Chemical burns in children

Chemical burns are tissue damage caused by direct exposure to chemical agents. Most often affected face, hands, esophagus and stomach. Among the main substances that cause burns, there are:

• 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;
• salts of heavy metals (zinc chloride, silver nitrate, etc.);
• some volatile oils:
• phosphorus.

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

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

• For chemical skin burn with concentrated solutions of acids, the formation of a dense, dry scab (coagulation necrosis) is characteristic. When burned with sulfuric acid, the scab is initially white, then with a blue-green tint and, finally, black. When burned with hydrochloric acid, the scab is a soft yellow-brown color, followed by drying and hardening. After its rejection, a granulating surface is exposed, sometimes bleeding.
• When exposed to solutions of alkalis, the scab is soft, friable and moist (colloidal necrosis). Pain with burns with alkalis is more intense than with burns with acids.
• When heavy metals are affected by salts with high concentration (silver nitrate, etc.) a dry, limited scab of different shades is formed.
• When phosphorus hits the body surface, it spontaneously ignites, resulting in a thermal burn. The skin on the damaged area is first covered with a dry, smoking scab, glowing in the dark, then a belt of yellow-gray color turns into brown.

When toxic substances get inside, chemical burns with alkalies and concentrated solutions of ammonia (NH ₄ ) are the most dangerous . When the esophagus is burned with alkaline solutions, intoxication is poorly expressed and symptoms of deep lesion of its walls come to the fore in the clinical picture.

Emergency medical care for chemical burns in children

First aid in case of chemical burn - washing of the affected part of the body with running water for at least 10-20 minutes. Exceptions are burns with quick lime (calcium oxide, CaO), when when water is flushed, the burn intensifies with the expansion of the area affected, as well as burns with organic compounds of aluminum: gasoline, kerosene (ignition occurs). If calcium oxide hits, it is necessary to cleanse the skin and apply lotions with 20% glucose solution, and when organoaluminum compounds, gasoline and kerosene hit, mechanically remove them.

The powdered substance is removed by mechanical purification before washing with water. If a chemical enters the mucous membranes. In the conjunctival cavity they are washed off with water-salt solutions. In the case of chemical eye burns in children and adolescents, prolonged and profuse washing of the conjunctival sac with boiled water or neutralizing solution is carried out by means of a syringe spray, directing the flow to the medial angle, and local anesthesia is also performed. With a chemical burn of the pharynx, larynx and esophagus, it is necessary to wash the mouth, esophagus and stomach with water 18 "C. Take vegetable oil (2-3 tablespoons) and pieces of ice.

When chemical skin burns with concentrated acid solutions, in addition to water, the surface of the burn is treated with 2-4% sodium hydrogen carbonate solution, and for burns with alkalis, apply lotions with 1-3% solution of boric acid, citric acid or acetic acid. When burned with phenols, a 40-70% ethanol solution must be washed, followed by treatment with olive oil.

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

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

When burned with phosphorus, it is necessary to throw any cloth moistened with water on a burning surface, clean the wound of phosphorus, then apply a bandage moistened with 2% solution of copper sulfate (copper sulfate), 5% sodium bicarbonate (baking soda) or 3-5% solution of potassium permanganate.

For analgesia, non-narcotic (50% solution of metamizole sodium-analgin 10 mg per 1 kg of body weight), narcotic analgesics (1-2% solution of trimiperidine (promedola) or omnopon 0.1 ml per year of life) are administered for anesthesia. To reduce the spasm of the smooth muscles of the esophagus and laryngeal walls, intramuscularly inject 0.1% atropine solution 10-15 μg per 1 kg of body weight or 2% papaverine solution 0.1 ml per year of life.

[1], [2]