Chemical Burns

1. Expose body surfaces, brush off dry chemicals, and copiously irrigate with clean water. Large volume (> 20 L) serial irrigations may be needed to thoroughly cleanse the skin of residual agents.
2. Do not attempt to neutralize any chemicals on the skin.
3. Use personal protective equipment to minimize exposure of medical personnel to chemical agents. Resuscitation strategy and goals for patients with chemical burns are the same as for thermal injuries.
4. White phosphorus fragments ignite when exposed to air. Clothing may contain white phosphorus residue and should be removed.

a. Fragments embedded in the skin and soft tissue should be irrigated out if possible or kept covered with soaking wet dressings. Note that if the dressings dry the white phosphorus may ignite them.

b. Urgently retrieve deeply embedded fragments in the OR.

c. Use a Wood’s lamp to help locate the fragments. Monitor calcium levels closely and treat hypocalcemia with IV replacement.

d. Plan a second-look operation within the day to identify missed fragments.

Refer to Inhalation Injury and Toxic Industrial Chemical Exposure CPG for additional information.4