Chemical burns in children

Chemical burns are tissue damage caused by direct exposure to chemical agents. The face, hands, esophagus and stomach are most often affected. The main substances that cause burns include:

• acids (sulfuric (H ₂ S0 ₄ ), hydrochloric (HCL), nitric (NHO ₃ ), hydrofluoric (HF), etc.;
• alkalis [sodium hydroxide (caustic soda - NaOH), potassium hydroxide (potash - KOH), etc.];
• organoaluminum compounds, gasoline, kerosene;
• heavy metal salts (zinc chloride, silver nitrate, etc.);
• some volatile oils:
• phosphorus.

The severity of damage to the skin and mucous membranes from a chemical burn depends on the concentration of the substance and the duration of its exposure to the tissue.

External signs of tissue damage due to exposure to reagents depend on the chemical and do not always reflect their depth and severity.

• Chemical burns of the skin with concentrated acid solutions are characterized by the formation of a dense, dry scab (coagulative necrosis). In the case of a sulfuric acid burn, the scab is initially white, then with a blue-green tint, and finally black. In the case of a hydrochloric acid burn, the scab is soft, yellow-brown, and then dries and hardens. After its rejection, a granulating surface is exposed, sometimes bleeding.
• When exposed to alkali solutions, the scab is soft, loose and moist (colliquation necrosis). The pain from alkali burns is more intense than from acid burns.
• When affected by heavy metal salts in high concentrations (silver nitrate, etc.), a dry, limited scab of various shades is formed.
• When phosphorus hits the surface of the body, it spontaneously ignites, resulting in a thermal burn. The skin on the damaged area is first covered with a dry, smoking scab that glows in the dark, then a yellow-gray belt forms, turning brown.

When toxic substances enter the body, the most dangerous chemical burns are those caused by alkalis and concentrated ammonia solutions (NH ₄ ). When the esophagus is burned by alkaline solutions, intoxication is weakly expressed and the symptoms of deep damage to its walls come to the forefront in the clinical picture.

Emergency medical care for chemical burns in children

First aid for chemical burns is to rinse the affected area of the body with running water for at least 10-20 minutes. The exception is burns with quicklime (calcium oxide, CaO), when rinsing with water causes the burn to intensify with an expansion of the affected area, as well as burns with organic aluminum compounds: gasoline, kerosene (ignition occurs). If calcium oxide gets in, it is necessary to clean the skin and apply lotions with a 20% glucose solution, and if organoaluminum compounds, gasoline and kerosene get in, they must be removed mechanically.

The powdered substance is removed by mechanical cleaning before rinsing with water. If the chemical gets on the mucous membranes. in the conjunctival cavity, they are washed off with water-salt solutions. In case of chemical eye burns in children and adolescents, a long and abundant rinsing of the conjunctival sac with boiled water or a neutralizing solution is carried out using a syringe in a jet, directing the flow to the medial angle, and local anesthesia is also carried out. In case of chemical burns of the pharynx, larynx and esophagus, it is necessary to rinse the oral cavity, esophagus and stomach with water 18 "C. intake of vegetable oil (2-3 tablespoons) and pieces of ice.

In case of chemical burns of the skin with concentrated acid solutions, in addition to water, the burn surface is treated with a 2-4% solution of sodium bicarbonate, and in case of alkali burns, lotions with a 1-3% solution of boric acid, citric or acetic acid are applied. In case of phenol burns, it is necessary to wash with a 40-70% solution of ethanol followed by treatment with olive oil.

After washing and cleaning the wound, a sterile bandage with chloramphenicol (syntomycin liniment) and Vishnevsky ointment is applied to the affected surface.

In case of damage by hydrofluoric acid (HF), it is necessary to wash with water, subcutaneously administer a 10% solution of calcium gluconate and moisten the affected surface with it against the background of regional anesthesia and the use of narcotic analgesics. The introduction of calcium gluconate continues until the pain stops. The therapeutic effect of this drug is due to the precipitation of fluoride ions in damaged tissues.

In case of phosphorus burns, it is necessary to throw any cloth soaked in water onto the burning surface, clean the wound of phosphorus, and then apply a bandage soaked in a 2% solution of copper sulfate (copper sulfate), 5% solution of sodium bicarbonate (baking soda) or 3-5% solution of potassium permanganate.

For pain relief, non-narcotic (50% solution of metamizole sodium - analgin 10 mg per 1 kg of body weight), narcotic analgesics (1-2% solution of trimeperidine (promedol) or omnopon 0.1 ml per year of life) are administered. To reduce spasm of the smooth muscles of the wall of the esophagus and larynx, 0.1% solution of atropine 10-15 mcg per 1 kg of body weight or 2% solution of papaverine 0.1 ml per year of life are administered intramuscularly.

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