Solid Metal Chemical and Thermal Injury Management

Area of Science:

• Military medicine
• Toxicology
• Burn management

Background:

• White phosphorous (WP) causes severe caustic and thermal injuries.
• WP is frequently used in military munitions and smoke screens.
• Military clinicians require expertise in WP injury management.

Purpose of the Study:

• To review the identification and management of white phosphorous injuries.
• To outline long-term sequelae of WP exposure.
• To inform clinical practice and military guidelines.

Main Methods:

• A narrative review of English-language manuscripts on WP injuries.
• Data curated from PubMed and Medline up to January 31, 2024.
• Analysis guided by the Scale for the Assessment of Narrative Review Articles.

Main Results:

• WP injuries present with characteristic wounds, smoke, garlic odor, and spontaneous combustion.
• Key management includes decontamination, aqueous irrigation/submersion, and topical cooling to prevent ignition.
• Disposal of contaminated materials is crucial; long-term sequelae include death and jaw osteonecrosis.
• Current Tactical Combat Casualty Care guidelines do not address WP injuries.

Conclusions:

• Education on WP injury and sequelae is vital for military clinicians.
• Both resource-replete and limited settings can adapt management strategies.
• Burn wound management guidelines must integrate specific WP treatment principles.