Phosphorus burns

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [3]

WikiDoc Resources for Phosphorus burns
Articles
Most recent articles on Phosphorus burns Most cited articles on Phosphorus burns Review articles on Phosphorus burns Articles on Phosphorus burns in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Phosphorus burns Images of Phosphorus burns Photos of Phosphorus burns Podcasts & MP3s on Phosphorus burns Videos on Phosphorus burns
Evidence Based Medicine
Cochrane Collaboration on Phosphorus burns Bandolier on Phosphorus burns TRIP on Phosphorus burns
Clinical Trials
Ongoing Trials on Phosphorus burns at Clinical Trials.gov Trial results on Phosphorus burns Clinical Trials on Phosphorus burns at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Phosphorus burns NICE Guidance on Phosphorus burns NHS PRODIGY Guidance FDA on Phosphorus burns CDC on Phosphorus burns
Books
Books on Phosphorus burns
News
Phosphorus burns in the news Be alerted to news on Phosphorus burns News trends on Phosphorus burns
Commentary
Blogs on Phosphorus burns
Definitions
Definitions of Phosphorus burns
Patient Resources / Community
Patient resources on Phosphorus burns Discussion groups on Phosphorus burns Patient Handouts on Phosphorus burns Directions to Hospitals Treating Phosphorus burns Risk calculators and risk factors for Phosphorus burns
Healthcare Provider Resources
Symptoms of Phosphorus burns Causes & Risk Factors for Phosphorus burns Diagnostic studies for Phosphorus burns Treatment of Phosphorus burns
Continuing Medical Education (CME)
CME Programs on Phosphorus burns
International
Phosphorus burns en Espanol Phosphorus burns en Francais
Business
Phosphorus burns in the Marketplace Patents on Phosphorus burns
Experimental / Informatics
List of terms related to Phosphorus burns

Overview

Phosphorus burns are a rarely encountered chemical burn, typically occurring in battle, industrial accidents, or from fireworks. Death may result even with minimal burn areas. Early recognition of affected areas and adequate resuscitation is crucial.

Pathophysiology

Effects on Humans

White phosphorus (WP) can cause injuries and death in three ways;

• By burning deep into tissue
• By being inhaled as a smoke
• By being ingested

Extensive exposure in any way is fatal.

Effects of Exposure to White Phosphorus

Incandescent particles of WP cast off by a WP weapon's initial explosion can produce extensive, deep (second and third degree), burns. Phosphorus burns carry a greater risk of mortality than other forms of burns due to the absorption of phosphorus into the body through the burned area, resulting in liver, heart and kidney damage, and in some cases multi-organ failure. These weapons are particularly dangerous to exposed people because white phosphorus continues to burn unless deprived of oxygen or until it is completely consumed. In some cases, burns are limited to areas of exposed skin because the smaller WP particles do not burn completely through personal clothing before being consumed. "White phosphorus results in painful chemical burn injuries."

Exposure and Inhalation of Smoke

Burning WP produces a hot, dense white smoke. Most forms of smoke are not hazardous in the kinds of concentrations produced by a battlefield smoke shell. Exposure to heavy smoke concentrations of any kind for an extended period (particularly if near the source of emission) does have the potential to cause illness or even death.

WP smoke irritates the eyes and nose in moderate concentrations. With intense exposures, a very explosive cough may occur. However, no recorded casualties from the effects of WP smoke alone have occurred in combat operations and to date, there are no confirmed deaths resulting from exposure to phosphorus smoke.

The Agency for Toxic Substances and Disease Registry has set an acute inhalation Minimum Risk Level (MRL) for white phosphorus smoke of 0.02 mg/m³, the same as fuel oil fumes. By contrast, the chemical weapon mustard gas is 30 times more potent: 0.0007 mg/m³ .

Oral Ingestion

The accepted lethal dose when white phosphorus is ingested orally is 1 mg per kg of body weight, although the ingestion of as little as 15 mg has resulted in death. It may also cause liver, heart or kidney damage. There are reports of individuals with a history of oral ingestion who have passed phosphorus-laden stool ("smoking stool syndrome").

Treatment

Medical Therapy

First aid for this type of burn is complicated by the fact that white phosphorus particles ignite upon contact with air. Superficial burns caused by simple skin contact or burning clothes should be flushed with water and treated like thermal burns. Partially embedded white phosphorus particles must be continuously flushed with water and removal with whatever tools are available (i.e., tweezers, pliers, forceps). This is done quickly but gently. Firmly or deeply embedded particles that cannot be removed must be covered with a saline soaked dressing, which must be kept wet until the victim reaches a medical treatment facility.

The wounds containing embedded phosphorus particles may then be rinsed with a dilute, one percent freshly mixed solution of copper sulfate. This solution combines with phosphorus on the surface of the particles to form a blue-black cupric phosphite covering, which both impedes further oxidation and facilitates identification of retained particles.

Under no circumstances should the copper sulfate solution be applied as a wet dressing. Wounds must be flushed thoroughly with a saline solution following the copper sulfate rinse to prevent absorption of excessive amounts of copper, since copper has been associated with extensive intravascular hemolysis.

An adjunct to the management of phosphorus burn injuries is the identification of the retained phosphorescent particles in a darkened room during debridement.

Combustion of white phosphorus results in the formation of a severe pulmonary irritant. The ignition of phosphorus in a closed space such as the BAS tent or sickbay may result in the development of irritant concentrations sufficient to cause acute inflammatory changes in the tracheobronchial tree. The effects of this gas, especially during debridement, can be minimized 4-80 by placing a moist cloth over the nose and mouth to inactivate the gas and by ventilating the tent.