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White phosphorus
From WikEM
Contents
Background
- White phosphorus is classically among only 2 chemical burns (other is Hydrofluoric Acid) that required an antidote
- The antidote of copper sulfate is controversial and is not universally recommended
- Incendiary agent that spontaneously burns in air and used during WWI, WWII, Vietnam, Korean wars; most recently in Iraq (OIF)
- Usually not seen unless in military or patients exposed to fireworks
- Damage due to both chemical and thermal burn
Complications
- The lethal dose when white phosphorus is ingested orally is 1mg per kg of body weight[1][2]
- Particles that penetrate tissue continue to cause caustic damage until debrided
- Hypocalcemia
- Hypophosphatemia
- Hepatic necrosis
- Death may occur from burns of only 10-15% total body surface area (TBSA)
Differential Diagnosis
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents
- Incendiary agents
- Agent orange
- White phosphorus
- Cyanide chemical weapon agents
- Nerve Agents
- Acetylcholinesterase inhibitors
- Includes household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman) and V-series (VX)
- V-series high viscosity with oily consistency
Management
- ABCs to secure airway especially if there is any sign of oral or facial burns.
- Remove all O2 tanks and tubing from patient
- As healthcare provider, avoid contact with ignited white phosphorus
- Continuous irrigation and grossly debride (use Wood's lamp if available to fluoresce the white phosphorus)[3]
- Wet dressings that cut off O2 exposure to remaining white phosphorus[4]
- Monitor Calcium and Phosphorus levels
- Traditionally, copper sulfate used to both convert white phosphorus and visualize end product (cupric phosphate), but copper is systemically absorbed and may lead to intravascular hemolysis, Renal Failure, and Cardiovascular collapse
- Update Tetanus
Disposition
- Transfer the the patient to a burn care center
References
- ↑ Konjoyan TR.[White phosphorus burns: case report and literature review]. Mil Med. Nov 1983;148(11):881-4
- ↑ Agency for Toxic Substances and Disease Registry (ATSDR). U.S. Department of Health and Human Services, Public Health Service. Toxicological Profile for White Phosphorus. 1997
- ↑ Karunadasa et Al. White Phosphorus Burns Managed Without Copper Sulfate: Lessons From War. Journal of Burn Care & Research: May/June 2010 - Volume 31 - Issue 3 - p503.
- ↑ Rabinowitch IM. et al. Treatment of Phosphorus Burns : With a note on Acute Phosphorus Poisoning. Can Med Assoc J. 1943 Apr;48(4):291-6
Authors
Kevin Lu, Daniel Ostermayer, Vincent Chan, Ross Donaldson, Neil Young
