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Bélanger A, Pichette A, Gauthier M, Legault J. Diphoterine, an amphoteric rinsing solution, reduces hydrofluoric acid injuries in an ex vivo pigskin model. Burns 2024; 50:488-494. [PMID: 38087660 DOI: 10.1016/j.burns.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 02/24/2024]
Abstract
Hydrofluoric acid (HF) is a ubiquitous industrial chemical that is particularly hazardous because of the potential for systemic effects and the induction of severe cutaneous necrosis after contact with the skin. Minimizing skin injury requires decontaminating the affected area promptly with an emergency rinsing solution. Few experimental studies have objectively characterized rinsing solutions such as Diphoterine (DP). Here we develop an ex vivo pigskin model to study and compare the efficacy of rinsing solutions as initial decontaminating agents to stop the progression of skin lesions after HF splashing. The pigskin model shows an immediate local response to HF at varying concentrations and exposure times. We then exposed the pigskin biopsies to 3.75% HF for 1 min and rinsed them with different solutions, including water, 0.9% NaCl solution (saline), 10% calcium gluconate (CaG), Hexafluorine (HXF), and DP. We found DP to be a more effective agent for decontaminating HF lesions than water, saline, and CaG. DP had a similar efficacy as HXF, an emergency rinsing solution used specifically for decontaminating HF-exposed skin. This study shows that skin exposed to HF must be treated quickly from the first minute of exposure.
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Affiliation(s)
- Audrey Bélanger
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - André Pichette
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Marcel Gauthier
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Jean Legault
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
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2
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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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Abstract
Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.
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Affiliation(s)
- Karl Walsh
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Isabel Hughes
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Baljit Dheansa
- Department of Burns and Plastics, Queen Victoria Hospital, East Grinstead, UK
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4
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The knowledge and availability of amphoteric compounds for chemical burns in the emergency departments of the South West of the United Kingdom. Burns 2022; 48:474-475. [PMID: 34887122 DOI: 10.1016/j.burns.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
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Arnaudet I, Montassier E, Javaudin F, Naux E, Le Bastard Q. Prise en charge des brûlures en préhospitalier et aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Une brûlure est une lésion de la peau ou d’un autre tissu organique principalement causée par la chaleur ou les rayonnements, la radioactivité, l’électricité, la friction ou le contact avec des produits chimiques. Les plus fréquentes, les brûlures thermiques (dues à la chaleur), surviennent lorsque certaines cellules ou toutes les cellules de la peau ou d’autres tissus sont détruites par des liquides bouillants, des solides chauds (brûlures de contact), ou des flammes. En France, l’incidence des brûlures prises en charge à l’hôpital est environ de 13 pour 100 000 habitants. La prise en charge en urgence du brûlé grave par lésion thermique est bien décrite, une recommandation de pratique professionnelle a été publiée en 2019 par la Société française d’anesthésie et de réanimation, en association avec la Société francophone de brûlologie, la Société française de médecine d’urgence et l’Association des anesthésistes-réanimateurs pédiatriques d’expression française. Pourtant, l’urgentiste va être confronté à de nombreuses brûlures de gravité et de nature différentes. Nous faisons ici une mise au point sur les données connues en termes d’épidémiologie, de manifestations cliniques et des différentes thérapeutiques qui peuvent être proposées dans la prise en charge des brûlures. Nous faisons aussi le point sur les localisations à risque particulier que l’urgentiste doit connaître, ainsi que sur les intoxications qui peuvent être associées aux brûlures. Nous détaillons aussi certains contaminants qui sont à connaître.
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Nahaboo Solim MA, Lupion-Duran TM, Rana-Rahman R, Patel T, Ah-Kine D, Ting DSJ. Clinical outcomes and safety of Diphoterine ® irrigation for chemical eye injury: A single-centre experience in the United Kingdom. Ther Adv Ophthalmol 2021; 13:25158414211030429. [PMID: 34350381 PMCID: PMC8287404 DOI: 10.1177/25158414211030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Diphoterine® is an amphoteric irrigating solution armed with rapid
pH-neutralising action. It serves as an effective first-aid treatment for
managing chemical burns, including chemical eye injury (CEI). However, its
use is not widely adopted in current clinical practice, primarily attributed
to limited clinical evidence. This study aims to highlight the experience in
using Diphoterine for managing CEI in a UK tertiary referral centre. Methods: This retrospective case series included all patients who presented with CEI
and treated with Diphoterine at the James Cook University Hospital, UK,
between April 2018 and February 2020. Results: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years
(ranged, 3–70 years) and 85.7% were male. All patients presented with an
alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median
(±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of
0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the
eyes were of grade-I and -IV CEI, respectively. All eyes received normal
saline/water as the first irrigation fluid and Diphoterine as second
irrigation fluid. The mean pH improved slightly after first irrigation
(8.4 ± 0.7; p = 0.13) and significantly after second
irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation
used was significantly less for Diphoterine (520 ± 193 mL) than for normal
saline/water (2700 ± 2451 mL; p = 0.016). At final
follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28
logMAR (p = 0.60). One patient developed near-total limbal
stem cell deficiency as a complication of grade-IV injury and was awaiting
limbal stem cell transplantation at last follow-up. Conclusion: This study represents the first case series in the United Kingdom, reporting
the use of Diphoterine in managing CEI. The rapid pH-neutralising action of
Diphoterine, with less volume required, makes it an ideal initial treatment
for efficiently managing adult and paediatric patients with CEI in
clinics.
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Affiliation(s)
| | | | - Romeela Rana-Rahman
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Trushar Patel
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Desiree Ah-Kine
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - Darren S J Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Claassen K, Rodil Dos Anjos D, Broding HC. Current status of emergency treatment of chemical eye burns in workplaces. Int J Ophthalmol 2021; 14:306-309. [PMID: 33614462 DOI: 10.18240/ijo.2021.02.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
Chemical eye burns present an avoidable, but frequent, occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured. A periodical review of guidelines is required to assure the optimal emergency management. We reviewed the literature with emphasis on current German guidelines, primarily MEDLINE. If the crucial first-line measure, the injury prevention has failed and an eye burn has been sustained, the immediate and copious rinsing of the eye is the pivotal emergency treatment modality. Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous, there is an ongoing debate about the benefits and risks of specific rinsing solutions, and regular updates on guidelines and recommendations for the emergency treatment are warranted. The easiest and readily available rinsing solution is tap water, which fulfils the crucial criteria conveniently in most industrialized countries: purity, sterility, and neutral pH. Other rinsing solutions are proposing higher osmolality to stabilize the physiological pH, because of their superior buffering capacity. However, there is no compelling evidence for a substantial benefit, and some reports suggest that there could be unwanted side effects. In combination with the substantially increased expenditure and a more complex handling procedure, currently a general recommendation of any other solution than tap water is not warranted.
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Affiliation(s)
- Kevin Claassen
- Faculty of Health Department of Human Medicine, Occupational Medicine and Corporate Health Management, Witten/Herdecke University, Alfred-Herrhausen-Strabe 50, Witten 58448, Germany
| | - Dominique Rodil Dos Anjos
- Faculty of Health Department of Human Medicine, Occupational Medicine and Corporate Health Management, Witten/Herdecke University, Alfred-Herrhausen-Strabe 50, Witten 58448, Germany
| | - Horst Christoph Broding
- Faculty of Health Department of Human Medicine, Occupational Medicine and Corporate Health Management, Witten/Herdecke University, Alfred-Herrhausen-Strabe 50, Witten 58448, Germany
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Dua HS, Ting DSJ, Al Saadi A, Said DG. Chemical eye injury: pathophysiology, assessment and management. Eye (Lond) 2020; 34:2001-2019. [PMID: 32572184 PMCID: PMC7784957 DOI: 10.1038/s41433-020-1026-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/09/2022] Open
Abstract
Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.
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Affiliation(s)
- Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmed Al Saadi
- Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, UAE
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
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Lewis CJ, Hodgkinson EL, Allison KP. Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies. Burns 2019; 46:213-218. [PMID: 31784238 DOI: 10.1016/j.burns.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.
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Affiliation(s)
- C J Lewis
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK.
| | - E L Hodgkinson
- Psychology in Healthcare, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K P Allison
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
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10
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Diphoterine® in therapeutic care of chemical burn: To recommend or not to recommend? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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