Thermal Injuries
Uploaded by
Roman MamunThermal Injuries
Uploaded by
Roman MamunThermal injuries
Presented by Dr.Jashwant
Guidance by Dr. Ganesh Govekar
Dr. S.D. Kalele
Classification
1. Due to exposure to extreme cold
a)General effects: Hypothermia
b)Local effects: Frost bite, Trench foot
2.Due to exposure to extreme heat
a)General effects: Heat stroke, heat cramps, heat
exhaustion
b)Local effects: Burns, scald
Cold
Local effects
Factors influencing:
1.Body built & physique
2.Age
3.Clothing
4.Medium of exposure
Pathology :
1.vasoconstriction: Paleness & blanching of
skin
2.vasoparalysis& vasodilatation: Erythema,
swelling, oedema
3.Blister formation: May involve skin,
subcutaneous tissues, muscles, nerves
-Tissues may be frozen, stiff, hard, necrotic
Frost bite:
-Infarction of peripheral digits& redness, oedema,
necrosis beyond line of demarcation
-Exposure to dry cold
-Temp< 2.5°C
-Also affects nose, ear, face
• Trench foot: Immersion foot
-Exposure to wet cold
-Temp: 5 to8°C
-Blister formation & dry gangrene
General effects:
-Hypothermia
1st stage: cold & shivering
2nd stage: shivering stops, temp<32°C
-Depressed, lethargic, drowsy, sllepy,stupor,
coma
3rd stage: Temp<27°C,Fatal
P.M. findings:
External:
-Rigor mortis starts late, stay longer
-P.M.L. bright red in colour
-Generalised oedema
Internal :
-Organs congested
-Ice crystals in blood vessels, heart, interstial
tissues
-Blood bright red
-Necrosis of pancreas
Medico legal importance:
-Accidental
-Homicidal
-Suicidal not common
Heat
General effects:
1.Heat cramps: Minor’s cramps, stoker’s cramps,
fireman’s cramps
2.Heat prostration: Heat exhaustion, heat
syncope, heat collapse
3.Heat hyperpyrexia: Heat stroke, sun stroke
P.M. findings:
-P.M. caloricity
-R.M. appears early, passes off early
-Decomposition starts early
-organs congested
Burns
Definition: An injury caused by application of
heat or chemical substances to external or
internal surfaces of body, causes destruction of
tissues.
Injury(sec. 44 IPC): Any harm whatever illegally
caused to any person in body, mind, reputation,
property.
Hurt(sec.319 IPC): Any bodily pain, disease,
infirmity caused to any person
Heat: Min.Temp-44°C for 5-6 hours
-Temp. 65°C for 2 seconds
Causes :
-Flame
-Hot liquids
-Chemical, corrosive
-X rays
-U.V. rays
- Electric(Joule)
- Flash burn
- Explosions
- Brush burns, friction burns
- Cement (concret) burns
Degree of burns:
Dupuytren:
1st : Reddening
2nd : Blistering
3rd : Skin partially destroyed, extremely painful
:Scar, no contracture, singeing of hair
4th : Skin completely destroyed
:Scar, not painful
5th :Subcutaneous tissues, deep fascia
:great scaring, deformity
6th : Muscles, bones.
Blister
Wilson:
1st degree(1st&2nd of Dupuytren):
Epidermal
2nd degree(3rd&4th of Dupuytren):
Dermo-Epidermal
3rd degree(5th&6th of Dupuytren):
Deep
Clinical:1. Superficial
2. Deep
Effects depends on:
1.Intensity of heat
2.Duration of exposure
3.Extent of surface involved: rule of nine
4.Site
5.Age :child & old more susceptible
6.Sex : women more susceptible
Causes of death:
1. Shock: Primary (neurogenic) within few hours
Secondary (hypovolemic) within 1-2 days
2.Toxemia: Toxic substances produced due to
burns/ destruction
3.Sepsis : >4-5 days
4. Biochemical disturbances
5. Acute renal failure
6.G.I.T. disturbances: Curling's ulcer,
haemorrhage in intestine
7. Asphyxia : CO& CO2 poisoning
8. Glottic &/ pulmonary Odema
9.Pyemia, gangrene, tetanus
10.Accidental injury
11. Marjolin’s ulcer
12.Pumonary embolism
13. Inflammation of internal organs
Meningitis, peritonitis, pleurasy, bronchitis,
bronchopneumonia
Difference
Antimortem Postmortem
burns burns
1.Line of redness Present Absent
2.Blisters Serous fluid with Air &thin clear fluid
protiens & cl
3.Base Red & inflammed yellow
4.Vital reaction Present Absent
5.Repairative process Present Absent
6.Infection Present Absent
7. Enzymes in peripheral Present Absent
zone
Post mortem findings:
External:
-Burnt area
-Pugilistic attitude
-Kerosene smell
-Singeing of hair
-Heat rupture: Due to desiccation
Over fatty areas
Intact vessels & nerves
Irregular margins
Internal :
1.Heat heamatoma :
-On parietotemporal region
-Soft, friable, light chocolate colour, may be pink
due to co
-Honey comb
2.Skull fracture(thermal fracture):
-Rapid increase in I/C pressure leads
displacement of fragment outward
-Involves outer table only
-On parietal bones just above temporo parietal
region
3.Brain :
-Shrunken, firm, yellow to light brown
-Dura leathery
4.Trachea : carbon particles
5. Organs: Congested
6.Liver:Centrilobular necrosis
Difference :
Burns Scalds corrosive
1. Cause Flame Hot fluid Acid/ Alkali
2. Splashing Absent Present Present
3. Skin Dry Shriveled Sodden & black Destroyed
4.Vesicles Circumference Over Burnt area Rare
5. Redline Present Present Absent
6. Colour Black Bleached Destroyed
Burns Scalds corrosive
Charring Present Absent Absent
Singeing Present Absent Absent
Clothings Burnt Not burnt Destroyed
Scar Thickened, Thin Thick
Contracted
Ulceration
Scald
Medico legal importance:
1.Actual cause of death
2.Accidental, suicidal, or homicidal
3.Postmortem burning
4.Indentification
5.Preternatural combustion
Electrocution
Injuries caused depends upon:
1.Kind of current: AC or DC
2.Amount of current: CV/R
3.Path of current
4.Duration of flow
Local effects:
Joule burns: Specific & Diagnostic of contact
with electricity
-At point of entry of current
- Crater: Round, shallow, pale floor
Entry wound
-When voltage very high & skin offers
considerable resistance
Sufficient heat produced
Burning, Scorching, blackening, charring
M/E:
-Coagulation of dermis
-Separation of epidermis
-Flattening of cell
Exit:
-Usually on body part in contact with earth(bare
sole)
-If exit site Hard, thick, dry(sole)→ Rupture of
tissues
-Generation of heat → burning
General features:
-Tingling, Numbness
-Painless
-Stunned
-Suspended animation
Exit wound
-Mental confusion
-Lack of Response
-Retrograde Amnesias
-Practical Deafness
-Defective vision
-Vertigo
-If current passes through base of brain
Failure of vital centers
-If current passes through Heart→ VF
Causes of death:
1.Very low intensity→ VF
2.Paralysis of respiratory centre
3. Paralysis of respiratory muscles
4.Mechanical injury
“Factors Affecting fatality”:-
1. Site of contact
- Wet body- Wash/Sweat/Bath
-Thick epidermis: Sole/Palm
- Dermis removed area
- High voltage - Charring→↓conductivityof tissue
2. Duration of Contact- Severity
High voltage - (m) Conv. → throw victim
Low voltage – (m) Spasm contraction – Not
allow Separation
3. Heart Disease
4. Earthing
P.M. changes:
External:
-Examination of scene
-Entry &exit wound
Internal:
-Asphyxial findings
-Lungs & brain → Congested & odematous
-Petechial haemorrhages along line of passage of
current
-
Medicolegal importance:
-Accidental
-Suicidal
-Homicidal
-Judicial
LIGHTENING
Lightening : There is discharge of electricity
between the clouds
Lightening Stroke :When charge Jumps from
clouds to Earth
It Chooses the easiest (Not-Shortest) Path and
hence it sometimes takes a wandering zigzag
path
When lightening strikes a person a potential of
1000×106Volt cause to pass 20,000 Amp
Current through body → induces lethal
electrocution.
- It is of DC type.
-Strikes a near by metallic object it may give rise
to induced Voltage.
Atmospheric gas becomes heated to 20000 C°
↓
Explosive expansion
↓
Blast effect Devastating
• AUTOPSY FINDINGS:-
(A) Ext – a) Linear Burns: 6 - 25MP in width
- Linear
- Moist surface of skin
b) Arborescent Burns – Formation of
Superficial
Thin
Tortious
Marking over skin Branching pattern of tree
↓
Filigree Burns (Fern like) - in low voltage
c) Surface Burns – Due to Heating up metallic
object
d) Magnetized object (Sometimes)
e) Mechanical Injuries – due to blast effect
(expansion/Regressive of area) (B) Other
Effects – Clothes may be torn
Shoes may burst open
Tympanic membrane Burst open
C) Internal – Injuries from may extend to
s/c/m/bone
- Bone Injuries – Periosteal elevation
- Patechial He – Brain spinal cord
- Chromatolysis & Fragmentation of Axons
- Organs – Congested
-
