Alkali burns

• Cause liquefactive necrosis

• Often appear less dramatic

• Tend to cause deeper injury

• Common causes

  • Household bleaches​

  • Oven cleaners

  • Fertilizers

  • Cement

Acid burns

• Cause coagulative necrosis

• Often appears more dramatic

• Tends to cause less deep injury​

Special cause of chemical burn that requires specific treatment and can be fatal

Injury mechanism

• Hydrogen ions cause acid burns​

• Free fluoride ions cause extensive local and systemic necrosis

Should be managed by copious irrigation and repeated local application of 10% calcium gluconate​

• Application guided by pain​

• Available in topical or injectible forms

Phosphorus is present in:

• Fireworks​

• Firearms

• Insecticides

• Fertilisers

Managed with copious irrigation​

May re-ignite on drying

Caused by lithium, sodium or potassium metals

Most commonly originating from lithium ion battery containing devices that explosde such as e-cigarettes or vaping machines

Should NOT be irrigated in the first instance as they may ignite!

Treatment involves

• Extinguishing flames​

• Covering area with oil to isolate metal from any metal

• Removal of visible metal fragments

Stop further damage from offending chemical

• Remove clothing and causative agent from patient

• Copious irrigation for up to 1-2 hours, except in elemental metal burns

• Nails, hair and web spaces should be examined for traces of chemical

• Exclude ocular injury

• Calcium gluconate in hydrofluoric acid burns

Assessment, management and surgery as per standard flame burn