Burn with acetic acid
Burn with acetic acid is damage to the skin tissues under the influence of this chemical substance and its vapors. Such burns can have serious consequences, so if they are received, you should provide immediate medical attention.
Pathogenesis
As a result of contact with the skin of aggressive substances (such as concentrated acid solution or alkali), the process of rapid necrosis of tissues begins. The effect of acid continues until the chemical reaction ceases.
The effect of concentrated acids on the skin immediately causes the destruction and death of tissues and cells, so at the initial stage, necrosis can occur, which, after contact with the skin, occurs almost immediately.
After contact with the skin solutions with a low concentration of acid morphological changes may occur after a while (in some cases, only a few days). The effect on the skin of the acid causes the development of coagulation necrosis.
Symptoms of the burn with acetic acid
When burned with acid, a hard and dry crust appears on the injury site, which has a clearly delimited line at the point where the healthy part of the skin begins. Damage from acid is often superficial. In this case, vinegar leaves dirty-white burns on the skin.
Acid skin burn with acetic acid
Since vinegar is part of the group of organic acids, skin damage resulting from exposure to this substance is called chemical burns. Upon contact with the skin, a corresponding chemical reaction starts, which leads to damage.
Burn with acetic acid of the esophagus
Since the esophagus tissues contain a lot of nerve endings, the victim experiences severe pain when burned, which occurs behind the sternum, the neck, and the upper abdomen. In addition, traces of burns and swelling can be seen in the mouth and on the lips. Due to the fact that the vocal cords are damaged by the action of chemical substances, hoarseness is observed. The tissues of the esophagus are rapidly swollen due to the burn, so that the lumen is blocked, which prevents the swallowing process.
Since there is also edema in the larynx, dyspnea appears, which often causes vomiting, which is mixed with pieces of burned mucous digestive tract, blood and mucus. In some cases spasmodic contractions of the esophagus are observed.
As a result of ingestion of acetic acid, the mucous membrane begins to damage, and then the remaining envelopes of the digestive tract. Chemicals have a destructive effect on cells, which causes tissues to die. The most severely damaged areas of the physiological narrowing of the esophagus, as the acid lingers in them, causing even more severe burns.
If the third degree is damaged, a hole may appear in the wall of the digestive tract. In more severe cases, the bronchial wall is destroyed, which leads to the development of the esophageal-tracheal fistula.
There is also a general intoxication of the body, which develops due to the accumulation of toxins in it, resulting from the disintegration of the tissue. Symptoms of poisoning - severe nausea and weakness, fever, as well as problems with the heart.
In general, the severity of the destruction of internal organs will depend on how much the victim has swallowed, as well as on the acid concentration.
Eye burn with acetic acid
The strength of the eyeball will depend on what substance the burn was caused (alkalis are more dangerous than acids). In the case of a burn with acetic acid, a protein coagulation reaction occurs, resulting in a crust formation. This prevents deep penetration of acid deep into the eye.
Also, the severity of the destruction depends on the concentration index - if from the table vinegar the victim feels only a burning sensation, then the saturated acetic essence immediately melts the eye cornea. Vision as a result is lost irrevocably, since the 3 and 4 degree of opacity of the cornea are almost incurable.
Burning lungs with vapors of acetic acid
In some cases, intoxication with acetic vapors occurs - in this case there is coughing, lacrimation, and also a runny nose. General intoxication of the body occurs rarely. A chemical burn of the lungs can occur as a result of inhalation with saturated vapors of acetic acid. In this case, the victim will need immediate medical attention.
Complications and consequences
Complications of the infectious type that can occur as a result of a burn of the esophagus are gastritis and pneumonia, esophagitis, as well as peritonitis and pancreatitis in the reactive stage.
Other complications due to burns can be divided into 2 categories: early (1-2 days) and late (from the 3rd day). The first group includes early bleeding (primary and secondary), mechanical asphyxia, reactive pancreatitis in acute form, intoxication delirium, primary oliguria. The second group includes pneumonia and tracheitis, as well as late bleeding and intoxication psychoses, scar deformations within the esophagus with possible subsequent cancerous degeneration of its walls, renal or hepatic insufficiency.
Diagnostics of the burn with acetic acid
To diagnose an internal burn with acetic acid, an evaluation of the history of the patient as well as clinical symptoms is performed. Diagnosis of intoxication is carried out on the basis of the presence of a smell of vinegar from the mouth or gastric wash water.
With an external burn, the type of damaging agent can be determined by the color and smell of the crust on the wound. In case of contact of tissues with acetic acid, it acquires white color, has a dense consistency, dry, and is clearly limited within the damage site.
Analyzes
For the diagnosis, laboratory research methods can be used additionally. Analyzes in this case show an increase in acute inflammatory markers, in particular, C-reactive protein, increased ESR, and metabolic acidosis.
To clarify the nature of the substance that caused the burn, samples of vomiting, damaged tissues, and saliva can be sent for analysis 2 days after the injury is obtained.
Instrumental diagnostics
To determine the area of spread of burn destruction of the digestive tract with internal burn, fluoroscopy is used. This method of instrumental diagnosis should be performed only at the acute stage of the disease (not later than the first week after receiving the burn).
Differential diagnosis
Differential diagnosis of such poisoning is usually carried out without difficulty. In the process, the depth and prevalence of the lesion is ascertained, and all possible complications of the resulting injury are determined in a timely manner. Due to the presence of pronounced erythrocytolysis, poisoning with acetic essence is usually easily differentiated with burns from other acids of cauterizing type.
Treatment of the burn with acetic acid
To avoid the reaction of exotoxic shock, the patient is injected with fentanyl, analgin or promedol, and in addition spasmolytic drugs - such as papaverine or halidor. To prevent pain, the patient should be given an atropitol solution or a glucose-novocaine mixture. These treatment measures will be very effective, but only if they are started no later than 6 hours after receiving the damage.
Treatment of internal burns mainly consists of the use of anti-inflammatory drugs, as well as antibiotics. Often the process of therapy is based on the implementation of such a complex of therapeutic measures:
- Execution of forced diuresis, in which blood alkalization is additionally carried out;
- The use of sodium hydrogencarbonate in the case of metabolic acidosis;
- To eliminate a burn shock, use drugs stabilazol or refortan;
- As prevention of the development of secondary infection, antibacterial agents may be prescribed;
- To reduce the risk of narrowing the esophagus, hormones are used;
- With the development of DIC syndrome, a freshly frozen plasma is transfused;
- If massive erythrocytolysis is observed, it is necessary to perform the procedure of early hemodialysis;
- If the process of destruction of the liver has begun, glutargic acid is used.
If the digestive system burn is too strong, the patient is given parenteral nutrition.
As local therapy, you can use Almagel with the addition of anesthesin (every 3 hours). To accelerate the healing, sea buckthorn oil is used (orally).
If cicatricial compression of the digestive tract occurs, the bougie procedure is performed. With its help restore patency and diameter of the esophagus. For this, special tubes are used, which are introduced to the victim in the esophagus.
Buzhirovanie appointed individually. There are several ways to carry out the procedure - using a metal conductor or an esophagoscope, or blindly.
Before the operation, the patient is administered drugs that reduce salivation, as well as pain medications. In accordance with the narrowing form, a suitable bougie is chosen, then it is lubricated with petroleum jelly and injected into the patient's esophagus, where it remains for 30 minutes. This procedure can cause internal bleeding and the development of inflammatory processes.
Help with acetic acid burns
Providing quick help with external burn with acetic acid
In the event that the vinegar has poured out on clothes, the victim first thing is to remove this thing from himself. If you can not remove, it should be cut, and in parts removed from the body.
After that, the place of burn immediately needs to be placed under running water - this is one of the most important stages of the first aid procedure. The washing process should be abundant and lasting - at least 20 minutes. The plus of this procedure is also the fact that cold water reduces pain from burns. To weaken influence of vinegar it is possible a soda solution or simple solution of soap.
In the event of an aggressive substance entering the eye mucosa, the rinsing is carried out in a similar manner. Running water can be alternated with a low-concentration soda solution, which must be thoroughly mixed.
After washing, you need to put a moist compress on the burned place for a short time. It will remove vinegar residues on the skin if they are left after rinsing.
It is also necessary to treat the burn with a disinfectant and a special anti-burn agent (Ricinol or Panthenol). After this, the bandage should be applied to the wound (it should be free and do not squeeze the lesion).
Providing quick help with an internal burn of vinegar
Internal burns are considered much more dangerous to health than external burns. They are fraught with serious consequences for the victim. If vinegar enters the esophagus, then such a person needs to urgently perform a procedure of washing the stomach with simple water with the addition of a solution of soda. At the same time, an ambulance team must be called in immediately to provide professional assistance.
Medications
Refortan is prescribed to treat shock conditions caused by infections, injuries or burns.
Contraindications to the use of the drug: high sensitivity to the elements of the drug (for example, starch), water poisoning, hypervolemia, lack of potassium, excess sodium or chloride, heart failure, decompensated heart failure, renal failure with concomitant oliguria or anuria, hemorrhages inside the skull, cardiogenic edema lungs, HD, expressed problems with blood coagulability, dehydration of the body. Be wary appoint with renal, compensated cardiac (in chronic form) or liver failure, hemorrhagic diathesis, as well as HFG.
Among the side effects: the drug causes liquefaction of the infusion, which may decrease the hematocrit value, as well as the saturation of the blood plasma protein (depending on the dosage). In addition, there may be a transient decrease in the rate of blood clotting, but this does not affect the function of platelets, so it does not cause clinically significant bleeding.
The continued daily use of Refortan in high and medium dosages often causes itchy skin, which is not easily eliminated. In addition, it can occur and a few weeks after the end of treatment and persist for a long time.
If there are no other prescriptions, Refortan is administered intravenously via a dropper depending on the need for replacement of the VCP. The daily dosage, as well as the rate of intravenous administration, are selected depending on the hematocrit number, hemorrhage and hemoglobin concentration. For young patients, the hematocrit limit, at which there is no risk of developing pulmonary or cardiovascular complications, is 30%.
Dosages of the drug are as follows: for adults and children 12+ years, the average daily dose is 33 ml / kg; for children 3-6 and 6-12 years old - an average of 15-20 ml / kg; for children under 3 years - an average of 10-15 ml / kg. For all ages, the maximum daily limit is 33 ml / kg.
Panthenol is used to accelerate the healing process of the skin and mucous membranes for lesions of various origins. The spray is used as follows - before applying to the skin, the can should be shaken. You need to apply the medicine on a burn several times a day. The duration of therapy depends on the severity of the damage to the skin.
Among the side effects of the drug: in case of high sensitivity, allergy may occur.
Contraindication to the use of Panthenol is a high individual sensitivity to the components of the spray.
Alternative treatment
There are methods of alternative treatment of burns with acetic acid.
Bark of summer oak: 1-2 tbsp. Sliced bark cook about 15-30 minutes (take water 500 ml), then strain and leave to cool. Use the resulting medicine as compresses. It should be noted that you can only use freshly prepared broth.
Bark of a crooked elm: 2 tablespoons chopped bark with boiling water (2 stacks), then keep on low heat until the volume of water is reduced by 2 times, and then strain. The broth should be used for lotions, and the treatment procedure should be performed 4-5 times a day.
Aspen bark: 1 tbsp. Cut the bark with hot water (2 stacks), then hold in a water bath in a closed container for 30 minutes. Hot broth should be filtered through 2-3 gauze layers, and then boiled water bring the volume of the medicine to the original value. Use the decoction, after sweetening, 1-2 tablespoons. 3-4 rubles / day. During the meal.
Forecast
Burn with acetic acid can be extremely dangerous in case of severe damage (grade 3 burn) - in this case, the mortality rate reaches 50-60%. In less dangerous cases, with the proper timely treatment of the digestive tract burn, the result is positive in 90% of the situations.
In the case of a 1 or 2 degree eye burn, the prognosis is usually favorable. But with burns of 3 or 4 degrees often there is a change in the location of the edges of the eyelids, there is a symphobaron or a thorn in the cornea, due to which the vision falls sharply.