if the burn is significant. Arrhythmias are a primary cause of death. Monitor for Q-T prolongation from hypocalcemia or signs of hyperkalemia.
a. Treatment for HF burns includes basic life support and appropriate decontamination, followed by neutralization of the acid by the use of calcium gluconate. If exposure occurs at an industrial site, obtain and transport any treatment literature available.
b. Acute life threats are assessed and managed in the usual manner. EMS personnel use gloves, masks and gowns, if necessary.
c. Remove soiled clothing. Initially decontaminate by irrigation with copious amounts of water.
d. Ice packs on the affected area may alleviate symptoms. If calcium gluconate gel is available, apply liberally to the affected area.
1. Skin Burns
a. Remove soiled clothing.
b. Decontaminate by irrigation with copious amounts of water.
c. Assess and manage life threats as with any other cause.
d. Commence comprehensive monitoring for significant exposures.
e. Intravenous 10% calcium gluconate should be administered early if there is any evidence of hypocalcemia.
f. Application of 2.5% calcium gluconate gel to the affected area. If the proprietary gel is not available, constitute by dissolving 10% calcium gluconate solution in 3 times the volume of a water soluble lubricant such as KY gel.
g. For burns to the fingers, retain gel in a latex glove.
h. If pain persists for more than 30 minutes after using calcium gluconate gel, further treatment is required. Subcutaneous infiltration of calcium gluconate (not the chloride salt as it is an irritant and may itself cause tissue damage) is recommended at a dose of 0.5 ml of a 10% solution per square centimeter of surface burn extending 0.5 cm beyond the margin of involved tissue.
Local infiltration of digits is not reccommended due to pain, disfugurement and potential complications.
a. IV regional calcium gluconate : 10-15 ml of 10% calcium gluconate plus 5,000 units of heparin diluted up to 40 ml in 5% dextrose. Using a Bier's ischemic arm block technique, the solution is infused intravenously and the cuff released when the first of the following occur: pain from the digits is resolved; the cuff is more painful than the burn, or 20 minutes of ischemic time has elapsed. Treatment can be repeated after 4 hours if needed.b. Intra-arterial calcium gluconate : An arterial catheter is placed in the radial or brachial artery as needed to perfuse the affected digits. The solution of 10 ml of 10% calcium gluconate in 40 ml of 5% dextrose is infused over a 4 hour period, followed by further infusions repeated after 4-8 hours, if necessary.
Several treatments may be needed.
Continuous ECG and clinical monitoring is essential during these procedures.3. Ocular burns
Irrigate generously with sterile water or saline for at least 5 minutes. Local anaesthetic may be required. If pain persists, irrigate with a 1% solution of calcium gluconate by diluting the 10% solution in 10 times the volume of normal saline.
Undiluted 10% calcium gluconate should NOT be used.4. Inhalation burns :
All exposures to the head and neck should arouse suspicion of pulmonary involvement. If there is any doubt, admission for observation is advised.
Specific treatment includes: 100% oxygen by mask, 2.5% calcium gluconate by nebulizer with 100% oxygen, continuous pulse oximetry, ECG and clinical monitoring.5. Pulmonary edema is treated along conventional lines as needed.
By Edouard Bastarache
Article by Edouard Bastarache
Edouard Bastarache is a well known doctor that has written many articles on the subject of toxicity of ceramic materials and books on technical aspects of ceramics. He writes in both English and French.