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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.
While beginning to wear contact lenses, I had an experience which the use of the Morgan Lens saved the day.
I was just finishing a sixteen-hour shift as manager and staff nurse of the ED when I was notified that they had received a bomb threat. Disaster situation were part of my duties, so I went into action. By 4:00 AM, I realized I still had my contacts in. So I got a container and soaked them in an eye solution from our eye tray. I arrived home with enough time to take a quick nap before returning to work for another sixteen-hour shift. When I put my contacts in, I felt like someone had placed a hot poker into my eyes. I took the contacts out, but my eyes continued to burn and were also fire engine red. I did report to work at 7:00 AM but my eyes continued to burn. I then decided the best thing I could do was to irrigate, so I placed a Morgan lens into both eyes and irrigated with 1000 cc of lactated Ringer's. Laying down during the irrigation process was relaxing and I felt no discomfort while my eyes were irrigated. After the process, the burning was relieved and I was able to complete my shift without further discomfort.Registered Nurse (South Carolina)
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.