White phosphorus is a highly reactive chemical substance that ignites spontaneously upon contact with air, producing a bright flame and dense smoke. Burns caused by white phosphorus are dangerous due to this autoignition property; the chemical continues to burn as long as it is exposed to oxygen. This leads to deep tissue damage, as burning particles can embed themselves within the skin and underlying tissues. White phosphorus can also be absorbed through the skin, leading to serious systemic toxicity affecting multiple organ systems.
Initial Response Steps
Ensuring the safety of the rescuer is the first priority. Rescuers should wear appropriate protective gear to prevent direct contact. The immediate step is to extinguish the burning phosphorus by depriving it of oxygen, best achieved by continuously irrigating the affected area with water or saline.
The goal of continuous irrigation is to cool the burn, dilute any remaining phosphorus, and prevent re-ignition. Contaminated clothing should be carefully removed while irrigation continues, as these materials may harbor phosphorus particles. Visible white phosphorus particles should be removed meticulously using forceps, ideally while submerged under water or under a constant flow of water to prevent reignition.
After initial particle removal and continuous irrigation, cover the burn wound with a wet, airtight dressing. This can be accomplished using water-soaked gauze or a wet cloth, which helps to exclude air. Avoid oily or greasy dressings, as these can facilitate phosphorus absorption. Seek immediate emergency medical assistance; continue cooling the burn throughout transport.
Professional Medical Care
Upon arrival at a medical facility, continuous irrigation and cooling of the burn must continue. Medical personnel will meticulously search for and remove all remaining white phosphorus particles; this process is known as debridement. This surgical debridement is often performed while the affected area is submerged in water or under a constant flow of saline to prevent reignition.
Specialized techniques, such as using a Wood’s lamp, can help identify embedded phosphorus particles, as they may fluoresce under ultraviolet light. Once particles are removed, the burn wound is managed like any other deep chemical burn, with appropriate dressings and infection control. Pain management is also crucial, often requiring strong analgesics due to the severity of the burns.
Patients with white phosphorus burns require close monitoring for signs of systemic toxicity, as phosphorus can be absorbed through the damaged skin. Depending on the extent and depth of the burn, transfer to a specialized burn unit may be necessary for comprehensive care. These units are equipped to handle complex burn wounds and potential systemic complications.
Health Risks and Systemic Effects
In addition to localized tissue damage, white phosphorus can cause severe health risks due to its absorption into the bloodstream. Once absorbed, it can lead to systemic toxicity, affecting various internal organs. One significant complication is hypocalcemia, a dangerous drop in blood calcium levels, which occurs because phosphorus binds with calcium. This imbalance can disrupt physiological functions and lead to cardiac arrhythmias.
Systemic absorption can also cause significant damage to the liver and kidneys, impairing their ability to filter toxins. In chronic or severe exposure, bone necrosis of the jawbone has been observed, historically known as “phossy jaw.” Inhalation of white phosphorus fumes can also lead to respiratory irritation, causing coughing and shortness of breath.
Healing and Aftercare
The healing process for white phosphorus burns is often protracted due to deep tissue destruction. Ongoing wound care, including regular dressing changes and meticulous cleaning, is essential to promote healing and prevent infection.
Patients may experience significant scarring and disfigurement, impacting physical function and appearance. Physical therapy is crucial for functional recovery, helping to restore movement and reduce contractures from severe scarring. Psychological support is also important due to the traumatic nature of the injury and potential for long-term physical changes. Regular follow-up appointments monitor healing progress, manage delayed complications, and address ongoing needs.