We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Tar burn
From WikEM
Contents
Background
- Tar is a product of the distillation of coal.[1]
- Asphalt (now more commonly used than tar) and tar are both forms of bitumen
- Currently used mainly for roofing and road paving
- When used for these purposes, tar/asphalt is heated to between 140-190°C (for paving) and 210-270°C (for roofing)[1]
- Injuries limited almost exclusively to occupational exposure in these fields
- Tar/asphalt is highly viscous and sticks to skin, making it difficult to remove and leading to more severe burns
- Tar itself is sterile, but dead tissue underneath is not
Clinical Features
- Viscous black substance on skin in setting of history of working with coal tar or asphalt
- May be hardened or still relatively fluid on presentation to ED
Differential Diagnosis
Caustic Burns
- Caustic ingestion
- Caustic eye exposure (Caustic keratoconjunctivitis)
- Caustic dermal burn
- Airbag-related burns
- Hydrofluoric acid
- Tar burn
- Cement burn
Evaluation
- Clinical diagnosis
- Workup should be based on clinical presentation, and may include:
- VBG, CBC, chem, total CK
- CXR
- ECG
- Urinalysis (assess for myoglobinuria)
- Serial assessments for compartment syndrome
Management
- Immediate treatment
- Cool tar with cold water until hardened to stop burning and limit tissue damage
- Take care to avoid hypothermia
- Removal of tar/asphalt (unless small area, will generally occur in inpatient setting)
- Needs to be dissolved as manual debridement of hardened tar/asphalt damages underlying tissue[2]
- The best solvents are chemically similar to tar/asphalt ("like dissolves like") - suggested agents include baby oil, sunflower oil, butter, and mayonnaise[2][1]
- Neosporin ointment has a petroleum base and is successful at slowly dissolving tar/asphalt (may also help prevent infection)[1]
- Mineral oil has also been identified as a safe, non-toxic, and effective means of dissolving tar/asphalt[3]
Disposition
- Admit or transfer to burn center for:
- >10% TBSA (>5% for full thickness injury)
- Burns of face, eyes, ears, genitalia, joints
- Circumferential burns
- Airway involvement
- Significant comorbidity
See Also
References
- ↑ 1.0 1.1 1.2 1.3 Bosse GM, et al. Hot asphalt burns: a review of injuries and management options. Am J Emerg Med. 2014 Jul;32(7):820.e1-3.
- ↑ 2.0 2.1 Iuchi M, et al. The comparative study of solvents to expedite removal of bitumen. Burns. 2009 Mar;35(2):288-93.
- ↑ Carta T, et al. Use of mineral oil Fleet enema for the removal of a large tar burn: a case report. Burns. 2015 Mar;41(2):e11-4.
Authors
Kevin Lu, Michael Holtz, Daniel Ostermayer, Ross Donaldson, Neil Young
