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Chemical burns can be caused by organic and non-organic substances in the solid, liquid and gaseous state. The degree of damage depends on the amount of substance, its concentration and time of contact with the skin.
The pathogenesis of chemical burns differs from the pathogenesis of thermal lesions. When concentrated acids act on the skin, tissue proteins coagulate (with the formation of acid albuminates) and dehydrate the affected tissue due to the high hydrophilicity of the acid (coagulation necrosis). A dry "pressed" scab forms, no bubbles.
Concentrated alkalis (potassium hydroxide, caustic soda, quicklime, caustic soda), unlike acids, do not coagulate, but emulsify proteins, forming alkaline albuminates, as a result of which they quickly penetrate deep into the tissues and cause them to swell. Wet (collicative necrosis) is formed. The loose wet scab easily detaches, exposing a bleeding ulcer. Subsequently, necrosis also spreads to surrounding tissues due to a violation of the colloidal properties of their proteins.
According to the depth of the lesion, chemical burns are divided in the same way as thermal burns into four degrees.
The basic principle of first aid to the injured person when a chemical enters the skin is its immediate and complete removal. The best tool is a long (10-15 minutes) rinse with a stream of water under pressure. If clothes are contaminated, they must be removed (cut if necessary).
The previously recommended method of neutralizing with antidotes in practice was not very effective, since the necessary antidote, as a rule, is not at hand, and its search or preparation leads to an unacceptable loss of time. Neutralization can only be used as an additional measure after an energetic flush.
Further treatment of chemical burns is carried out in accordance with the same principles as thermal. Due to the fact that chemical burns, as a rule, are deep, they require treatment in a hospital using surgical methods.
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