Dangerous error in AAOS text

[HuiNeng]

The 9th edition of Emergency Care and Transportation of the Sick and Injured says on page 522,

The only time you should not irrigate the contact area with water is when a poison reacts violently with water, such as contamination with phosphorus or elemental sodium.

(Emphasis added.)

They mean, of course, potassium. Phosphorus must be stored under water to prevent spontanaeous combustion with atmospheric oxygen.
The workbook compounds the error on page 175 with question 24 which suggests applying a dry dressing. Great, now the patient has thermal burns from a flaming 4x4. The error repeats on workbook pages 177 and 179.

But what do I know. I'm just a lowly EMT-B student with a postgraduate science degree :glare:. I played with phosphorus in high school B). I have a scar to prove it :blush:.

 

[rescue99]

The 9th edition of Emergency Care and Transportation of the Sick and Injured says on page 522, (Emphasis added.)

They mean, of course, potassium. Phosphorus must be stored under water to prevent spontanaeous combustion with atmospheric oxygen.
The workbook compounds the error on page 175 with question 24 which suggests applying a dry dressing. Great, now the patient has thermal burns from a flaming 4x4. The error repeats on workbook pages 177 and 179.

But what do I know. I'm just a lowly EMT-B student with a postgraduate science degree :glare:. I played with phosphorus in high school B). I have a scar to prove it :blush:.

AAOS is filled with errors. The Basic text is the least of them from my prospective. Burns, which are normally dressed pre-hospital with dry dressings, are changed to wet in the basic text. Burn dressings are cause specific....usually dry but certainly not always.

Do take the time to contact AAOS publishes on their error. Perhaps they can get it corrected before the new text goes to print...which is very soon.

 

[mycrofft]

Pure phosphorous will ignite on exposure to active atmosphere (O2, Cl, Fl).

A number of pure lightweight metals will ignite on exposure to air or other active atmospheres, but exposure to a pure chemical are very very rare. Burns from phosphorous will primarily be burning phosphorous salts such as are found in flares, other pyros, and fertilizer. Military "willy peter" rounds can put burning elemental phosphrous on you, tx is mineral oil or other means to exclude air if tiny, but if it's big it has to come off because the body's fluids will cause it to continue to release heat.

Elemental potassium, calcium, sodium, and phosphrous will also cause chemical burns as well as ignition burns, but again, how often will you be exposed to elemental materials.

 

[HuiNeng]

tx is mineral oil or other means to exclude air if tiny

http://emedicine.medscape.com/article/833585-treatment
Here's a bit from eMedicine: CBRNE - Incendiary Agents, White Phosphorus: Treatment & Medication

Prehospital Care

Direct prehospital management toward the evaluation and management of trauma.

* Secure the scene because live munitions may be in the area.
* Perform ABCs of resuscitation.
* Terminate further oxidation of phosphorus by irrigation or placement of saline-soaked and/or water-soaked pads on areas of exposure.
o Do not use an oily or greasy dressing because the element is lipid soluble and can penetrate into the tissue.(emphasis added)
o Remove contaminated clothing because it may re-ignite and cause more extended and worsened burns than those sustained with white phosphorus alone.

So, don't use mineral oil. Copper sulfate is also contraindicated.

Yeah, we probably won't see much willie peter in the civilian EMS market, but fools do bring home souvenirs from the sandbox. I'm ticked because we're constantly told to do what the doctor ordered and not use our own knowledge (if any ^_^) yet this textbook has this gawdawful error. Amusingly, the orange book goes on to say that alcohol reduces reaction time.

 

[lightsandsirens5]

I thought WP had to be removed from the pt because total air exclusion is next to impossible.

I really hope I never have to deal with a Willy Pete burn......

~~~~~~~~

And I would defiantly contact AAOS and point that out to them.

 

[mycrofft]

White Phosphorous (WP, Willy Peter)


I had a reply post here but the WIKI article and CDC PDF are a lightyear past me.
http://en.wikipedia.org/wiki/White_phosphorus
Expediently, get the phosphorous off fast, smother the remainder fast, and get the pt tx'ed fast.

(yikes)

 

[MrBrown]

It's an AAOS book, what do you expect?

 

[Aidey]

Now, could they be referring to phosphorous based chemical compounds like powdered fertilizers and such? I was under the impression that water shouldn't be used to rinse those off.

 

[Veneficus]

If I may...

Assuming that a patient has some kind of hazardous material like a flammable solid burning on them perhaps the best course of action for an EMT-B is to decide the scene is unsafe and not get any more involved.

There are reasons we have hazmat experts and firefighters. You should not be getting your firefighting nor your hazmat training in EMT class.

Without the proper knowledge and equipment, the chances of hurting yourself or your team members are very real, especialy when dealing with flammable solids.

 

[mycrofft]

Texts are written by people sitting in offices.

If you have a wound with a harmful agent in it and I run get a garden or fire hose with lots of gallons per second and literally flood at (reasonable) pressure that area, there will be relative benefit if I do it FAST and I don't overdo it or force the agent deeper. Text authors are thinking about someone dabbling Sterile Normal Saline irrigation solution or a drinking fountain or such onto a wound.