Author: Amshel CE, Fealk MH, Phillips BJ, Caruso DM. Department of Surgery, Maricopa Medical Center, Phoenix, AZ 85008, USA.
Journal: Burns. 2000 Aug;26(5):493-7.
Abstract: Chemical burns are associated with significant morbidity, especially anhydrous ammonia burns. Anhydrous ammonia is a colorless, pungent gas that is stored and transported under pressure in liquid form. A 28 year-old patient suffered 45% total body surface area of second and third degree burns as well as inhalational injury from an anhydrous ammonia explosion. Along with fluid resuscitation, the patient’s body was scrubbed every 6 h with sterile water for the first 48 h to decrease the skin pH from 10 to 6-8. He subsequently underwent a total of seven wound debridements; initially with allograft and then autograft. On post burn day 45, he was discharged. The injuries associated with anhydrous ammonia burns are specific to the effects of ammonium hydroxide. Severity of symptoms and tissue damage produced is directly related to the concentration of hydroxyl ions. Liquefactive necrosis results in superficial to full-thickness tissue loss. The affinity of anyhydrous ammonia and it’s byproducts for mucous membranes can result in hemoptysis, pharyngitis, pulmonary edema, and bronchiectasis. Ocular sequelae include iritis, glaucoma, cataracts, and retinal atrophy. The desirability of treating anhydrous ammonia burns immediately cannot be overemphasized. Clothing much be removed quickly, and irrigation with water initiated at the scene and continued for the first 24 h. Resuscitative measures should be started as well as early debridement of nonviable skin. Patients with significant facial or pharyngeal burns should be intubated, and eyes irrigated until conjunctivae sac pH below 8.5 is achieved. Although health care professionals need to be prepared to treat chemical burns, educating the public, especially those workers in the agricultural and industrial setting, should be the first line of prevention.
Thanks for the opportunity to sing the praises of the Morgan Lens! Those of us who have been in the field for a while wonder what we ever did without them! We find two general uses for the lenses. One is for contact irritation: most typically, splashes. After local anesthetic, for ease of insertion, the lenses fit comfortably on patients of all ages and provide gentle and thorough irrigation of irritant substances. We have many cases of this type. The second most common use is for patients show suffer multiple injuries due to automobile accidents, major trauma, burns, falls, etc. Not only does the lens thoroughly irrigate the eye, removing most or all of the debris that has accumulated, it more importantly frees up the nurse's hands so that she can perform other lifesaving functions. Quite frankly, eye irrigation was treated as "the bottom of the list" often because other patient's other injuries were more devastating with higher morbidity and mortality. Particularly in the burn patient, the soothing effect of the irrigation and potential to prevent infection or further injury, make it an easy to use, valuable asset for patient care.
Registered Nurse (Montana)
MorTan Inc.
Mailing Address:
P.O. Box 8719
Missoula, MT 59807
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329 East Pine St
Missoula, MT 59802
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Toll-Free Telephone: 1-800-423-8659
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Email: mortan@morganlens.com
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The Morgan Lens is used in 90% of hospital emergency departments in the USA and can be inserted in less than 20 seconds. There simply is no other "hands-free" method of eye irrigation. Nothing else frees medical personnel to treat other injuries or to transport the patient while irrigation is underway. Nothing is more effective at treating ocular chemical, thermal, and actinic burns or removing non-embedded foreign bodies, even when the patient's eyes are closed tightly. Its design makes it simple and straightforward to use so minimal training is required.