Tar burn: Difference between revisions

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==Background==
==Background==
[[File:1024px-0118Hot-mix asphalt concrete manual pouring-paving in the repair and maintenance 19.jpg|thumb|Hot asphalt mixer.]]
*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>
*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''
**Asphalt (now more commonly used than tar) and tar are both forms of ''bitumen''
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==Clinical Features==
==Clinical Features==
[[File:John Meintz, punished during World War I - NARA - 283633 (restored and edited v.2.).jpg|thumb|Mn who was "tarred and feathered."]]
*Viscous black substance on skin in setting of history of working with coal tar or asphalt
*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
**May be hardened or still relatively fluid on presentation to ED
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{{Caustic burn types}}
{{Caustic burn types}}


==Diagnosis==
==Evaluation==
*Clinical diagnosis
*Clinical diagnosis
*Workup should be based on clinical presentation, and may include:
*Workup should be based on clinical presentation, and may include:
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**[[CXR]]
**[[CXR]]
**[[ECG]]
**[[ECG]]
**UA (assess for myoglobinuria)
**[[Urinalysis]] (assess for myoglobinuria)
**Serial assessments for compartment syndrome
**Serial assessments for compartment syndrome


==Management==
==Management==
*Immediately
*Immediate treatment
**Cool tar with cold water until hardens to limit tissue damage
**Cool tar with cold water until hardened to stop burning and limit tissue damage
**Take care to avoid hypothermia
**Take care to avoid hypothermia
*Removal
*Removal of tar/asphalt (unless small area, will generally occur in inpatient setting)
**Case reports suggest using mild solvents like sunflower oil, butter, or mayonnaise for thin layers
**Needs to be dissolved as manual debridement of hardened tar/asphalt damages underlying tissue<ref name="Iuchi">Iuchi M, et al. The comparative study of solvents to expedite removal of bitumen. Burns. 2009 Mar;35(2):288-93.</ref>
**Neosporin cream with polysorbate base (not the petroleum base) dissolves tar and may be used for residual tar
**The best solvents are chemically similar to tar/asphalt ("like dissolves like") - suggested agents include baby oil, sunflower oil, butter, and mayonnaise<ref name="Iuchi" /><ref name="Bosse" />
**If thick layer adherent, may use diesel to remove top layers
**Neosporin ointment has a petroleum base and is successful at slowly dissolving tar/asphalt (may also help prevent infection)<ref name="Bosse" />
***However, such hydrocarbons can be absorbed through burns if in contact with pt
**Mineral oil has also been identified as a safe, non-toxic, and effective means of dissolving tar/asphalt<ref name="Carta">Carta T, et al. Use of mineral oil Fleet enema for the removal of a large tar burn: a case report. Burns. 2015 Mar;41(2):e11-4.</ref>
***Thus, use diesel only for top layer and use other milder solvents for bottom layer


==Disposition==
==Disposition==
*Admit to burn center for >10% TBSA or significant full thickness injury
*Admit or transfer to burn center for:
**>10% [[TBSA]] (>5% for full thickness injury)
**Burns of face, eyes, ears, genitalia, joints
**Circumferential burns
**Airway involvement
**Significant comorbidity


==See Also==
==See Also==
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<references/>
<references/>


[[Category:Derm]]
[[Category:Dermatology]]
[[Category:GI]]
[[Category:GI]]
[[Category:Tox]]
[[Category:Toxicology]]
[[Category:Trauma]]

Latest revision as of 19:52, 15 November 2023

Background

Hot asphalt mixer.
  • 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

Mn who was "tarred and feathered."
  • 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

Evaluation

  • Clinical diagnosis
  • Workup should be based on clinical presentation, and may include:
    • VBG, CBC, chem, total CK
    • CXR
    • ECG
    • Urinalysis (assess for myoglobinuria)
    • Serial assessments for compartment syndrome

Management

  • Immediate treatment
    • Cool tar with cold water until hardened to stop burning and limit tissue damage
    • Take care to avoid hypothermia
  • Removal of tar/asphalt (unless small area, will generally occur in inpatient setting)
    • Needs to be dissolved as manual debridement of hardened tar/asphalt damages underlying tissue[2]
    • The best solvents are chemically similar to tar/asphalt ("like dissolves like") - suggested agents include baby oil, sunflower oil, butter, and mayonnaise[2][1]
    • Neosporin ointment has a petroleum base and is successful at slowly dissolving tar/asphalt (may also help prevent infection)[1]
    • Mineral oil has also been identified as a safe, non-toxic, and effective means of dissolving tar/asphalt[3]

Disposition

  • Admit or transfer to burn center for:
    • >10% TBSA (>5% for full thickness injury)
    • Burns of face, eyes, ears, genitalia, joints
    • Circumferential burns
    • Airway involvement
    • Significant comorbidity

See Also

References

  1. ↑ 1.0 1.1 1.2 1.3 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.
  2. ↑ 2.0 2.1 Iuchi M, et al. The comparative study of solvents to expedite removal of bitumen. Burns. 2009 Mar;35(2):288-93.
  3. ↑ Carta T, et al. Use of mineral oil Fleet enema for the removal of a large tar burn: a case report. Burns. 2015 Mar;41(2):e11-4.
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