Management of Alkaline Burn on the Shoulder

Immediate Decontamination (First Priority)

The American College of Cardiology recommends immediate irrigation with copious running water for at least 15 minutes to remove alkaline substances, as outcomes are directly dependent on how quickly decontamination begins 1
The American Heart Association suggests that alkaline burns may require longer irrigation than acid burns due to their tendency to penetrate deeper into tissues 2, 1
If dry alkaline powder is present, it is recommended to brush it off before water irrigation to prevent exothermic reactions 1
The American College of Surgeons recommends removing all contaminated clothing immediately to prevent the chemical from being trapped against the skin and causing continued injury 1

The American Burn Association recommends cooling the burn with clean running water (15-25°C) for 5-20 minutes if the burn area is small (<20% TBSA in adults) to limit burn depth and reduce pain 3, 4
The American Society of Anesthesiologists advises against cooling if the patient shows signs of shock or if the burn covers >20% TBSA in adults or >10% in children, as this increases hypothermia risk 5, 6
Assessment of burn depth, size, and location is crucial to determine whether specialized burn center referral is needed 3

The American Society of Anesthesiologists recommends providing adequate analgesia during wound care, as alkaline burns are typically very painful 6
The use of short-acting opioids and titrated intravenous ketamine is suggested for severe pain, as ketamine is particularly effective for burn-induced pain and can reduce morphine requirements 6, 1

The American College of Surgeons recommends cleaning the wound with tap water, isotonic saline, or an antiseptic solution in a clean environment after proper pain control is established 5, 3
Application of a moist dressing such as petrolatum-based ointment or antibiotic ointment with a clean nonadherent dressing is advised 3
The American Burn Association suggests avoiding prolonged use of silver sulfadiazine on superficial burns as it may delay healing 3
Topical antibiotics should not be used as first-line treatment, but rather reserved for infected wounds to prevent antimicrobial resistance 5, 3

Referral to a burn center or emergency department is recommended if the burn involves the face, hands, feet, or genitals 3
Referral is also recommended if the burn covers >10% TBSA in adults or >5% in children 3
Any full-thickness (third-degree) burn or signs of respiratory involvement require immediate referral 1
Signs of infection, such as increasing pain, redness, swelling, or purulent discharge, also necessitate referral 3

Delaying irrigation is critical to avoid, as every minute counts in removing alkaline substances 1
Applying ice directly to burns, using butter or oil, or breaking blisters can cause additional tissue damage or increase infection risk 3, 4, 1