Treatment of Dermal Exposures

Caustic injuries to the skin most frequently occur on the extremities. Most acid injuries, excluding hydrofluoric acid, respond well to local copious saline irrigation. Alkali dermal exposures may appear deceptively superficial, yet burn more deeply and for extended periods.17 Management of these injuries should include copious irrigation and local wound debridement to remove residual compound (Fig 175-3). In cases of lime exposure and other caustic powders, patients should brush off the dry compound and remove contaminated clothing before irrigating.

FIG. 175-3. Guidelines for treatment of caustic dermal exposures.

Portland or ready-mix cement is an alkali mixture of lime that warrants special mention. When water is added to the dry mixture, calcium, sodium, and potassium hydroxide are produced. Patients may initially present with severe pain without obvious injury but eventually develop blisters and skin necrosis if the affected area is not irrigated early. All cutaneous caustic injuries require close follow-up or early referral to a plastic surgeon to ensure the injuries are not progressing.

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Dealing With Back Pain

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