By Rob Goodier
NEW YORK (Reuters Health) Jan 28 - Asphalt burns can be complicated to treat because asphalt is often stuck to the injury and can lead to infection. A new literature review suggests guidelines for immediate treatment: ABCC, or Airway, Breathing, Circulation, and Cooling.
"These guidelines emphasize the principles of early cooling, gradual removal of adherent asphalt using topical antibiotics, and avoidance of the use of topical agents which are likely to result in tissue toxicity. Once the asphalt is removed, standard burn management is advised," Dr. George Bosse of the University of Louisville in Kentucky and colleagues write in their report, published online January 21 in the American Journal of Emergency Medicine.
Asphalt burns most often occur during roofing and road repair. Roofing accidents account for deeper burns because the asphalt is heated to a higher temperature, 210-270 degrees C, compared to paving asphalt, which is heated to 140-190 degrees C, the researchers note.
Injuries can include blunt trauma and fractures from falls from buildings and traffic accidents and burns from spills, pipe breakage, and other accidents.
At the start of treatment, "Early cooling of involved areas is critical," Dr. Bosse told Reuters Health in an email. The researchers recommend running cool or even lukewarm water over the wound, and ice packs can also be applied. Cold water and immersion may not be preferable due to the risk of hypothermia, they write.
Physicians should then use a solvent to remove the asphalt. Solvents that have been used in these cases include topical antibiotics, petroleum jelly, De-Solv-it, sunflower oil, baby oil, liquid paraffin, butter, mayonnaise, and Moist Exposed Burn Ointment (MEBO).
The researchers recommend topical antibiotics. Antibiotic ointments are readily available and more commonly described in the literature than other products.
"They would also be used in the treatment of burns after asphalt removal. For these reasons, topical antibiotics are our first choice in the treatment of burns with adherent asphalt," they write.
Reports describe the removal of asphalt 12 hours after applying Neosporin (Ashbell TS et al, 1967) and as soon as one hour after applying a liquid paraffin-based solvent (Juma A, 1994). But a separate study found that patients prefer a slower removal of the asphalt over the course of several days (Hill MB et al, 1984). One study described picking off the asphalt from some patients and, for other patients, letting it fall off as the wound healed (James NK et al, 1990).
The researchers suggest changing dressings every four hours until the asphalt naturally separates from the injury.
Physicians should not use kerosene, gasoline, or ethanol as solvents. They can damage tissue, Dr. Bosse and his colleagues write.
"Aggressive early cooling and subsequent gradual removal of asphalt with topical antibiotics are the cornerstones of treatment," the researchers conclude.
Am J Emerg Med 2014.
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