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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Thursday, January 12, 2023

Caustic Skin Injuries

TAMING THE SRU
Taming The SRU - January 11, 2023 - By Ann Wolsey
WHY DO WE CARE ABOUT CAUSTIC SKIN INJURIES?
  • Chemical burns come with complications that thermal burns do not. Specifically: 
  • Chemical burns are more likely to involve prolonged exposure, both before ED arrival and throughout hospital stay.
  • The human body protects against continued protein denaturation in thermal burns through immediate and irreversible protein coagulation. In chemical burns, protein denaturation does not halt, but instead continues through hydrolysis.
  • Chemical burns cause systemic effects, including distant organ damage and electrolyte abnormalities, which can in turn cause fatal cardiac arrhythmias.
  • Almost all chemical burn patients require hospitalization. Das (2015) reports that 0.13% of the chemical burn patients studied were treated as outpatients, compared to over 50% of thermal burn patients. 
  • Even when chemical burns and thermal burns are of similar size, hospitalization for chemical burns is 30% longer.
  • Close to 55% of chemical burns go on to require surgery.
  • Chemical burns produce more hypertrophic scarring than thermal burns; this can in turn lead to decreased quality of life and mental health decline.
Chemical burns are also an evolving pathology, with thousands of new chemicals added to the market each year. Since 2000, both assault and warfare with chemical weapons have increased, although these pathologies vary based on practice location. For instance, chemical burns can comprise up to 14% of burns in the developing world, compared to 3% in the US and Europe. It is therefore important to understand your local chemical burn patterns, in much the same way providers learn local patterns of antibiotic resistance.