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Chapter 16: The Skin and Subcutaneous Tissue

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Following caustic injury to the skin with an alkaline agent the effected area should initially be

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A. Treated with running water or saline for 30 minutes

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B. Treated with running water or saline for 2 hours

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C. Treated with a neutralizing agent

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D. Treated with topical emollients and oral analgesics

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Answer: B

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The treatment for both types of injuries is based on neutralization of the inciting solution and starts with running distilled water or saline over the affected skin for at least 30 minutes for acidic solutions and 2 hours for alkaline injuries. It should be noted that neutralizing agents do not offer a significant advantage over dilution with water, may delay treatment, and may worsen the injury due to the exothermic reaction that may occur. The clinician observes and treats based on the degree of presentation. Many cases are successfully managed conservatively with topical emollients and oral analgesics, and most cases result in edema, erythema, and induration. If signs of deep second-degree burns develop, local wound care may include debridement, Silvadene, and protective petroleum gauze. In severe cases, injury to the underlying vessels, bones, muscle, and tendon may occur, and these cases may be managed within 24 hours by liposuction through a small catheter and then saline injection. Surgery is indicated for tissue necrosis, uncontrolled pain, or deep-tissue damage. Antibiotics should not be administered unless signs of infection are ­present. (See Schwartz 10th ed., p. 479.)

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The treatment of a hydrofluoric acid skin burn is

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A. Application of calcium carbonate gel

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B. Irrigation with sodium bicarbonate

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C. Injection of sodium bicarbonate

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D. Local wound care only

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Answer: A

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Injuries that have specific additional treatments include hydrofluoride burns. Hydrofluoride is found in air conditioning cleaners and petroleum refineries. Treatment of hydrofluoride burns should include topical or locally injected calcium gluconate to bind fluorine ions. Intra-arterial calcium gluconate can provide pain relief and preserves arteries from necrosis, whereas intravenous (IV) calcium repletes resorbed calcium stores. Topical calcium carbonate gel and quaternary ammonium compounds detoxify fluoride ions. This mitigates the leaching of calcium and magnesium ions by the hydrofluoric acid from the affected tissues and prevents potentially severe hypocalcemia and hypomagnesemia that predispose to cardiac arrhythmias. (See Schwartz 10th ed., pp. 479–480.)

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The area most amenable to salvage by resuscitative and wound management techniques following thermal injury is called the

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