Tar burn: Difference between revisions
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==Background== | ==Background== | ||
* | *Tar is a product of the distillation of coal.<ref name="Bosse">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.</ref> | ||
**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)<ref name="Bosse" /> | |||
**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 | *Tar itself is sterile, but dead tissue underneath is not | ||
==Clinical Features== | ==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== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*VBG, CBC, chem, total CK | *Clinical diagnosis | ||
*[[CXR]] | *Workup should be based on clinical presentation, and may include: | ||
*[[ECG]] | **VBG, CBC, chem, total CK | ||
*UA (assess for myoglobinuria) | **[[CXR]] | ||
*Serial assessments for compartment syndrome | **[[ECG]] | ||
**UA (assess for myoglobinuria) | |||
**Serial assessments for compartment syndrome | |||
==Management== | ==Management== | ||
*Immediately | *Immediately | ||
**Cool tar with cold water until hardens to | **Cool tar with cold water until hardens to limit tissue damage | ||
**Take care to avoid hypothermia | **Take care to avoid hypothermia | ||
*Removal | *Removal | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Derm]] | [[Category:Derm]] | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 06:34, 1 March 2016
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
Diagnosis
- Clinical diagnosis
- Workup should be based on clinical presentation, and may include:
Management
- Immediately
- Cool tar with cold water until hardens to limit tissue damage
- Take care to avoid hypothermia
- Removal
- Case reports suggest using mild solvents like sunflower oil, butter, or mayonnaise for thin layers
- Neosporin cream with polysorbate base (not the petroleum base) dissolves tar and may be used for residual tar
- If thick layer adherent, may use diesel to remove top layers
- However, such hydrocarbons can be absorbed through burns if in contact with pt
- Thus, use diesel only for top layer and use other milder solvents for bottom layer
Disposition
- Admit to burn center for >10% TBSA or significant full thickness injury