Burn / Electric Injury

1. Burn / Electric Injury Dr. Gunawan Arsyadi, SpPA(K), SpF

2. Heat Trauma Definition: Wound by touching outer or inner body with heat, cold, chemical reagent or electricity Devided to: 1. Thermal Burn a. Cold b. Heat : * Scald (moist heat) * Burn (dry heat) 2. Chemical Burn 3. Electrical Burn

3. Cold Trauma General Reaction: • Pale skin caused by vasoconstruction  reddish due to vasodilatation  visceral organ congestion  coma • Autopsy: * Heart contains of light red blood * Visceral organ congestion * Light red of livor mortis with dark red blood rashes

4. Cold Trauma Manner of death: * Accident * Infants murdering

5. Scald, Moist Heat - Burn wound by heat liquid / gasses - 3 grade : * Erythema * Blister * Coagulation / necrosis Burn (Dry Heat) • There are 4 grades: 1. Erythema 2. Blister 3. Necrosis 4. Carbonization

6. Chemical Burn - High concentrate acid  Skin/ tissue - Dry - Rough - Dark brown • High concentrate alkaline Skin : - Smooth - White - “Soapy” touch Manner of death: • Usually accident • Murdering • Suicide

7. General reaction of heat 1. Heat Exhaution - Increase of thermal body - Irregular pulse - Collaps  death - Dark colour of heart erythrocyte 2. Heat Stroke  Heat causes paralyse of thermal centre in medulla  tacchycardia  circulatory collaps  death

8. General reaction of heat Autopsy: • Congested organ • Dark blood in heart • Brain oedema • occur by increasing of temperature and air moist. 3. Heat Cramps Increasing temperature  more sweating  increase of ion Cl excretion  muscular spasms

9. Severity of burn • The severity of thermal injury depend on : • The extent of the burned area • The severity of the burn • The age of the victim • The presence of inhalation injuries

10. A. The extent of the burned area • Determined by the rules of nine. • The head is 9 % • Upper extremities are each 9 % • The front torso is 18 % • The back is 18 % • Each lower extremities is 18 % • Perineum is 1 %

12. B. The severity of the burn • Can be described as : • First degree (superficial burns) The skin is erythematous  congested vessels in the dermis * Second degree burns • Partial thickness burns subdivided into : 1. Superficial 2. Deep

13. Second degree burns • Superficial Destruction of the striatum granulosum and cornium with the basal layer, not totally destroyed  heals without scarring. 2. Deep Complete disruption of epidermis and destruction of most basal layer

14. Third degree burns Coagulation necrosis of the epidermis and dermis with destruction of the dermal appendages  scar

15. Fourth degree burns Incinerating injuries extending deeper than the skin

16. Intravital signs of burn wound • Light red of livor mortis(cherry red)  COHb • Blister • Respiratory tract  dusty • Inflammation of burn wound tissue.

17. Intravital signs of burning cases • Burn wound bullae • Carbon in respiratory tract • COHb level : above 10 %, heavy smoker more than 25 %

18. Cause of death: a. Fast : - CO intoxication  Asphyxia - Larinx oedema - Neurogenic shock b. Moderate : - Dehydration c. Slow : - Renal failure Acute tubular necrosis - CÜRLING ulcer - Sepsis - Auto intoxication

19. Manner of death : • Murdering • Accident • Suicide

24. Electrical Burn The factor that influent electrical effect : 1. Voltage Density V = 60 Volt dangerous 2. Current Density > 65 mA dangerous 3. Current Path Resistence Burn skin  increasing meassurement 4. Time Duration of Current Flow

25. Electrical Burn 5. Victim situation - Consiousness or not - Victim’s occupation - Health/sick Cause of death : • Ventrikel fibrillation • Paralyze Centrum medulla • Paralyze Respiratory muscle

26. Mechanism of death • Current Density is the most important factor, currents between 75 – 100 mA caused ventricular fibrilation. Extremelly high currents 1A/ higher usually cause ventricular arrest. • Paralysis of the muscles usually caused by low amperage electrocution  asphyxia • Paralysis of the respiratory center of the brain stemp caused by the hyperthermic effect of the current (high voltage current)

27. Autopsy findyngs • Electrical burns, could at the point of entry or the point of exit • Accelerated onset of rigor mortis caused by the muscle contraction and depletion of ATP • Bone fracture due to generalised muscular contraction • High voltage current  third degree burns • Rhexiss of the heart muscle

28. Electricution Manners of death * Accident * Suicides * Homocides

29. Autopsy: 1. Outer examination - Electrical marks (current marks) * Palm / plant * Dorsal hand, etc Burnt skin, cloth or burnt hair may occur

30. Autopsy: 2. Inner examination • Heart filled with blood • Congestion of visceral organs • Lung Oedema • Conjunctiva bleeding, pericard bleeding • Rhexis of muscles • “Pearl like body” on bone. Bone fracture

34. Lightning Static electric content in cloud with voltage up to 1 million volt and current density up to 100.000 ampere in 1/1000 – 1 second released to earth. Body disorders depends on: • Electrical ware factor * Signs like electrical injury * Arboresscent marking caused by blood vessel dilatation * Magnetisation

35. 2. High temperature factor (Electical energy) W = V x A  heat Heat: * Burning wound * Metalization 3. Air exchange/ explotion factor blunt trauma

36. Thank you