Therapeutic interventions needed for specific chemical agents include which of the following?

A. Prolonged saline irrigation of eyes injured by concentrated sodium hydroxide using a scleral lens with an irrigating sidearm.

C. Intra-arterial infusion of calcium gluconate for relief of refractory deep tissue pain due to hydrofluoric acid injury.

D. Use of propylene glycol to remove residual phenol following water lavage.

DISCUSSION: An eye injured by a strong chemical agent must be irrigated immediately at the site of the accident to minimize corneal damage. Prolonged irrigation for 12 to 72 hours is recommended for eyes injured by a strong alkali solution. Irrigation is difficult because of blepharospasm unless a modified scleral contact lens with an irrigating sidearm is used. Emetics should be avoided in the early treatment of patients following chemical ingestion since additional injury of the esophagus, oropharynx, and upper airway may be caused as the chemical is regurgitated. The intra-arterial infusion of calcium gluconate has been reported to limit tissue damage and relieve pain, but local excision of the involved tissue may be necessary for definitive control of pain and removal of the injured tissue. Even though phenol is only slightly soluble in water, initial water lavage of burns caused by phenol should be carried out. Following that initial lavage, the involved area should be washed with a lipophilic solvent such as polyethylene glycol, propylene glycol, or glycerol to remove the residual phenol. A dilute 0.5% to 1% solution of copper sulfate can be used as a wash to facilitate identification and impede the ignition of embedded phosphorus particles. If excessive amounts of copper sulfate are absorbed through the injured tissues, intravascular hemolysis can occur and may cause renal failure. Consequently, one should avoid the use of more concentrated solutions of copper sulfate and should never apply the copper sulfate solution as a soak. The important principle of treatment is to prevent ignition of the particles by preventing their exposure to air, and that can be done most safely by applying an occlusive dressing soaked with saline or water.