This review covers the recognition and management of electrical injury, chemical burns, injury from chemicals of mass destruction, cold injury, toxic epidermal necrolysis (TEN), and ionizing radiation burns. Electrical injuries can be divided into low-voltage burns, high-voltage burns, and super-high-voltage burns. Chemical burns are commonly caused by strong alkalis or acids and less commonly by anhydrous ammonia. Chemicals used in war include napalm, white phosphorus, and vesicants such as mustard gas, lewisite, and phosgene. Cold injuries result either from direct freezing (frostbite) or from more long-term exposure to an environment just above freezing (chilblain, pernio, trench foot). TEN, though not a burn, can cause similar tissue damage and is managed similarly in a number of respects. Ionizing radiation burns may be encountered in three settings: (1) deliberate or accidental exposure to radiation in a hospital, laboratory, or industrial environment (by far the most common setting); (2) failure of a nuclear power plant (as at Chernobyl); and (3) nuclear explosion. This review contains 12 figures, 5 tables, and 122 references.
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