In chemical burns, which is the most critical initial management step?

• A. Immediate copious irrigation and decontamination; identify chemical type and continue irrigation until neutralization or hazard removed.
• B. Apply topical antibiotic ointment and cover.
• C. Delay irrigation until a chemical specialist arrives.
• D. Elevate the limb and monitor without irrigation.

Answer: (A)

In chemical burns, the main danger is ongoing tissue damage from residual chemical. The most critical initial step is rapid, copious irrigation and decontamination to wash away the chemical before it penetrates deeper tissues. Use clean running water, remove contaminated clothing, and flush the area for as long as needed—typically at least 15–30 minutes, longer for large exposures or certain chemicals. If possible, identify the chemical type to guide any further specific decontamination steps, but irrigation should continue until the chemical hazard is removed or neutralization is achieved. This approach minimizes ongoing caustic injury and reduces the risk of deeper burns or systemic absorption.

Topical antibiotics or ointment don’t address the ongoing chemical damage and can delay decontamination. Delaying irrigation until a specialist arrives allows continuous exposure and worsens injury. Elevating the limb and monitoring without irrigation fails to remove the chemical and does not mitigate tissue damage.