RESUMO
This is a case report of decontamination and treatment of a 70% hydrofluoric acid (HF) dermal splash injury. A worker was splashed with 70% HF, sustaining approximately 10% TBSA first- to third-degree chemical skin burns of the face, trunk, and left thigh and leg. Initial decontamination involved water rinsing, removal of contaminated clothing, more water rinsing, topical application of magnesium oxide, and administration of intravenous narcotics for management of severe pain. After a delay of approximately 3 hours, active skin washing with Hexafluorine®, 5 L, was performed, followed by intravenous, intradermal perilesional, and topical inunction administration of calcium gluconate. Pain relief and a cooling sensation were quite prompt after Hexafluorine® decontamination. Surgical debridement and skin grafting of the more severe burns were required. No significant systemic toxicity developed, although this has occurred in previously reported similar concentrated HF dermal splash exposure cases, some of which resulted in fatality. While burns did develop, the patient was released from the intensive care service after 2 days and, after skin grafting, had a good outcome at 90-day follow-up. Even after a long delay, decontamination with Hexafluorine® appeared to be beneficial in this case.
Assuntos
Acidentes de Trabalho , Queimaduras Químicas/terapia , Gluconato de Cálcio/uso terapêutico , Descontaminação/métodos , Compostos de Flúor/uso terapêutico , Ácido Fluorídrico/efeitos adversos , Adulto , Queimaduras Químicas/patologia , Tratamento de Emergência , Seguimentos , Humanos , Masculino , Metalurgia , Resultado do TratamentoRESUMO
Um trabalhador sofreu projeção de ácido hidrofluorídrico a 70% de concentração em aproximadamente 10% de superfície corpórea (SC), causando queimaduras químicas de 1º, 2º e 3º graus em face, tronco e membro inferior esquerdo. A descontaminação inicial envolveu enxágue com água, remoção da vestimenta, e enxágue adicional com mais água, bem como aplicação tópica de solução de óxido de magnésio e analgésico intravenoso para controle da dor. Após retardo de aproximadamente 3 horas, realizou-se descontaminação ativa com 5 litros de solução ativa de um quelante anfótero, Hexafluoriner, seguida de aplicação intravenosa, intradérmica perilesional e tópica de gluconato de cálcio. Alívio da dor e sensação refrescante foram relatados após aplicação do quelante. Não ocorreu intoxicação sistêmica significante, embora isto tenha ocorrido em casos previamente relatados de exposição ao ácido hidrofluorídrico concentrado. Apesar das queimaduras, o paciente foi liberado da Unidade de Terapia Intensiva após 2 dias, e os tratamentos cirúrgicos posteriores, enxertia, tiveram bons resultados.
A worker was splashed with 70% hydrofluoric acid (HF), sustaining approximately 10% total body surface area (TBSA) 1st-3rd degree chemical skin burns on the face, trunk and left leg. Initial decontamination involved water rinsing, removal of clothing, and more water rinsing, as well as topical application of a magnesium oxide solution and administration of intravenous narcotics for management of severe pain. After a delay of approximately 3 hours, the active skin decontamination solution Hexafluoriner, 5 liters, was used followed by intravenous, intradermal perilesional and topical application of calcium gluconate. Pain relief and a cooling sensation were quite prompt. No significant systemic toxicity occurred, although this has occurred in previously reported concentrated HF exposure cases. While burns did develop, the patient was released from the intensive care service after 2 days and after skin grafting had a good outcome.