177 Burn: Chemical 87 Definition Injury to the tissue as a result of exposure to corrosive chemical agents, such as strong acids, alkalis, oxidizers, reducing agents, and solvents. Burn severity is determined by the amount of body surface area (BSA) involved and burn depth. First-degree burns involve the epithelial layer (erythema) second-degree burns include a partial thickness of the dermal skin layer (erythema with blister) and third-degree burns involve full thickness of the dermal skin layer (white or leathery, with no blisters and charred appearance) and can extend to muscle and bone (sometimes considered fourth-degree burns). Chemical burns may occur through direct contact on body surfaces including skin and eyes, inhalation, and ingestion. Characteristics First-degree burns usually are superficial and result initially in reddening of the skin and in pain. Second-degree burns (partial thickness) are accompanied by severe pain, erythema, latent blister formation, and cell fluid loss. In third-degree burns, the area can appear black, white, or leathery. In fourth degree burns, most of the hypodermis is lost, charring and ex- posing the muscle underneath. Workers will often manifest with two or all three types of burns at the same time. It is important to quantify the extent of each (first, second, and third degree). Excessive fluid loss can cause shock. Other symptoms include itching, bleaching or darkening of skin, burning sensations, dysp- nea, hemoptysis, or tissue necrosis. Policy Immediately irrigate the burn site with copious amounts of water (or normal saline), except when powdered chemicals are present that could be activated by water (check Material Safety Data Sheet). Carefully brush powdered chemicals from the skin. Avoid contaminating the eyes. Evaluate employee in the occupational health unit. Develop guidelines for specific chemicals used at the worksite, particularly hydrofluoric acid burns that may require treat- ment with a fluoride binding solution (calcium gluconate). Objectives Clinical Assessments and Interventions Referral for Medical Action ● Burn involving face, eyes, feet, or perineum. ● Electrical or inhalation burn. ● Burn with associated major trauma. ● Second-degree burn 10% of BSA or any third-degree burn. ● Elderly employee or employee with chronic disease. ● Hydrofluoric acid burn. Determine em- ployee status and extent and severity of injury. ● Inspect burned area and record brief history. ● Brush dry powder chemicals from the skin before flushing with copious amounts of water be particularly careful with the eyes. ● Gently flush the burned area with cool water or saline for a minimum of 30 min- utes and advise shower if needed. ● Remove contaminated clothing and con- stricting jewelry. ● Estimate total extent of burn injury (see Rule of Nines, page 182). ● Obtain accurate history of burn event (e.g., sudden flash, scald). Guideline continues on next page