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cause a compartment syndrome requiring fasciotomy. Patients with a
normal electrocardiogram (rate and rhythm) in the ED do not appear to be
at significant risk for later development of arrhythmias. Severe electrical
injuries require extensive evaluation for internal injuries, which should be
done at a pediatric tertiary care or regional burn center.
A common electrical injury occurs to the lips and mouth of toddlers who
suck on plugs or extension cords. Deep burns at the corner of the mouth
require specialized attention to prevent severe scarring and contracture (see
Chapter 105 Dental Trauma ). Bleeding from the labial artery 1 to 2 weeks
after injury, when the eschar separates, can result in significant blood loss.
In previous years, children with electrical injuries were hospitalized for 2
weeks, but most burn specialists now manage these children as outpatients
after giving careful instructions to caregivers.

Chemical Burns
More than 25,000 different caustic products are in use in the United States.
Most are either acidic or alkaline. Acids cause coagulation of tissue
proteins, which limit the depth of penetration. Alkali results in liquefaction
and deeper injury. Some organic compounds, including petroleum products,
damage tissue by dissolving the fats in cell membranes. Caustic chemicals
on the skin cause a prolonged period of burning compared with most
thermal burns. The patient may arrive in the ED with the chemical still
present, and so careful attention to decontamination and avoiding staff
exposure is crucial.
The chemical exposure should be removed as quickly as possible, most
often using irrigation. Close consultation with a toxicologist or poison
control center is recommended as water irrigation can worsen some
chemical burns, and specific antidotes are indicated for specific exposures
(see Chapter 102 Toxicologic Emergencies for further details).
Edema of the underlying tissue can make full-thickness injuries appear
deceptively superficial. A thorough examination is necessary to identify

other areas of skin exposed from splashes or contact that also require
irrigation. Chemical burns to the eye can threaten vision and, after starting
irrigation, require prompt consultation with an ophthalmologist.
Consultation with a burn specialist and admission are recommended at
smaller percentages of BSA with chemical burns than with thermal injuries.