A patient with acid and base burns can be difficult to reason with, especially if the eyes are affected. Acids and bases (alkalies) are found in laboratories (industrial, hospital. and school), retail stores, homes, and both on and alongside highways.
Acids are compounds which have a pH of less than 7.0. This is a measure of the reciprocal of the hydrogen ion concentration of a solution. The lower the pH, the higher the hydrogen ion concentration, and thus the mane acidic a compound is.
Acids react with metals to yield a chemical salt and hydrogen gas. In general, acids are caustic. That is, they burn the skin and eyes. In solution, acids rapidly dissociate into their component anions (negative ions) and cations (positive ions), the cations always being hydronium ions (H30).
Interacting with acids and bases
Acids
Acids are found in the form of drain cleaners, storage battery electrolytes, concrete cleaners, and many other household materials. Industrially, acids are used for -pickling” metals, etching glass, dissolving “burrs” from machining metals, and many other applications.
In the laboratory, acids are used for solvents and reagents. Acids are transported in almost any size container, from one-pint glass or plastic bottles to tank can. Accidental exposure to an acid can result from spillage, splashing, transportation accidents, and even the improper “jump-starting” of a vehicle.
Bases
Bases, by comparison, have a pH greater than 7.0. Bases react with acids to form a chemical salt and water. This is known as a neutralization reaction. If the acid and base are mixed in the proper proportions, the resulting salt solution will have a pH of 7.0 (neutral). Like acids, bases can be very caustic.
Also like acids, bases rapidly dissociate into their component anions and cations. Bases can be found around the home in the form of drain cleaners, jewelry cleaners, oven cleaners, lye, and other fairly common cleaning solutions. Industrially, bases are used as electrolytes, cleaners and in various production processes.
In the laboratory, like acids, bases are used for solvents and reagents. Bases are shipped in their anhydrous as well as solution forms. Because of this, a transportation accident involving bases may take the form of either a liquid or a solid spill. Accidental exposure to bases may be caused by spilling or splashing or even discharging an aerosol can of oven cleaner into the eyes.
Related reading: The Anatomy Of Burn Injuries And Their Medical Treatment
By now, you’ve probably noticed that except for the actual chemistry, acids and bases are very similar. Both classes are caustic, both are good electrolytes, and both can be found virtually anywhere, from the home to the school, to the work-place to the highway.
One big, important difference exists, however. When an acid attacks body tissue, a protective film is formed which tends to limit the depth of the damage. When a base attacks body tissue, it dissolves it. A way to remember this is the KOH (Potassium Hydroxide—a strong base) test used to diagnose a fungus infection.
A drop of KOH is placed on skin scrapings on a microscope slide. Anything that remains visible on the slide are fungus spores, as the skin itself is totally dissolved by the base. It is obvious then that while both acids and bases are damaging to human tissue, bases have the potential to carry that damage deeper into the affected tissue.
Modes of exposure to acid and base
There are essentially three modes of exposure to either acids or bases.
INGESTED
Except in the case of attempted suicide, this mode will usually not be encountered in any patients other than toddlers. The mouth area will be red, swollen, and sometimes blistered. The throat will have similar visible signs as well of the passage of a caustic material.
Treatment consists of diluting the ingested material with milk or water. DO NOT induce vomiting as this will only re-expose damaged tissue to the caustic agent. Particular attention needs to be paid to the patient’s respiratory effort. Since, in passing through the upper digestive tract, the material also passed through the patient’s upper respiratory system, airway obstruction from edematous (swollen) tissue can occur. Needless to say, the container the material was in should be transported, with the patient to the emergency department.
INHALED
Except for laboratory or transportation incidents, inhalation injuries from acids and bases are infrequent. As noted with ingestion type injuries, the upper airway can become partially obstructed due to edema (swelling due to fluid buildup).
Additionally, as lung tissue is damaged, fluids begin to infiltrate the area. As a minimum, the patient should be kept in a sitting position and placed on 100 percent oxygen using a face mask with a reservoir bag, if possible. Any burning sensation of the skin or eyes should be treated appropriately.
CONTACT
Contact with the skin should be treated by immediately flushing the affected area with large amounts of water. If in a laboratory or industrial environment, safety showers will be available. These should be used. The patient’s clothes should be removed entirely if the torso has been exposed to the agent. If only an extremity is affected, the clothing surrounding the extremity needs to be removed.
The exposed area needs to be flushed for a minimum of five minutes prior to initiating transport. This flushing tends to wash away the bulk of the offending agent and substantially dilute the remainder. In the absence of safety showers, a household shower, garden hose, fire hose or any other source of running water should be used. Buckets of water repeatedly poured over the patient will accomplish more than doing nothing.
Suggested article: Symptoms And Treatment To Survive Carbon Monoxide Poisoning
Contact with the eyes deserves special mention. Many industries provide emergency eyewash stations. Some of these consist of a plastic squeeze bottle with an eyecup attached. These are effective until another source of running water can be located. The better eyewash stations consist of two spherical outlets suspended over a basin. The outlets are positioned such that both eyes are flushed (lavaged) simultaneously.
If one of these “permanent” stations is available, the patient should be assisted in using it. Encouragement and possibly physical assistance may be required to hold th eyelids open and thoroughly irrigate the areas under both lids, as well as the eye itself.
Eye lavage should be performed for a minimum of 10 minutes prior to the initiation of transport if an eyewash station is available. In the absence of an eyewash station, any source of running water can be used. Irrigation should continue throughout transport if possible.
How to do an eye lavage
This is most easily accomplished by setting up an intravenous set using normal saline and holding the flashbulb end of the administration set at the medial (towards the center of the body) part of the affected eye.
By holding the eye open and pulling the lids away from the eye, the solution is allowed to run over the eye and away from the patient, into a basin or towel. If both eyes are affected, the administration tube is held such that the solution strikes the face at the bridge of the nose and can irrigate both eyes simultaneously. In the absence of normal saline, Ringer’s Lactate or 5 percent dextrose in water or any other solution designed for intravenous (IV) administration can be used.
In situations where IV fluids and administration sets are unavailable, continue to flush the eyes with water from a bucket or other container. The important thing is no flush, and continue to flush, the offending agent rut and away from the rye. It is not uncommon to see first degree burns of the cheek as a result of proper eye lavage. The material that caused the facial burns could have resulted in blindness had it stayed in contact with the eye.
In summary
Never attempt to neutralize an acid or base that is in contact with a patient. Regardless of what bystanders or co-workers may say, neutralization reactions are exothermic (heat-producing). By attempting to neutralize a chemical on the patient’s skin, you may add a thermal burn to the damage initially done by the chemical.
A patient who has been burnt by an acid or base, especially in an eye can be difficult to reason with. Their actions can be somewhat irrational. A calm, relaxed explanation of what you are doing and why, as well as the consequences of not doing it are a necessary, integral part of your treatment protocol.
It is also extremely helpful to have at least two attendants per patient. In this way, one can hold the eyelids open, or manipulate the affected part, while the other directs the irrigating stream.
A last-but-not-least consideration of dealing with a patient who has sustained an acid or base injury is to protect yourself. The offending chemical does not just do its damage and then disappear. At least wear rubber gloves and some type of eye protection, if possible.
If entering an enclosed space where an acid or base has been spilled, or when working at the site of a transportation incident where acids or bases have been spilled, a good rule of thumb is, if you can smell it, use SCBA (Self Contained Breathing Apparatus) or hold your breath until you can get the patient out of the immediate area. A rescuer ceases to be a rescuer when he becomes a victim himself. Acid and base burns require special treatment and this article should give you an idea of what you have to deal with.
This article has been written by James H. Redford MD for Prepper’s Will.
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