Ver el código de «Tar burn»

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==Background==

[[File:1024px-0118Hot-mix asphalt concrete manual pouring-paving in the repair and maintenance 19.jpg|thumb|Hot asphalt mixer.]]
*Tar is a product of the distillation of coal.<ref name="Bosse">Bosse GM, et al. Hot asphalt burns: a review of injuries and management options. Am J Emerg Med. 2014 Jul;32(7):820.e1-3.</ref>
**Asphalt (now more commonly used than tar) and tar are both forms of ''bitumen''
*Currently used mainly for roofing and road paving
**When used for these purposes, tar/asphalt is heated to between 140-190°C (for paving) and 210-270°C (for roofing)<ref name="Bosse" />
**Injuries limited almost exclusively to occupational exposure in these fields
*Tar/asphalt is highly viscous and sticks to skin, making it difficult to remove and leading to more severe burns
*Tar itself is sterile, but dead tissue underneath is not


==Clinical Features==

[[File:John Meintz, punished during World War I - NARA - 283633 (restored and edited v.2.).jpg|thumb|Mn who was "tarred and feathered."]]
*Viscous black substance on skin in setting of history of working with coal tar or asphalt
**May be hardened or still relatively fluid on presentation to ED


==Differential Diagnosis==

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{{Caustic burn types}}
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==Evaluation==

*Clinical diagnosis
*Workup should be based on clinical presentation, and may include:
**VBG, CBC, chem, total CK
**[[Special:MyLanguage/CXR|CXR]]
**[[Special:MyLanguage/ECG|ECG]]
**[[Special:MyLanguage/Urinalysis|Urinalysis]] (assess for myoglobinuria)
**Serial assessments for compartment syndrome


==Management==

*Immediate treatment
**Cool tar with cold water until hardened to stop burning and limit tissue damage
**Take care to avoid hypothermia
*Removal of tar/asphalt (unless small area, will generally occur in inpatient setting)
**Needs to be dissolved as manual debridement of hardened tar/asphalt damages underlying tissue<ref name="Iuchi">Iuchi M, et al. The comparative study of solvents to expedite removal of bitumen. Burns. 2009 Mar;35(2):288-93.</ref>
**The best solvents are chemically similar to tar/asphalt ("like dissolves like") - suggested agents include baby oil, sunflower oil, butter, and mayonnaise<ref name="Iuchi" /><ref name="Bosse" />
**Neosporin ointment has a petroleum base and is successful at slowly dissolving tar/asphalt (may also help prevent infection)<ref name="Bosse" />
**Mineral oil has also been identified as a safe, non-toxic, and effective means of dissolving tar/asphalt<ref name="Carta">Carta T, et al. Use of mineral oil Fleet enema for the removal of a large tar burn: a case report. Burns. 2015 Mar;41(2):e11-4.</ref>


==Disposition==

*Admit or transfer to burn center for:
**>10% [[Special:MyLanguage/TBSA|TBSA]] (>5% for full thickness injury)
**Burns of face, eyes, ears, genitalia, joints
**Circumferential burns
**Airway involvement
**Significant comorbidity


==See Also==

*[[Special:MyLanguage/Burns|Burns]]


==References==

<references/>

[[Category:Dermatology]]
[[Category:GI]]
[[Category:Toxicology]]
[[Category:Trauma]]
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