Cases reported "Burns, Chemical"

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1/72. Anhydrous ammonia burns: case presentation and literature review.

    Anhydrous ammonia, a caustic compound commonly used in industry, can cause severe burns, even with brief contact. As with other alkali burns, early irrigation to remove the ammonia from burned areas is crucial to limit tissue damage. Two cases of identical exposure to industrial strength ammonia are presented. Each patient was exposed to ammonia liquid and vapors simultaneously when a tank containing this compound exploded. One patient showered at the scene immediately after exposure, whereas the other deferred irrigation until he arrived at the hospital. The first patient suffered minor burns with a 2-day, uncomplicated hospital stay. The second patient suffered 14% total body surface area burns and a significant inhalation injury. He required intubation, mechanical ventilation, and skin grafting during his 13-day hospitalization. Although much is written about the management of chemical burns, few articles address ammonia burns. Aggressive initial management significantly reduces morbidity of ammonia burns.
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2/72. Liquid ammonia injury.

    The toxic effects of a gas depend on the time of exposure, concentration and its chemical nature. Pressurized liquids and gases exert an additional cold thermal injury and this may complicate the clinical picture. A patient who had an accidental exposure to liquid ammonia over a prolonged period, manifesting in cutaneous, respiratory and ocular damage in addition to a severe cold thermal injury (frostbite) with a fatal outcome is presented. The patient had flaccid quadriparesis and episodes of bradycardia, which has not been reported previously. These manifestations raise the possibility of the systemic toxicity in patients with prolonged exposure to ammonia.
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3/72. Inadvertent topical exposure to isocyanates caused damage to the entire eyeball.

    isocyanates are part of a group of important chemicals necessary in the production of adhesives, synthetic rubbers, and a variety of plastics. They are known to have minimal toxic effects when administered locally. However, we experienced a case of damage involving the entire eyeball in a person who accidentally exposed his eye to isocyanates. The patient presented with inflamed conjunctiva, and shrunken cornea and sclera, with focal atrophic changes in the iris. The lens and vitreous were opacified. After removal of the lens and vitreous, there were large areas of atrophic retina and areas of retinal necrosis with holes. We found that locally absorbed isocyanates can cause damage to the entire eyeball. Therefore, we recommend that if there is any evidence of isocyanate penetration, early vitrectomy should be performed to help in determining the extent of retina damage and to decrease the amount of toxic substance in the vitreous.
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4/72. Successful treatments of lung injury and skin burn due to hydrofluoric acid exposure.

    Recent growth in the electronics and chemical industries has brought about a progressive increase in the use of hydrofluoric acid (HF), along with the concomitant risk of acute poisoning among HF workers. We report severe cases of inhalation exposure and skin injury which were successfully treated by administering a 5% calcium gluconate solution with a nebulizer and applying 2.5% calcium gluconate jelly, respectively. Case 1: A 52-year old worker used HF for surface treatment after welding stainless steel, and was hospitalized with rapid onset of severe dyspnea. On admission to the critical care medical center he had widespread wheezing and crackles in his lungs. Chest radiograph showed a fine diffuse veiling over both lower pulmonary fields. Severe hypocalcemia with high concentrations of F in serum and urine were disclosed. He was immediately given 5% calcium gluconate solution by intermittent positive-pressure breathing (IPPB), utilizing a nebulizer. On the 21st hospital day, chest film and CT scan did not demonstrate any abnormality. He was discharged very much improved on the 22nd hospital day. Case 2: A 35-year old worker at an electronics factory was admitted to his local hospital with severe skin burn on his face and neck after exposure to 100% HF. Treatment began with immediate copious washing with water for 20 min. calcium gluconate 2.5% gel (HF burn jelly) was applied to the area as a first-aid measure. Persistent high concentrations of serum and urinary F were disclosed for 2 weeks. After treatment with applications of HF burn jelly, he was confirmed as being completely recovered. The present cases and a review of published data suggest that an adequate method of emergency treatment for accidental HF poisoning is necessary.
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5/72. Lime burns in a professional football goalkeeper - an unusual hazard.

    burns due to lime, although well reported as a result of occupational exposure, are uncommon in the sports arena. A case of such a chemical burn, which required surgery in a football goalkeeper is presented. There are safe alternatives to line marking on football pitches the use of which will prevent such injuries and avoid litigation.
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6/72. Cutaneous burns from CS incapacitant spray.

    A case of a superficial burn following exposure to CS incapacitant spray is reported. This is followed by a summary of the properties and effects of CS and the other agents which occur in the incapacitant spray. CS is relatively safe, but it does have unwanted effects, especially on skin exposure. Possible contributing factors to the production of a skin burn are discussed.
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7/72. povidone-iodine related burns.

    skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.
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8/72. Exposure to liquid sulfur mustard.

    Chemical weapons continue to pose a serious threat to humanity. With the use of chemical weapons by terrorists in tokyo, and the projected disarming of the chemical weapon stockpile in this country, the possibility that emergency physicians will encounter patients contaminated by chemical munitions, such as sulfur mustard, exists. Mustard is a vesicating agent with a long latency between exposure and symptoms. Exposure can cause burns, conjunctivitis, pneumonia, and death. We describe 3 workers exposed to mustard at a chemical weapon storage facility. This article reports the first case of an exposure to mustard at a storage facility, as well as the first documented incident occurring in the united states. All physicians who manage patients in an acute care setting should be aware of the presentation and emergency treatments involving patients contaminated with mustard.
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9/72. sodium azide burn: a case report.

    Chemical burn injuries commonly occur at the workplace and can be caused by a variety of agents. sodium azide is a volatile compound used in the industrial setting and it is also a constituent of car airbags. The known toxic effects of sodium azide include hypotension, bradycardia, and headaches. At the cellular level, it inhibits of ATP production by blocking the respiratory oxidation cascade. In the burn literature only one previous report documents a sodium azide hand burn caused by airbag malfunction. We report a case of massive exposure and resultant systemic toxicity from a sodium azide canister explosion.
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10/72. Hypocalcaemia and hypomagnesaemia due to hydrofluoric acid.

    hydrofluoric acid readily penetrates the skin and mucous membranes, causing deep tissue layer destruction. Dermal exposure can produce hypocalcaemia, hypomagnesaemia, hyperkalaemia, cardiac dysrhythmias and death. We report the case of a 52-year-old man who presented hypocalcaemia and hypomagnesaemia due to occupational dermal contact with hydrofluoric acid. Hypocalcaemia and hypomagnesaemia were corrected by i.v. administration of calcium gluconate and magnesium sulphate.
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