Case 22 – A Bad Burn

Case #22: A Bad Burn
Author: Michael Gottlieb, MD
Peer Reviewer: Michael Christian, MD

A 23 year old male is brought to the ED by paramedics after some industrial grade drain cleaner splashed into his eyes. Immediately after it occurred, he splashed water on his face for 10 minutes and then called for an ambulance. He notes severe pain and significantly decreased vision, as well as pain with eye movement and photophobia. His exam is significant for diffuse ocular erythema, superficial partial thickness chemical burns in the periorbital area, and visual acuity limited to hand motion bilaterally

Vitals: Temp: 98.8, HR: 126, RR: 18, BP: 158/98, O2 Sat: 100% on RA

What is the most likely etiology of this patient’s presentation?
What other clinical symptoms might you expect to see with this patient?
What is the initial treatment for this patient?
What further work-up is required?
What is the disposition of these patients?
How would the management change if this were a Hydrofluoric Acid (HF) burn?

References:

Turner A, Robinson P. Respiratory and gastrointestinal complications of caustic ingestion in children. Emerg Med J 22: 359, 2005.

Havanond C. Clinical features of corrosive ingestion. J Med Assoc Thai 86: 918, 2003.

Spector J, Fernandez WG. Chemical, thermal, and biological ocular exposures. Emerg Med Clin North Am 26: 125, 2008.

Hall AH, Maibach HI. Water decontamination of chemical skin/eye splashes: a critical review. Cutan Ocul Toxicol 25: 67, 2006.

Kuckelkorn R et al. Emergency treatment of chemical and thermal eye burns. Acta Ophthalmol Scand 80: 4, 2002.

Schiettecatte D et al. Treatment of hydrofluoric acid burns. Acta Chir Belg 103: 375, 2003.

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