Fosfor biały powoduje rozległe i głębokie oparzenia. Substancja ta w kontakcie ze skórą wchłania się i penetruje w głąb tkanek. Ze względu na toksyczne właściwości fosforu białego oparzenie nawet niewielkiej powierzchni ciała może doprowadzić do zgonu.
Fosfor biały to toksyczny i skrajnie łatwopalny środek chemiczny, który zapala się samoczynnie w powietrzu w temperaturze około 34 stopni C. Palący się fosfor osiąga temperaturę ponad 1000 stopni. W 1980 roku w Konwencji Genewskiej zabroniono wykorzystywania bojowych środków rażenia zawierających tę substancję.
Do oparzeń fosforem białym dochodzi jednak nie tylko na polu walki, ale także wskutek katastrof przemysłowych, w trakcie używania sztucznych ogni, w zakładach produkujących m.in. fajerwerki, nawozy sztuczne, pestycydy, detergenty, zapałki czy trutki na gryzonie. Części bomb z fosforu białego z czasów II wojny światowej wciąż można znaleźć na plażach – wyglądem przypominają bursztyny.
Obrażenia skóry wskutek oparzenia fosforem białym
Fosfor biały w zetknięciu się z lipidami skóry i tłuszczem tkanki podskórnej wchłania się i penetruje w głąb tkanek. Może doprowadzić do przepalenia na wylot wszystkich tkanek – ścięgien, mięśni, stawów czy kości. Fosfor biały nie powoduje oparzeń I stopnia, tylko pośrednie lub głębokie oparzenia. Obrażenia mają postać czarnego twardego strupa otoczonego pęcherzami. Toksyczne właściwości fosforu białego sprawiają, że oparzenie nawet niewielkiej powierzchni ciała może doprowadzić do zgonu. Absorpcja fosforu do krwi może wywołać m.in. zespół niewydolności narządowej.
Obrażenia spowodowane oparami fosforu białego
W trakcie spalania fosforu białego tworzy się gęsty dym o wysokiej temperaturze. Wskutek powstania dymu wytwarza się pięciotlenek fosforu, który pod wpływem wilgoci powietrza zmienia się w kwas fosforowy. Kwas fosforowy powoduje miejscowe podrażnienia skóry i śluzówek dróg oddechowych. Wywołuje m.in. łzawienie oczu, światłowstręt i skurcz powiek oraz silny kaszel. Wdychanie oparów fosforu białego czy połknięcie tej substancji powoduje ostre i przewlekłe uszkodzenia tkanek i może doprowadzić do toksycznego obrzęku płuc.
Pierwsza pomoc w przypadku oparzenia fosforem białym
Powierzchnię, na której znajduje się fosfor biały, należy przykryć wilgotnym materiałem i zablokować dopływ powietrza. Kwas fosforowy można zneutralizować 5-proc. wodnym roztworem dwuwęglanu sodowego, bieżącą wodą oraz fizjologicznym roztworem soli kuchennej. Cząstki fosforu mogą ulec kolejnemu samozapłonowi, dlatego niezwłocznie należy mechanicznie usunąć je z ciała. W tym celu można użyć wilgotnego materiału. Ze względów bezpieczeństwa najlepiej usuwać je pod wodą. Na rany nie powinno się stosować substancji oleistych ani tłustych maści, ponieważ przyspieszają wchłanianie fosforu do krwi. Należy przede wszystkim zadbać o szczelność wilgotnego opatrunku na ranie.
Podczas udzielania pierwszej pomocy nie można bezpośrednio dotykać fosforu – rękawiczki nie uchronią przed oparzeniem. Resztki fosforu należy zabezpieczyć – odciąć im dopływ tlenu, włożyć je do wody czy przysypać piaskiem. Osoba udzielająca pomocy powinna również ustawić się pod wiatr, by uniknąć wdychania dymu i toksycznych oparów substancji.
Dalsze leczenie oparzeń fosforem białym
Po usunięciu cząstek fosforu postępowanie z pacjentem jest takie samo jak w przypadku innych oparzeń termicznych i chemicznych. Wdraża się resuscytację płynami regulowaną diurezą godzinową i prowadzi stałą kontrolę czynności życiowych chorego. W zależności od rozległości oparzeń konieczne mogą okazać się procedury chirurgiczne, m.in. przeszczepy skóry. Właściwości lipofilne fosforu białego sprawiają, że gojenie ran oparzeniowych jest utrudnione i długotrwałe.
Źródło: „Leczenie ran oparzeniowych powstałych w wyniku użycia białego fosforu w warunkach polowych”, w: „Leczenie Ran” 2011;8(4):97–102
Przeczytaj także: Pierwsza pomoc przy oparzeniu chemicznym
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