ICU · Burns
Electrical & Chemical Burns
Also known as Electrical injury · High voltage burn · Chemical burn · Hydrofluoric acid burn · Alkali burn · Rhabdomyolysis electrical
The electrical and the chemical the burns — the electrical (the high the voltage → the deep the tissue the injury, the entrance + exit the wounds, the compartment the syndrome, the myoglobinuria → AKI, the cardiac the arrhythmia) and the chemical (the acid → the coagulative; the alkali → the liquefactive, the deeper; the hydrofluoric → the hypocalcaemia → the arrhythmia; the calcium the gluconate the gel). The copious the irrigation (the chemical); the ECG + the CK (the electrical); the fasciotomy.
On this page & tools
Your progress
Saved locally on this device.
Target exams
Overview & definition
The electrical and the chemical the burns — the distinct from the thermal; the deeper the injury (the beneath the skin); the systemic (the cardiac, the renal). The TBSA the UNDERESTIMATES the injury. The specific the management the for the each.[1][1]
The pathophysiology — the Ohm's the law, the current the pathway
The electrical the injury → the damage the by the the CURRENT (the NOT the voltage). The Ohm's the law: the the I = the V / the R.[1][1][1]
- The current (the I) — the amperes; the DETERMINES the harm. The higher the current → the more the damage. The current the determines the VF, the tetanic the contraction, the thermal the injury.[1]
- The voltage (the V) — the push (the potential). The high the voltage (the above 1000 V) → the overcomes the skin the resistance → the deep the tissue the injury. The low the voltage (the below 1000 V) → the local the contact.[1]
- The resistance (the R) — the tissue the dependent. The dry the skin the high (~100 000 the ohm); the wet the skin the low (~1000 the ohm) → the wet → the more the current → the worse. The muscle, the nerve, the vessel, the blood — the LOW the resistance (the good the conductors → the deep). The bone, the fat — the HIGH (the heat the generation).[1]
The current the thresholds (the AC, the 50 to 60 the Hz the mains)
The increasing the current the → the escalating the harm:[1][1]
- The ~1 the mA — the perception (the tingle).
- The 10 to 20 the mA — the "the no-let-go" the threshold (the tetanic the contraction the grips the source — the AC → the cannot the release). The MOST the dangerous (the sustained the exposure).
- The 30 to 100 the mA — the respiratory the arrest (the tetanic the contraction the of the respiratory the muscles).
- The 50 to 100 the mA — the the ventricular the fibrillation (the AC → the VF → the cardiac the arrest).
- The above 1000 the mA (1 the A) — the thermal the injury + the asystole. [1]
The AC the vs the DC the vs the lightning — the current the type the compared
| The feature | The AC (the mains, the 50 to 60 Hz) | The DC (the battery, the rail) | The lightning (the massive the DC) |
|---|---|---|---|
| The source | The household / the industrial (the 110 to the 240 V; the high the above 1000 V) | The battery, the rail, the DC the lines | The cloud (~the 100 the million the V, the ~30 000 the A, the milliseconds) |
| The muscle the effect | The tetanic the contraction (the grips the source — the "the no-let-go") | The single the strong the contraction (the throws the victim the AWAY) | The single the massive the depolarisation (the throws + the blast) |
| The cardiac the arrest the rhythm | The VF (the ventricular the fibrillation) | The asystole | The asystole (the initial); the secondary the hypoxic the VF |
| The deep the tissue | The along the path (the high the voltage) | The along the path | The rare (the flash / the linear — the superficial) |
| The let-go | The impaired (the dangerous — the grips) | The preserved (the thrown the away) | The n/a (the instantaneous) |
| The exam the pearl | The AC → the VF; the grips the source | The DC → the asystole; the thrown | The lightning → the asystole; the resuscitate the apparently-the-dead |
The current the pathway (the determines the danger)
- The hand-the-to-the-hand — the crosses the HEART → the MOST the dangerous (the VF).
- The hand-the-to-the-foot — the crosses the heart + the torso (the common).
- The foot-the-to-the-foot — the crosses the legs the only → the LEAST the dangerous (the local).[1][1]
The principle: the the deeper + the longer the pathway → the more the deep the injury; the pathway the crossing the heart → the arrhythmia.[1]
The electrical the burns
The high-the-voltage (above 1000 V)
The deep the tissue the injury — the current the passes the through the deep the tissues (the muscle, the nerve, the vessel) → the necrosis the far the beyond the visible the skin.[1][1][1]
- The entrance + the exit the wounds — the small the at the contact, the large the at the ground (the current the exits).[1]
- The compartment the syndrome (the deep the muscle the oedema → the fasciotomy).[1][1]
- The rhabdomyolysis + the myoglobinuria → the AKI (the fluids, the alkalinisation, the dialysis).[1][1]
- The cardiac the arrhythmia (the AC → the VF / the VT; the DC → the asystole). The ECG the 24 h the monitoring; the troponin.[1][1]
- The cataracts (the if the current the crosses the lens).[1]
- The spinal the cord, the fractures (the tetanic the contraction / the fall).[1][1]
The low-the-voltage (below 1000 V)
The local the contact the burns (the small, the deep). The mouth-the-commissure the burns (the children — the chew the cable).[1]
The lightning the injury
The special — the massive the DC (~the 100 the million the V, the ~30 000 the A, the duration the milliseconds). The brief → the little the thermal (the flash the over the surface) the but the massive the neurological + the cardiac.[1][1]
The cardiac + the respiratory (the unique the lightning)
- The asystole (the DC → the single the massive the depolarisation → the standstill). The intrinsic the pacemaker the often the RESTARTS → the heart the recovers.[1]
- The respiratory the arrest (the medullary the paralysis) → the PERSISTS → the secondary the hypoxic the VF / the asystole → the death. The "the heart the stops, the brain the dies the secondarily." The PROLONGED the CPR the justified (the heart the often the restarts).[1]
The Lichtenberg the figures (the pathognomonic)
The ferning / the feathering the skin the pattern (the superficial). The transient (the fades the over the hours). The NOT a true the burn (the erythema, the keraunographic). The PATHOGNOMONIC the for the lightning.[1]
The keraunoparalysis
The transient (the hours) — the lower-the-limb the paralysis, the vasomotor the spasm (the pale, the pulseless, the cold), the numbness. The RESOLVES the spontaneously. The NOT the compartment the syndrome → the do NOT the fasciotomise the for the keraunoparalysis.[1][1]
The other the lightning the features
- The tympanic-the-membrane the rupture (the common — the blast). The check the ears.[1]
- The dilated / the non-the-reactive the pupils (the NOT the brain the death — the lightning → the resolve the over the hours).[1]
- The cataracts (the if the current the crosses the lens — the delayed).[1]
- The blunt the trauma (the fall, the thrown — the blast the wave). The spinal, the fractures.[1]
- The temporary the amnesia, the confusion (the transient the neurological).
The reverse the triage (the mass the casualty)
The lightning the strikes the groups (the sports, the hikers, the open the field). The rule: the the resuscitate the apparently-the-dead the FIRST (the heart the may the restart; the respiratory the support the prevents the hypoxic the death). The "the dead" the first (the reverse the of the usual the triage).[1][1]
The low-the-voltage the vs the high-the-voltage the vs the lightning
| The feature | The low the voltage (the below 1000 V) | The high the voltage (the above 1000 V) | The lightning |
|---|---|---|---|
| The source | The household (the 110, the 240 V) | The power the lines, the industrial | The cloud (~the 100 MV) |
| The contact | The prolonged (the grips the source) | The brief, the arc | The instantaneous |
| The skin | The local (the small, the deep) | The entrance + the exit; the arc (the 4th-the-degree) | The flash (the superficial); the Lichtenberg |
| The deep the tissue | The minimal | The SEVERE (the muscle, the nerve, the vessel) | The rare (the flash) |
| The cardiac the arrest | The VF (the AC) | The VF (the AC) | The asystole (the DC) |
| The compartment | The rare | The COMMON (the fasciotomy) | The rare (the keraunoparalysis — the NOT the fasciotomy) |
| The rhabdomyolysis | The mild | The COMMON + the severe (the myoglobinuria) | The variable |
| The cataracts | The rare | The if the crosses the lens | The if the crosses the lens |
| The CPR the prognosis | The standard | The standard | The PROLONGED the CPR the justified (the heart the restarts) |
| The exam the pearl | The mouth-the-commissure (the children) | The TBSA the underestimates (the iceberg) | The reverse the triage; the Lichtenberg |
The chemical the burns
The two the mechanisms:[2][3][1]
- The acid (the HCl, the H2SO4, the nitric) — the the coagulative the necrosis (the coagulum the limits the penetration → the shallower).[1]
- The alkali (the NaOH, the KOH, the cement, the bleach) — the the liquefactive the necrosis (the saponification the of the fats → the deeper, the worse).[3][1]
The acid the vs the alkali (the mechanism the compared)
The acid the vs the alkali — the necrosis, the depth, the irrigation
| The feature | The acid (the coagulative) | The alkali (the liquefactive) |
|---|---|---|
| The mechanism | The coagulative the necrosis (the eschar) | The liquefactive the necrosis (the saponification the of the fats) |
| The penetration | The LIMITED (the coagulum the limits) | The CONTINUES (the hygroscopic → the deeper) |
| The depth | The shallower | The DEEPER (the WORSE) |
| The pain | The immediate (the prompt the irrigation) | The insidious (the delayed → the underestimates) |
| The irrigation | The 15 to the 20 the min | The 1 to the 2 the h (the LONGER) |
| The examples | The HCl, the H2SO4, the nitric, the chromic | The NaOH, the KOH, the cement (the CaO), the ammonia |
| The effluent the pH | The until the neutral (the check the litmus) | The until the neutral (the LONGER — the recheck) |
| The neutralise? | The NOT (the exothermic) | The NOT (the exothermic) |
| The exam the pearl | The shallower; the coagulum the limits | The DEEPER; the saponification; the WORSE the than the acid |
The specific the chemical the agents (the exam the list)
The specific the chemical the agents — the agent, the mechanism, the antidote
| The agent | The mechanism / the systemic | The specific the treatment |
|---|---|---|
| The hydrofluoric the acid (the HF) | The binds the Ca + the Mg → the hypocalcaemia + the hypomagnesaemia → the refractory the arrhythmia, the cardiac the arrest; the liquefactive (the deep); the decalcifies the bone; the pain the out the of the proportion. The fatal the at the ~1 the % the TBSA. | The the calcium the gluconate the gel (the 2.5 %, the topical — the massaged the in the for the 30 the min); the intradermal / the intra-the-arterial / the IV the calcium the gluconate for the deep / the severe / the unrelieved the pain; the monitor the ECG + the Ca + the Mg.[1][1] |
| The phenol (the carbolic the acid) | The coagulative; the ABSORBED (the lipophilic) → the CNS, the cardiac, the hepatic, the renal; the methaemoglobinaemia. The water the insoluble. | The wipe the off (the polyethylene the glycol / the PEG, or the vegetable the oil) the BEFORE the water (the water the may the ENHANCE the absorption); the then the copious the water.[1] |
| The white the phosphorus | The ignites the on the air (the thermal + the chemical); the continues the to the burn; the systemic → the hypocalcaemia, the hyperphosphataemia, the hepatotoxicity, the renal. | The wash the with the the copper the sulphate (the CuSO4) → the black the copper the phosphide (the identifies + the neutralises the particles); the keep the MOIST (the saline — the NEVER the let the dry → the reignites); the remove the particles.[3][1] |
| The cement (the CaO) | The alkali; the insidious (the onset the 6 to the 12 the h); the under the clothing / the boots; the saponification → the deep. | The copious the water (the prolonged — the 1 to the 2 the h); the remove the clothing / the boots (the trapped); the check the effluent the pH.[1] |
| The tar / the bitumen | The hot (the thermal — the ~150 the °C) + the solvent; the adheres (the skin the tears the if the peeled). | The COOL the first (the water — the 20 the min); the remove the with the the lipid the solvent (the baby the oil, the butter, the poly-the-sorbate); the NEVER the forceful the peel.[1] |
| The bleach (the sodium the hypochlorite) | The mild (the irritant); the coagulative (the mild); the rarely the deep. | The copious the water; the usually the benign.[1] |
| The hydrocarbon (the petrol) | The de-fatting (the dissolution the of the lipid the barrier); the systemic → the CNS, the hepatic (the toluene). | The copious the water; the ventilation (the vapour); the monitor the CNS.[1] |
The hydrofluoric the acid
The special — the binds the calcium + the magnesium → the the hypocalcaemia + the hypomagnesaemia → the arrhythmia, the cardiac the arrest.[1][1]
- The treatment: the the calcium the gluconate the gel (the topical), the the intra-the-arterial / the intravenous the calcium the gluconate for the deep / the severe.[1]
The management
The electrical
- The ABCDE + the ECG the monitoring (the 24 h — the arrhythmia). The troponin.[1][1]
- The CK + the urine the myoglobin (the rhabdomyolysis → the fluids the aggressively, the urinary the alkalinisation, the dialysis if the AKI).[1][1]
- The fasciotomy (the compartment the syndrome — the early; the NOT the escharotomy).[1][1]
- The surgical the debridement (the necrotic the muscle).[1]
The electrical the management (the step-the-by-the-step)
The management the of the electrical the injury
- The ABCDE + the scene the safety — (a) the ENSURE the scene the safe (the live the wire — the DISCONNECT the power the BEFORE the contact; the do NOT the touch the victim the until the power the off). (b) The airway + the C-spine (the blunt the trauma — the fall, the thrown). (c) The breathing + the oxygen. (d) The circulation — the cardiac the arrest the at the scene → the the CPR + the defibrillation (the AC → the VF — the SHOCKABLE; the lightning → the asystole — the prolonged the CPR).[1][1]
- The ECG + the cardiac the monitoring (the 24 the h) — (a) the 12-the-lead the ECG the on the arrival. (b) The continuous the monitoring the 24 the h (the arrhythmia — the VF, the VT, the conduction, the non-the-specific). (c) The troponin (the myocardial). (d) The echocardiogram the if the cardiac (the RV, the dysfunction). (e) The asymptomatic the + the normal the ECG → the monitoring the 24 the h; the symptomatic / the high-the-voltage → the ICU.[1][1]
- The CK + the urine the myoglobin (the rhabdomyolysis) — (a) the CK the trend (the peak the 12 to the 24 the h; the high-the-voltage → the high). (b) The urine the dipstick — the blood the positive + the NO the RBC → the myoglobin (the pigment). (c) The K+ (the hyperkalaemia — the cardiac), the Ca (the early the hypo — the do NOT the treat the unless the symptomatic), the creatinine, the U/O.[1][1]
- The aggressive the fluids (the myoglobinuria) — (a) the IV the crystalloid; the target the U/O the 1 to the 1.5 the mL/kg/h (the HIGHER the than the thermal — the flush the myoglobin). (b) The urinary the alkalinisation (the sodium the bicarbonate — the IV; the urine the pH above 6.5). (c) The mannitol (the debated; the osmotic the diuresis — the AFTER the volume the restored; the avoid the if the anuric). (d) The RRT the if the refractory the hyperkalaemia / the acidosis / the fluid the overload / the oliguric the AKI.[1][1]
- The surgical — the fasciotomy + the debridement — (a) the the fasciotomy (the compartment the syndrome — the EARLY; the deep the muscle the oedema; the pulseless / the pain / the pressure above 30 the mmHg); the NOT the escharotomy (the deep, the NOT the circumferential the skin). (b) The surgical the debridement (the necrotic the muscle — the serial; the second-the-look the 24 to the 48 the h). (c) The amputation the if the non-the-viable.[1][1]
- The systemic — the trauma, the neuro, the ophthalmology — (a) the trauma the survey (the fall, the thrown — the fractures, the spinal, the intra-the-abdominal). (b) The neuro (the spinal the cord, the peripheral the nerve; the transient / the permanent). (c) The ophthalmology (the cataracts — the DELAYED the weeks to the months; the dilated the pupils — the lightning). (d) The ENT (the tympanic-the-membrane — the lightning). (e) The tetanus / the infection (the necrotic the muscle → the gas the gangrene).[1][1]
The chemical
- The immediate the copious the irrigation (the water — the 15 to 20 the min the acid; the 1 to 2 h the alkali). The remove the contaminated the clothing. The NOT the neutralise (the exothermic).[2][3][1]
- The specific the antidotes (the calcium the gluconate the gel for the HF; the polyethylene the glycol for the phenol).[1]
- The surgical the debridement (the deep, the non-the-viable).[2]
The chemical the decontamination (the step-the-by-the-step)
The management the of the chemical the burn
- The rescuer the safety + the removal (the FIRST) — (a) the PPE (the gloves, the gown, the eye); the the secondary the contamination (the rescuer the burned — the HF, the phenol). (b) The remove the contaminated the clothing (the CAREFULLY — the scissors, the NOT the pull the over the head). (c) The bag the clothing (the evidence + the continued the off-gassing).[2][3][1]
- The immediate the copious the irrigation (the WATER) — (a) the START the IMMEDIATELY (the seconds the matter — the every the minute the deeper). (b) The copious the lukewarm the water (the NOT the high-the-pressure — the splash → the spread; the NOT the cold — the hypothermia). (c) The DURATION: the acid the 15 to the 20 the min; the alkali the 1 to the 2 the h (the longer — the liquefactive the continues). (d) The CHECK the effluent the pH (the litmus — the until the neutral the 7 to the 8); the recheck the 15 to the 30 the min the after the stop (the rebound).[3][1]
- The NEVER the neutralise (the exothermic) — (a) the neutralisation (the acid + the base → the heat) → the exothermic → the WORSE the burn. (b) The dilution the ONLY (the water). (c) The EXCEPTION the chemical-the-specific (the phenol → the PEG the first; the phosphorus → the copper the sulphate; the HF → the calcium the gluconate the gel — the AFTER the irrigation).[1]
- The specific the antidotes (the agent-the-specific) — (a) the HF → the calcium the gluconate the gel (the 2.5 % — the massaged the in the for the 30 the min; the repeat); the intradermal / the intra-the-arterial / the IV the calcium the gluconate for the deep / the severe / the unrelieved the pain. The monitor the ECG + the Ca + the Mg. (b) The phenol → the wipe the PEG / the oil the BEFORE the water. (c) The phosphorus → the copper the sulphate the wash + the keep the moist + the remove the particles (the NEVER the dry). (d) The tar → the cool the water the first; the lipid the solvent the to the remove.[3][1]
- The systemic the monitoring + the surgical — (a) the HF → the ECG (the QTc, the arrhythmia), the Ca, the Mg (the replace — the IV the calcium the gluconate); the K+. (b) The phosphorus → the Ca, the phosphate, the LFTs, the renal (the systemic). (c) The phenol → the methaemoglobinaemia (the co-oximetry; the methylene the blue the if the symptomatic). (d) The surgical the debridement (the deep, the non-the-viable; the chemical — the deeper the than the appears).[1][1]
- The scene + the toxico-vigilance (the source the control) — (a) the identify the agent (the label, the SDS — the safety the data the sheet; the call the poison the centre). (b) The mass the casualty (the industrial, the terrorism — the triage the by the severity + the decontaminate the BEFORE the ED). (c) The report (the occupational, the public the health).[2][3]
The rhabdomyolysis + the myoglobinuria → the AKI
The high-the-voltage the electrical the injury → the massive the muscle the necrosis → the myoglobin + the CK + the K+ → the pigment the nephropathy → the AKI.[1][1]
The mechanism (the pigment the nephropathy)
- The tubular the obstruction — the myoglobin the casts (the acid the urine → the precipitation).[1]
- The the vasoconstriction — the renal the vasoconstriction (the myoglobin → the NO the scavenging).
- The the direct the toxicity — the haem the group → the proximal the tubule.
- The the hypovolaemia — the fluid the into the injured the muscle (the sequestration) → the pre-the-renal.[1]
The diagnosis
- The CK the trend (the peak the 12 to the 24 the h; the above the 5000 → the AKI the risk).
- The urine the dipstick — the blood the positive + the the NO the RBC on the microscopy → the myoglobin / the haemoglobin (the pigment). The dark-the-red / the tea-the-coloured the urine.[1]
- The hyperkalaemia (the cardiac — the ECG), the hypocalcaemia (the early — the do NOT the treat the unless the symptomatic), the metabolic the acidosis, the raised the creatinine, the phosphate, the urate.[1]
The management (the fluids the target the U/O the 1 to the 1.5 the mL/kg/h)
- The aggressive the IV the fluids — the target the U/O the 1 to the 1.5 the mL/kg/h (the higher the than the thermal); the crystalloid; the EARLY + the rapid.
- The urinary the alkalinisation — the sodium the bicarbonate the IV → the urine the pH above 6.5 (the reduces the myoglobin the precipitation); the use the if the systemic the acidosis.
- The mannitol — the debated (the osmotic; the AFTER the volume the restored; the AVOID the if the anuric).
- The RRT — the refractory the hyperkalaemia / the acidosis / the fluid the overload / the oliguric the AKI.[1][1]
The thermal-the-shock the fluids the vs the electrical-the-rhabdomyolysis the fluids
| The target | The thermal (the Parkland) | The electrical (the rhabdomyolysis) |
|---|---|---|
| The formula | The 4 the mL/kg/%TBSA | The NO the formula (the CK + the U/O) |
| The U/O the target | The 0.5 the mL/kg/h (the adult) | The 1 to the 1.5 the mL/kg/h (the HIGHER) |
| The rationale | The capillary the leak → the burn the shock | The flush the myoglobin → the prevent the ATN |
| The alkalinisation | The NOT | The YES (the sodium the bicarbonate) |
| The endpoint | The U/O + the haemodynamics | The U/O + the CK the trend + the clearance |
Prognosis
The electrical the mortality the driven by the arrhythmia (the initial), the AKI (the rhabdomyolysis), the compartment. The chemical the by the depth (the alkali the worse), the systemic (the HF the hypocalcaemia).[1][2][1]
Short answer questions
SAQ — High-voltage electrical injury with cardiac arrest
10 minutes · 10 marks
A 34-year-old linesman is brought to the ED after contacting an 11 000 V overhead AC power line. Bystanders performed 6 minutes of CPR before paramedics found him in ventricular fibrillation; he was defibrillated once with 200 J biphasic and a perfusing rhythm returned. On arrival he is intubated, GCS 6, HR 118, BP 96/58, SpO2 97 per cent. There is a 2 cm charred entry wound on the right palm, a large exit wound over the left foot, and the urine is dark red-brown. ECG shows sinus tachycardia with non-specific ST changes. CK 18 400 U/L, K+ 6.2 mmol/L, creatinine 156 micromol/L, venous pH 7.24.
SAQ — Hydrofluoric acid burn with hypocalcaemia
10 minutes · 10 marks
A 26-year-old laboratory technician spills 70 per cent hydrofluoric acid (HF) onto the dorsum of her left hand (approximately 1 per cent TBSA). She irrigated the hand with water within 1 minute. Forty minutes later she presents with severe, excruciating deep throbbing hand pain out of proportion to the apparently minor erythema. ECG shows a QTc of 540 ms with runs of polymorphic VT (torsades de pointes). Ionised calcium is 0.62 mmol/L, magnesium 0.4 mmol/L, and the BP is 78/44 with widespread QRS prolongation.
Clinical pearls
Evidence + the trials
The electrical + the chemical + the lightning the evidence, the trials, the outcomes
The ABLS (the American the Burn the Association) + the EMSB (the ANZBA) the guidelines: the standard the for the burn the + the electrical the + the chemical. The ECG the 24 the h; the CK + the U/O for the rhabdomyolysis; the fasciotomy the early; the calcium the gluconate for the HF; the copious the irrigation for the chemical; the prolonged the CPR for the lightning.[1][1] The high-the-voltage the mortality + the morbidity (the review): the mortality the driven by the arrhythmia (the initial), the AKI (the rhabdomyolysis), the compartment, the sepsis (the necrotic the muscle). The amputation the rate the high (the deep). The long-the-term: the cataracts, the peripheral the neuropathy, the PTSD.[1] The lightning the mortality (the systematic the review — the Cooper): the mortality the ~10 the % (the lower the than the perceived); the morbidity the neurological + the cardiac (the usually the benign the if the initial the ECG the normal). The reverse the triage (the resuscitate the apparently-the-dead) → the improved the survival. The prolonged the CPR the justified (the heart the may the restart).[1][1] The HF the systemic (the case the series + the reviews): the fatal the at the small the %TBSA; the hypocalcaemia + the hypomagnesaemia → the refractory the arrhythmia. The calcium the gluconate (the topical the gel → the intradermal / the intra-the-arterial / the IV) → the dramatic the response. The monitor the ECG + the Ca + the Mg; the debride the necrotic.[1][1] The chemical the decontamination (the Diphoterine the vs the water — the European): the Diphoterine (the polyvalent, the amphoteric, the hypertonic) → the polyvalent the decontamination; the faster the pain the relief + the reduced the depth the vs the water (the French the occupational the data). The water the remains the standard (the universal, the cheap, the available).[2] The acute the cutaneous the wounds (the Singer + the Dagum, the NEJM 2008): the principles the of the wound the management (the irrigation, the debridement, the closure) the generalisable the to the chemical the + the electrical; the chemical → the copious the irrigation the + the specific the antidote; the electrical → the deep the + the serial the debridement.[1] The prognosis — the summary: the electrical (the high-the-voltage → the deep; the mortality the by the arrhythmia / the AKI / the compartment; the TBSA the underestimates). The lightning (the ~10 the %; the prolonged the CPR). The chemical (the alkali the worse; the HF the systemic; the phenol + the phosphorus the specific the antidotes).[1][3][1]
Red flags
References
- [1]Jeschke MG, et al. Assessment and Management of Acute Burn Injuries Phys Med Rehabil Clin N Am, 2023.PMID 37806692
- [2]Endorf FW, Gibran NS. Acute and perioperative care of the burn-injured patient Anesthesiology, 2015.PMID 25485468
- [3]Rizio EA, et al. Solid Metal Chemical and Thermal Injury Management Mil Med, 2025.PMID 39190559