Chemical burn quicklime: what to do?

Lime is a widely known material that we often encounter in everyday life when performing repair and construction and garden works. Mainly used is the so-called “fluff” or slaked (hydrated) lime, calcium hydroxide is a powdery substance of white color, poorly soluble in water. This material is safer, you can buy it in finished form at the store, but you can also cook it yourself from quicklime, which is also easy to buy. Lime burn, as a rule, is obtained, neglecting safety, in the process of its extinguishing.

Quicklime, which is a calcium oxide, is a highly toxic caustic substance. Slaked - is a strong base and chemically reacts with other substances like alkali, but when water enters it, a violent exothermic reaction no longer occurs.

Lime dust, settling on the mucous membrane of the upper respiratory tract or eyes, irritates it, burning the tissue and causing superficial ulceration.

Of particular danger is the process of slaking lime, that is, diluting it with water. This interaction is accompanied by the release of a large amount of thermal energy, that is, hot steam, falling into the zone of action of which is fraught with burns in open parts of the body.

[1]

Epidemiology

WHO statistics show that every year about 0.3-0.4% of the population on the planet seeks medical help for burns by various agents. Burn injuries cause prolonged hospitalization, disability and serious cosmetic defects. Severe injuries can lead to the death of the victim. Approximately 2/3 of burns occur in everyday life, their probability is higher in low-income families.

[2], [3], [4]

Causes of the lime burn

Quicklime is also called "boiling pot". Already this name suggests that when breeding, it strongly "boils", highlighting the caustic hot fumes. When water gets into the quicklime, the exothermic reaction starts instantly, hot sprays fly in all directions and the caustic vapor starts to rise.

Being close to the container, one can get burns on the skin, mucous epithelium of the eyes and upper respiratory tract, if splashes or hot steam are released on them.

The cause of a chemical burn with lime can be contact with a dry substance. It is caustic with alkaline reaction. It absorbs moisture from the skin and degreases it, the result of contact may be the appearance of cracks and sores on the skin, mucous membranes, on which small particles of powdered lime are deposited by inhalation of a dry suspension in the air.

Upon contact with water, thermal action is added to the chemical action - the cumulative effect leads to damage to the deep tissue layers.

Risk factors of a sharp burn by lime - non-observance of safety rules during the work with it. Prolonged industrial contact with building lime leads to atrophic changes in the mucous membranes of the respiratory tract and other complications caused by chronic microburns from inhaled fine particles of caustic substance.

Pathogenesis

The pathogenesis of burns with lime is associated both with the chemical effect on the tissues of the alkaline substance and with the thermal effect, since it is hot. Even with burns caused by limes, the steam contains microparticles of an alkaline substance. The vapor itself usually affects large areas of the surface, often the airways, however, such lesions are shallow. Human skin can withstand temperatures up to 41 ℃, heating to higher temperatures causes damage to epithelial cells. The water vapor that is released during the reaction has a temperature of about 100, the boiling substance is 512.

The depth of thermal damage is determined not only by the level of hyperthermia, but also by the time of its impact, and depends on the individual properties of the skin of the victim, for example, its heat capacity and thermal conductivity. The greater the warm-up time, the deeper the tissue will be damaged. The degree of overheating of the tissues is also directly proportional to the rate of cell death. However, short-term exposure, for example, if you quickly withdraw your hand, retract, even at very high temperatures, the steam may not lead to the development of burns.

Lime burns are caused not only by the effects of steam, but also by the ingestion of hot pieces or lime test on the skin. The ingestion of a hot piece of alkali ensures a sufficiently deep local damage to the tissues, since during a chemical burn with an alkaline substance, the protein eschar does not form (as with an acid burn), and nothing prevents it from penetrating deep into.

The extent of damage due to lime burns depends on many factors - the exposure time, the method of heat transfer, the properties of the skin of the victim and the quality of his clothing.

[5]

Symptoms of the lime burn

Clinical manifestations of burn injury may indicate to some extent the severity of the injury. Although the first signs are able to transform in the development of the disease. A chemical burn with lime can lead to the destruction of the deeper layers of the skin and mucous membranes, which will continue after the immediate cessation of contact, since the chemical substance has already been absorbed into the tissue of the burned area of the body. Therefore, the first symptoms do not always indicate the true depth of the lesion by a chemical. Alkaline liquids, such as lime mortar for whitewashing trees, have the ability to penetrate deep into tissues, because alkali, unlike acid, does not cause protein coagulation as a barrier to further penetration into the deeper layers of the skin.

However, if the skin is only swollen and reddened after the cessation of direct contact with lime, then this symptom speaks of the mildest, first-degree lesion.

If vesicles are visible on the skin, filled with a translucent or sukrovichnoy fluid - vesicles, then this is a sign of a burn injury, at least of the second degree. Later, small bubbles can merge into large (bullae), the diameter of which is more than 1.5 cm. Sometimes such bubbles appear immediately. They correspond to the third degree of defeat. Under bursting bullae after erosion of the skin film, erosion remains. After a burn, there may be foci of necrosis of the colliquation type, when the burned surface does not heal for a long time. An eschar in place of a chemical burn with an alkaline substance does not look like a crust, but a moist necrosis that is whitish, loose and weeping without clear edges. Such wounds quickly become infected, purulent exudate oozes out of them and an unpleasant odor emanates. Unlike dry necrosis, it tends to spread to healthy tissue.

If thermal damage prevailed, a brown crust of dead skin cells may form, with the removal of which ulcers of varying depth remain. A third-degree burn covers all layers of the epidermis to subcutaneous fat, however, if wounds are not infected, the skin surface can still recover on its own. The edema in the burn focus is considered to be a favorable sign, suggesting that self-healing is possible with the formation of subsequently tender small scars (grade IIIa).

With the involvement of the surface layers of the subcutaneous tissue, the visible surface in the lesion is light gray, not too sensitive to painful stimuli, is patchy - the pale areas are adjacent to the dark and even completely black, charred. After recovery, severe scars remain on the skin (grade IIIb).

The fourth, most severe degree of burn injury is diagnosed with the death of all subcutaneous soft tissues up to the muscle with charring of the bones. Fabrics turn black and become brittle, self-healing at this degree of damage, even with scars and scars is impossible. Requires skin transplants.

An eye burn with lime (quicklime, CaO) or calcium carbide (its derivative, CaC₂) is accompanied by an exothermic reaction when interacting with water, which is also present in the lacrimal fluid. Therefore, a strong burning sensation and a sharp pain will be felt in the eye. Local hyperthermia will occur. The eye will turn red, begin to swell, tears will flow from it, blisters may appear on the skin of the eyelids and mucous membrane. This is a combined chemical thermal burn. Nevertheless, quicklime and also calcium carbide are large pieces or lumps, which are quite problematic to get into the eye.

Much more often it can happen that slaked lime has got into the eye. Dry - when cleaning the ceiling or walls from old whitewash, inaccurate pouring fluff, in liquid - while sprinkling an already cooled mortar on the garden plot, applying it to the walls or ceiling. Hydrate lime is a caustic substance, but it does not enter into an exothermic reaction with water, so the burn to the mucous membrane of the eye will be only chemical.

In the process of quenching, a hot drop can get into the eye or on an unprotected surface of the body and cause lime hands to burn the skin of the hands. It happened that a hot solution was spilled on the leg. In the process of quenching the temperature of the solution reaches 512, so the burn with lime mortar can be very strong and deep. Contact with a hot and caustic chemical usually causes cell death of several layers of the skin, the symptoms often correspond to a third degree burn, however, their surface is limited to the zone of direct contact.

The burn by evaporation during the slaking of lime, on the contrary, is usually superficial, of the first or second degree, but the area of damage is more extensive.

Such a symptom as a lime razora hands indicates that a person neglects the elementary safety technique. It is quite possible to touch lime powder and even pick up a handful. The quick will seem tepid to the touch. It is possible to whitewash the trees at the cottage with a lime mortar without gloves or to spray the Bordeaux mixture on the plants, and to do this repeatedly. In the end, the caustic substance declares itself. Lime can degrease and dry the skin of the hands, they will crack, erosion. People with dry skin - before, with a rough and dense - later.

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Complications and consequences

Cosmetic defects in the form of scars and scars can remind all life of the trauma suffered. But a burn is not only damage to the skin layers in a particular area of the body, but also, depending on the severity of the lesion and the state of health of the injured person, causes a systemic reaction to the injury. With superficial burns covering more than a third of the body surface area, lesions of the deeper layers in the case of grade III-IV burns, burn disease can develop in people with chronic systemic diseases. It develops in several stages, each of which (except for recovery) may end in death. With more favorable developments, recovery is delayed for a long period of up to several months. The first stage is a burn shock caused by a severe pain syndrome and a forced redistribution of blood circulation as a result of damage to the blood vessels, followed by acute toxemia as a result of the breakdown products of damaged tissues, then septicotoxemia is the result of infection complications (this stage can be avoided). The last stage in a favorable development of events is the purification, granulation and / or epithelization of wounds. Burn disease is often accompanied by early and late complications - the development of abscesses, lymphadenitis, gangrene.

In patients with hepatic and renal failure and with severe burns, when such conditions develop in response to a lesion, endogenous intoxication syndrome may begin. This happens because overloaded withdrawal organs cannot cope with the utilization and elimination of decomposition products. They accumulate and poison the body. The most terrible complication of burn injury is sepsis.

Third and fourth degree eye burns may be complicated by inflammatory diseases, cataracts, secondary glaucoma, corneal perforation, and other damage to eye structures.

In addition, disfigured appearance, severe disease often leads to the development of post-traumatic stress disorder or depression. Many patients need the help of a qualified psychotherapist.

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Diagnostics of the lime burn

The doctor at the initial examination, first of all, assesses the severity of the burn injury and the physical condition of the victim, as well as the likelihood of the development of the burn disease.

Based on the above clinical signs, the depth of penetration of the chemical is estimated, as well as the area of the affected surface. There are schemes and rules that allow an approximate estimate of the percentage of the affected area. For example, the "rule of the palm." It measures the affected surface, calculating the area under the assumption that the surface of the palm is approximately 1-1.5% of the surface of the entire skin.

The clinics often have transparent film gauges with a measuring grid applied to them. They impose on the burned surface.

To assess the physical condition of the patient can assign tests and apply a variety of instrumental diagnostics (if necessary).

Since the burn agent is known in our case, the differential diagnosis concerns the determination of the degree of harm to the body and the likelihood of complications.

Treatment of the lime burn

The prognosis for further development of burn damage and recovery by 90% depends on how quickly and correctly first aid was given for burns with lime. First of all, it is necessary to stop contact with the damaging factor, remove any foreign objects from the burn site that are not “hot” to the skin and are removed freely, and cool the affected parts of the body, while maintaining access to oxygen.

Considering that lime can be slaked and quickened, hot and cold, dry powder and lime mortar, in addition, you can burn yourself with hot steam when extinguishing lime, and different parts of the body can suffer, let's consider possible cases in turn. Simultaneously with the provision of first aid, you need to call a doctor; the sooner he examines the patient, the better.

Dry slaked lime and cold lime mortar no longer react with water. They can be easily washed off with clean running water, then apply a sterile gauze cloth. Lime can be undercharged, so if it is possible to chill it or remove noticeable lumps with a dry napkin before rinsing, this should be done. Neither is it recommended to use neutralizing solutions, since the neutralization reaction on burned skin and mucous membranes can give an unpredictable effect due to impurities contained in lime, and there they are. These are magnesium oxides and other chemical compounds.

In case of chemical burns, it is not recommended to use preparations for treating wounds, as it is also possible to worsen the condition of the wound due to a chemical reaction.

A steam burn when extinguishing lime, that is thermal - removes the injured person from the steam zone and cools the burn site with a rich jet of clean cool water (if the skin is intact). You can attach a sterile napkin to the burn site and put ice on it, but it should be noted that the burned surface can be cooled only for 20 minutes, if the wound surface is still hot, the cooling procedure can be repeated after 10-15 minutes. A steam burn often captures a large surface, but usually does not affect the deeper layers of the skin.

However, when slaking lime, hot steam can sweep the face, burning the mucous membrane of the upper respiratory tract and eyes. The victim is removed from the area of the steam, provide him with access to fresh air. Ice or cold compresses can be applied to the eyes, if possible, anesthetize and immediately call an ambulance brigade. If the respiratory tract is severely burned, death can quickly occur due to sticking of burned trachea and bronchi, their obstruction and the development of respiratory failure.

Chemical burn eyes. There is no alternative to water, especially since one or two drops or a speck usually gets into the eye, and not a kilogram. Even if quicklime or calcium carbide got into the eye, they will immediately react with water in the tear fluid. So wash them with running water and as soon as possible - this is the only reasonable way out. If it is possible to turn the eyelid of the patient and remove the remnants of the substance with a cotton swab or by wrapping a piece of cotton tightly over a match, then this is not bad, but if no one can do this, then it is better to quickly rinse.

Wash the injured eye under a tap with cold water, but without releasing water under pressure (in field conditions, you can pour water from a plastic bottle, syringe, syringe, glass). It is necessary to direct the stream of water to the tear channel, turning the victim's head to the side and slightly downwards, making sure that the flush water does not fall into the healthy eye. Well washed eyes cover with a piece of gauze, cool (if there is something) and wait for the doctor. If the rapid provision of professional assistance is delayed and there are antiseptic eye drops (sulfacyl-sodium, chloramphenicol) on hand, they can be instilled to prevent infection and give a non-narcotic analgesic.

What needs to be done for quicklime burns (calcium carbide)? First of all - carefully clean it with a piece of dry, clean natural fabric. This also applies to splashes or pieces of hot mixture during the quenching. In this case, it still represents a danger, since it is most likely not fully redeemed. After cleaning, you can rinse the burned areas with cool running water, apply cold lotions or ice on a napkin until the temperature of the damaged part of the body decreases. If a hot piece of lime got on the clothes and stuck to the skin, then you should not tear off the fabric. We remove the lime from the clothes, but do not touch the burnt fragments, leaving the procedure to the doctors. Self-removal can lead to bleeding and wound infection.

In no case should lime oil be washed off (as some sources recommend, in order to avoid exothermic reaction with water). This is the most common mistake. Oil and other fat-containing substances are never used on a freshly burned surface. They are good then in the period of regeneration as a softening and nourishing agent. And on a hot burnt surface, the fat creates a thin film that does not allow air, interferes with heat exchange and contributes to the defeat of the deeper layers of the skin and the development of infection, as well as this film will complicate the subsequent provision of medical care and aggravate the pain of the victim, because the film will have to be removed.

Medicines that can be used for lime burns before the arrival of the doctor, are painkillers. Usually used nonsteroidal anti-inflammatory drugs Ketanov, Ibuprofen, Ketoprofen.

In the future, the treatment strategy and medications will be prescribed by a doctor. First- and second-degree burns affecting a small surface are treated by the external use of various ointment dressings that have a cooling, anesthetic, healing effect and prevent secondary infection. Conservative treatment is possible with burns of grade IIIA without secondary infection.

The anti-ignition aid is the gel dressings of Burnaid Pechaevskiye. They can be used immediately after removal of the chemical, with thermal and combined burns of any severity and on any surface area of the body. They are sterile and prevent the further spread of the damaging effect due to the ability to cool the burnt tissue, moisturize and anesthetize, protect against secondary infection. Do not interfere with the passage of air, do not stick, and if necessary they can be easily removed. They can be used even in the absence of clean water. As an option, there is also a mask bandage for use on face skin burns.

In the early period after cleaning and cooling the wound, the burns can be treated with Solcoseril gels, Actovegin gels, water-based antiseptics, Fastin ointments, Methyluracil, Rescue-man balm. But the most suitable dosage forms for treating burns are sprays. They eliminate direct contact with the skin, which reduces the pain effect during processing and reduces the likelihood of infection.

To speed up the healing process, Panthenol Spray can be recommended. Its active ingredient is provitamin B5 or dexpanthenol, which is well absorbed from the skin surface and participates in metabolic processes that promote granulation of damaged tissues. Burnt skin is experiencing an increased need for this substance, activating its recovery processes. The drug is sprayed, pre-shaking, on the affected skin from one to three or four times as needed. It can be applied to the skin of the face, however, it is first sprayed on the hand, and then applied to the face, bypassing the eyes, nose and mouth. Allergic reactions when using this tool are extremely rare, overdose and toxic effects when applied topically are unlikely.

As a means of accelerating the regeneration and improving the nutrition of the skin, no earlier than on the second or third day, you can apply ointments and creams, including fatty components.

With alkaline burns, wet necrosis often occurs and bacterial infection joins. In this case, Olazol-Spray, a complex preparation for external use, with components that have an anesthetic effect (benzocaine), antibacterial (chloramphenicol), antiseptic (boric acid) regenerating (sea buckthorn oil) can be prescribed. Regular application of burns to skin damaged areas reduces their pain, dries, disinfects and accelerates tissue epithelialization. The wound surface is cleaned of necrotic particles and treated with foam from a distance of 3-5 cm from one to four times a day. Not recommended for pregnant women and children, patients with renal insufficiency, as well as for persons sensitized to the components of the drug.

To the burned surface should be provided with free access of air, therefore, if possible, it is better to do without a bandage. It is applied only when there is a danger of rubbing wounds or dirt with clothes. The bandage should also be light gauze, and not tight.

In case of eye burns in the hospital, in the first hours they spend the jet washing of the conjunctival cavity, tear ducts, in order to anesthetize and reduce the risk of adhesions formation, they drop instillation of cytoplegic action (Atropine, Scopolamine). To prevent secondary infection, drops with antibiotics are used - Levomycetinum, eye tetracycline ointment, artificial tears are prescribed for moisturizing, and regenerating eye gels with dexpanthenol, Solcoseryl-gel and other drugs are used to activate the cornea recovery.

For severe burn lesions, symptomatic treatment is the maintenance of basic vital functions, systemic therapy with antibacterial and anti-inflammatory drugs, and surgical treatment.

Be sure to include in your diet foods containing vitamins A, B, C and E, which will help the healing of burn injuries of any degree of severity.

Home treatment

Alternative treatment of chemical and concomitant burns is possible only with minor lesions of the first or second degree, and then, if bubbles appear on the skin, it is better to consult a doctor.

These are mainly local procedures consisting of lotions and application of various mixtures. Immediately after providing first aid (cleaning the wound and cooling), thin slices of raw, peeled potatoes can be applied to the burn site, they can actually prevent further blistering and reduce the pain effect.

Applying a clean and hammered cabbage leaf will help cool the wound, relieve pain and inflammation.

Fresh plantain leaves can be found at any cottage. After washing the burn, you can attach clean leaves of this plant to it.

In the first days on the burnt surface you can make lotions with potato starch, lubricate with aloe juice or liquid honey. In no case do not use oil in the early postburn period, but on the third or fourth day it is already possible to lubricate the burn with sea buckthorn oil. It will accelerate the regeneration of skin cells.

Herbal treatments include lotions made from chamomile, marigold, hop cones, peppermint, tandem, yarrow, oak bark. It is possible to treat wounds with infusions of medicinal herbs on the first day, after cleaning and cooling. They are antiseptic and anti-inflammatory, help to avoid infection and restore the skin surface faster.

Homeopathy

If, upon receiving a burn injury, there is a homeopathic remedy on hand, then after washing and cooling the damaged surface, you can take three grains of one of the preparations Arnica, Akonit or Kantaris as an ambulance. Apply the 30th dilution for burns of any location and complexity.

Further treatment should be under the supervision of a physician.

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Surgery

Surgery for burns is carried out to cleanse burn wounds from areas of necrosis in order to reduce intoxication. Such operations are carried out in the first days immediately after removing patients from the shock.

In case of burn injuries of the third (B) -fourth degree, autodermoplasty is almost always required - transplantation of pieces of the patient's own skin to the burn sites, which is carried out immediately after necrotomy. Such a radical tactic allows in patients with severe burns to avoid the development of the following stages of a burn disease after shock.

At infection of burns, local surgical procedures are used - opening and cleaning of phlegmon and abscesses.

A new word in the surgical treatment of burns - cellular technology. Used instead of autografts with extensive burn lesions, artificially grown in laboratory conditions allofibroblasts.

[9], [10], [11], [12]

Prevention

When working with lime, certain precautions must be observed, especially when extinguishing it at home.

Quenching procedure should be carried out in the open air or in a well-ventilated free space.

When slaking a large amount of lime, you must properly dress: in a tight protective work suit, boots, long rubber gloves. The body should not be open areas. Eyes should be protected with sealed goggles, respiratory organs - with a respirator.

In reality, they often dilute a small amount of lime for domestic use, and no one dresses like an astronaut. But nevertheless you should not forget about long gloves and glasses, as well as clothes that are not adjacent to your body. While adding water to the tank, mixing the solution should not bend over the container in order not to burn the airways and the face with hot steam.

It is necessary to work with a ready-made lime mortar at least in thick gloves, do not swing the brush and do not spray the solution on the sides. Points when performing cleaning and painting work will also not be superfluous.

If you still do not save your eyes, then in any case they can not be rubbed (this is an involuntary reaction). Immediately you need to clean and rinse and be sure to consult an ophthalmologist, even if the eye injury seems insignificant to you.

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Forecast

First-, second-degree burns, as well as - IIIA, without complications, usually heal independently and without residual cosmetic defects; for more severe burns, the prognosis depends on the depth and extent of the injury, the age and somatic condition of the victim.

[14], [15]