White phosphorus burn. Case report

Abstract

White phosphorus bum is a special subtype of chemical bums, rarely encountered and is very limited in literature. Case Presentation On January 11, 2009, an 18-year-old male was transferred to the Emergency room (ER), due to exposure to military attack with White Phosphorus shell, with multiple scattered patches of full thickness bum, surrounded by sloughed tissue, involving 30% of his body surface area, distributed in both upper and lower limbs and right shoulder, a clinical diagnosis of white phosphoms bum was made. Airway was secured, without signs of inhalation bums; resuscitation fluid was initiated, irrigation with diluted sodium bicarbonate solution and wet dressing were done. In the Bum Unit, White smoke was noticed coming up from the wounds which became deeper, with extensive necrotic tissue, apparent localized injuries weren’t correlated with underlying severe deep destruction. In the operation room, debridement and excision for dead tissues and removing phosphoms particles was accomplished, transferred to ICU for monitoring of vital signs, electrolyte disturbance and ECG changes where he was managed accordingly. After 8 days of hospitalization, the patient was relatively well, and discharged without manifestations of systemic complication of white phosphoms bum. White phosphoms is transparent combustible substance, associated with extensive full thickness bum injury with delayed wound healing. In our case, the management include irrigation by diluted sodium bicarbonate solution at ER, whereas, only water have been proved to prevent deaths , early excision and massive debridement of particles was accomplished, electrolyte disturbance was noticed as a complication.