Chemical Burn Injuries
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DERLEME/ REVİEW Kocaeli Med J 2018; 7; 1:54-58 Chemical Burn Injuries Kimyasal Yanıklar Ayten Saraçoğlu1, Mehmet Yılmaz2, Kemal Tolga Saraçoğlu2 1Marmara Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul, Türkiye 2Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Derince SUAM Anesteziyoloji ve Reanimasyon Kliniği, Kocaeli, Türkiye ÖZET ABSTRACT Kimyasal yanıklar sıklıkla koroziv maddelere maruziyet Chemical burns often develop after exposure to corrosive sonrasında gelişmektedirler. Tüm yanık türlerinin %10,7’sini, substances. They include 10.7% of all burn types and 2-6% of yanık merkezine hasta kabullerinin de %2-6’sını the patient admissions to the burn center. Chemical compounds oluşturmaktadır. Kimyasal komponentlere bağlı hasar 6 farklı possess 6 different types of damaging mechanisms; reduction, mekanizmayla ortaya çıkmaktadır. Bunlar redüksyon, oxidation, corrosion, protoplasmic toxins, vesicants and oksidasyon, korozyon, protoplazmik toksinler, yakıcı desiccants. The characteristics of chemical burn injuries kimyasallar ve kurutuculardır. Kimyasal yanık hasarının include skin discoloration and contractures, having rarely karakteristikleri arasında ciltte renk değişiklikleri ve korozyon, regular shape, perforation in the gastrointestinal tract with the nadiren regüler bir yapı, gastrointestinal kanalda perforasyon, risk of severe systemic toxicity and mortality. Compared to the ciddi sistemik toksisite ve mortalite riski yer almaktadır. thermal burns, the wound healing process following chemical Termal yanıklarla karşılaştırıldığında yara iyileşme süreci burn injuries is markedly slower and also frequently related belirgin derecede daha yavaş olup sıklıkla hastanede uzamış with a prolonged stay at the hospital. Moreover, generally the yatış süresiyle ilişkilidir. Ayrıca yanık hasarı genellikle burn injury results following a prolonged exposure to the kimyasal ajana uzamış maruziyet sonrasında oluşmaktadır. chemical agent. White phosphorus burns are good examples Beyaz fosfor yanıkları bunun iyi bir örneğidir. Progresif nekroz for this process. It should be considered in presence of burns gelişen yanıkların patogenezinde akla getirilmelidir. Acil with progressive necrosis. Emergency resuscitation is crucial resusitasyon hasar yönetiminde önceliklidir. Evde oluşan for the management of injury. Most frequently observed agents kazalardaysa sıklıkla sebep sıvı amonyak ve nitrik asiddir. in home injuries are liquid ammoniac and nitric acid. For Kimyasal yanık hasarı tedavisinde halen altın standart yeterli chemical burn injuries the gold standart of treatment still is the miktarda su ile yaranın irrigasyonudur. Kimyasal yanık hasarı irrigation of the wound with a copious amount of water. It is prevalansını azaltmaya amaçlı olarak koruyucu önlemlerin important to take protective measures in order to reduce the alınması önemlidir. Genel nüfus ve önleyici stratejilerin prevalence of chemical burn injury. Nation-wide campaigns farkındalığını artırmak için medyanın tam desteğiyle ülke with full support from the media are needed to raise awareness çapında kampanyalara ihtiyaç duyulmaktadır. Kamu spotları, of the general population and preventive strategies. Public medya organları, özel kuruluşlar, hekimler ve hastalar bu service broadcastings, media organs, trade unions, physicians amaçla birlikte çalışmalıdırlar. and patients should work together for this purpose. Anahtar Kelimeler: kimyasal yanık, hasar, mortalite Keywords: chemical burn, injury, mortality İletişim / Correspondence: Dr. Ayten Saraçoğlu Marmara Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul, Türkiye E-mail: [email protected] Başvuru Tarihi:04.11.2017 Keywords: Female athlete triad, nutrition, stress reaction Kabul Tarihi:22.01.2018 Anahtar Kelimeler: Kadın sporcu üçlemesi, beslenme, stres reaksiyonu 54 Saraçoğlu A ve ark. Kocaeli Med J 2018; 7;1:54-58 INTRODUCTION unrestrained rise in the armament rate of chemical Chemical substances are commonly used as weapons of mass destruction constitutes one of the industrial products. There are over 5 million well- primary reasons for the increased rate of burn known chemical compounds and 300 of them were injuries. There are many types of chemicals with reported by the National Fire Protection various features and potency thus exposure to them Association as chemicals with a very high level of results in a broad spectrum of burn injuries ranging health hazard (1). At the moment more than 65000 from mild burns to life-threatening ones. Some of different types of chemical substances are present these burn injuries respond to medical treatment on the market and approximately 6000 new types while others may require surgical intervention. are added them each year. Direct exposure to some Compared to the thermal burns, the wound healing of these chemical agents unevitably result in process following chemical burn injuries is chemical burn injury. markedly slower and also frequently related with a Incidence and outcomes prolonged stay at the hospital (9). Moreover, the Chemical burns constitute roughly 10.7% of all burn injury results following a prolonged exposure burn injuries, 2-6% of all burn-center admissions to the chemical agent. White phosphorus burn is a (2) and 30% of all burn-related deaths (3). The good example for this process (10). It should be epidemiological features of chemical burn injuries considered in presence of burns with progressive vary among different countries; but they also necrosis. Emergency resuscitation is crucial and display domestic differences in a specific country simple for the management of injury. according to the geographical location, There are various other factors affecting the neighbouring industrial developments and even the intensity of a burn damage including the military state of that country being at war or at concentration of the chemical agent, the amount of peace (4). On the other hand the uncontrolled the burning substance, the duration of skin contact, expansion of chemical weapons in the developing the penetration and the mechanism of action. Under countries constitutes one of the primary reasons for certain circumstances the primary chemical reaction the increase in burn injuries. Thus the still goes on even after the arrival of the patient in epidemiological studies of various countries and the emergency room (11). The damage of the regions are of importance both for preventive and chemical burn injuries most frequently occur on the educational purposes. There are some study results skin and in the digestive system (12). on chemical burn injuries in Turkey but these studies are either confined to children (5,6) or they Compared to other types of burn injuries chemical reflect only the eastern part of the country (7). burns occur relatively rarely, nevertheless they mostly produce serious damage on the deep tissue Types of chemical injuries level. The burned tissues usually involve muscles, Chemical compounds possess 6 different types of tendons, articular capsules and organs situated on damaging mechanisms; reduction, oxidation, deeper levels. The relatively lower incidence of corrosion, protoplasmic toxins, vesicants and chemical burns results in burn cases with desiccants (2). Chemicals can be classified as acid, occasionally missed diagnosis, poor management or alkali, organic and inorganic compounds. Alkaline inaccurate treatment applications due to the lack of compounds cause liquefactive necrosis on the experience of the health professionals. The deeper surface epitelium of the skin whereas acid tends to involvement of the damaged tissues and its serious penetrate into deeper levels. Acid-related burns implications on the patients health result in a result in release of hydrogen ions which in turn prolonged rehabilitation period with an obvious rise cause coagulative necrosis; additionally they also in medical costs. Thus especially at the working induce dry necrosis thanks to their water absorbing places the augmentation of the preventive measures properties (8). They are frequently utilized in and the appropriate training of the physicians and various fields including pharmaceutical industry, the workers gained particular importance in the agricultural practice, paint industry and cleaning recent years. These patients need to be referred as solution manufacturing. On the other hand, the 55 Saraçoğlu A ve ark. Kocaeli Med J 2018; 7; 1:54-58 soon as possible to a burn center where a burn team with a low socioeconomic status. Liquid nitric acid specialized in this type of injury is going to take also is a frequently used solution to clear clogged care of them. waste pipes. This corrosive agent is a cheap and Xie et al. (13) reported male predominance among easily-found product in local stores and patients with chemical burn injuries. The general supermarkets. The ‘traditional usage’ of such tendency of male population to have a physically chemicals can easily give rise to severe more demanding occupation with a relatively consequences, especially for the pediatric age greater risk for injury is suggested as the main group. When these children are left unattended and reason behind this gender-specific difference. the plastic bottles are within their reach they can 42.2% of the patients in the study led by Xie et al. easily end up with ingesting these chemical have been operated. The presence of a more solutions. Nation-wide campaigns with full support experienced team immediately following the