Figure 4-49.-Electrical burns.

complicated by the fact that white phosphorus particles ignite upon contact with air.

Superficial burns caused by simple skin contact or burning clothes should be flushed with water and treated like thermal burns. Partially embedded white phosphorus particles must be continuously flushed with water while the first aid provider removes them with whatever tools are available (i.e., tweezers, pliers, forceps). Do this quickly, but gently. Firmly or deeply embedded particles that cannot be removed by the first aid provider must be covered with a saline-soaked dressing, and this dressing must be kept wet until the victim reaches a medical treatment facility. The wounds containing embedded phosphorus particles may then be rinsed with a dilute, freshly mixed 1% solution of copper sulfate. This solution combines with phosphorus on the surface of the particles to form a blue-black cupric phosphite covering, which both impedes further oxidation and facilitates identification of retained particles. Under no circumstances should the copper sulfate solution be applied as a wet dressing. Wounds must be flushed thoroughly with a saline solution following the copper sulfate rinse to prevent absorption of excessive amounts of copper. (Copper has been associated with extensive intravascular hemolysis.) An adjunct to the management of phosphorus burn injuries is the identification of the retained phosphorescent particles in a darkened room during debridement.

NOTE: Combustion of white phosphorus results in the formation of a severe pulmonary irritant. The ignition of phosphorus in a closed space (such as the BAS tent or sickbay) may result in the development of irritant concentrations sufficient to cause acute inflammatory changes in the tracheobronchial tree. The effects of this gas, especially during debridement, can be minimized by placing a moist cloth over the nose and mouth to inactivate the gas and by ventilating the tent.