Chemical burn

Jenny P · Jul 15, 2001

Boy, Huganurse, this story sounds strange to me. Some questions need to be answered here: what type of "shop" is it? What types of chemicals are in the shop? What types of machinery- anything that could be hot that he could have leaned on, or any with caustic chemicals (such as hydrochloric or sulfuric acid) on them?

Then, as a nurse, what are the edges of the wound like? Are they ragged- as in splash marks- or clearly defined? Is it one big wound, or are there a series of smaller wounds? Is it all the same thickness, or are there different thicknesses (related to different lengths of exposure)?

Find out why he waited 3 days before seeking treatment- there has to be a reason for that. What happened to the clothes he was wearing the day he started to feel the burn? Are they also damaged? Do they have holes in them? Did he wash at all when he started to feel the burning? Did he put any creams or salves on the area? What did he do to treat his symptoms before he sought medical help?

Does he use illegal drugs? Was he on them and that's why he didn't come in sooner? Did he have a Meth lab accident and that's why he delayed treatment?

Third degree burns without knowing what caused them just seems kind of extreme to me. And waiting several days seems really weird.

Sharon · Jul 15, 2001

Huganurse

Contact the employer of the patient and ask for a copy of the first report of injury and ALL MSDSs (material safety data sheets) which have to be in your patients position in 24 hours. Once you have a list of potential causes contact both the local poison control center and you can research or post questions to the Duke - Occupational Environmental Listsserve at http://gilligan.mc.duke.edu/oem/

All of the top Occupational and Environmental Medicine physicians and nurses from around the world participate. You should get a reponse to your messages within a few hours.

By the way don't forget to review any hobbies or activities of this patient. You may be dealing with a combination or idiosyncratic response to an exposure.

You may want to repost on the occupational and emergency nursing boards below. Some nurses check specific boards more often then the general boards.

Jenny P · Jul 16, 2001

One more question: is everyone 100% positive it is a burn? Could it be from an insect bite? That is probably way out in left field, but there a re insect bites that can cause wounds like this-- although because of the area involved, this doesn't sound like it as it doesn't sound like it would be following the lymph ducts or circulatory system.

Sharon, you have some very good advice. That's the nice thing about this site: I have no knowledge on occ. health; but someone who does know about it has valuable information we can all learn from.

Huganurse · Jul 17, 2001

Jenny, I knew I wasn't giving you all enough info, my hubby was giving me a hard time about it (LOL) when he read my post..Thanks you for your interest and help!!

Sharon, Thank you so much for such an informative post to this thread. It is nurses like you that have expert and invaluable advice to give and share that make this BB so wonderful! This situation is unlike any that I have dealt with and it is great to be able to use this BB to find nurses like you!

Sharon · Jul 17, 2001

Based on the story and that he still has not identified exactly what type of shop or what is done in it. I am wondering if it was Lye or Battery Acid. If he or his friends were mixing their own chemicals (i.e. methamphetmane or nazi meth which is meth w/ battery acid). Both chemicals if not neutralized will continue to burn over a period of time. You can get pockets of trapped chemicals in tissue so through cleaning is essential.

When you feel comfortable, I think you should still post this case to the OEM L-serv. You will give some poor nurse or doctor on some far-flung outpost the opportunity to be distracted.

Jenny P · Jul 18, 2001

Thanks for the info, Hug-a-nurse. Sharon, it sounds like you have some better ideas than I do, but I agree about the meth lab idea. It definitely sounds like splash burns; but what kind-- it makes me wonder who or what he is hiding. Did you find out what happened to the clothing?