PHYSICAL INJURIES

1. PHYSICAL INJURIES Causes and types: 1- Dry heat application of the hot solid 2- Moist heart e.g. hot liquids scalds 3- Acids and alkalis corrosive burns 4- Electricity electric burns 5- Irradiationradiation burns.

2. Causes of Burns • Flame 33% • Scald 30%  • Contact 15%  • spark 10%  • Electrical l5%  • Radiation 1% 

6. Classification of burns: • 1st degreeburn consists of an erythema • 2nd degreecharacterized by the formation of vesicles • 3rd degree destruction of the full thickness and nerve endings • 4th degree. destruction of the dermis and SC tissues • 5th degree burn, the muscles are involved in. • 6th degree complete charring of the affected area

7. 3rd 4th 5th

9. 1st 2nd 3rd 4th

10. Wilson states that Dupuytern's classification is of limited practical value. He classify burns into: 1-Epidermal burns: characterized by erythema with or without vesicles or bullae. 2-Dermo-epidermal burns: the epidermis and dermis are separated . 3- Deep burns: the skin is destroyed and the underlying tissues

11. Factors affecting the seriousness of burns: • Degree of burn • 2.Site: burns • 3.Age of burnt person • 4.General health of the person • 5.The extent of burn

14. Mechanism of death in burns. A- Within 0-6 Hours of burns : • Neurogenic shock form fear or pain • 2.Asphyxia from inhalation • 3.Traumatic asphyxia • 4.Head injury

16. B- Death occurring from 6-48 hours 1- Acute edema of the glottis 2- Hemoconcentration due to evaporation of fluids 3- Hematogenic shock due to absorption of histamine like 4- Fat embolism in the pulmonary arteries

17. C- Death occurring from 2-7 days 1- Infection and sepsis in the burnt area. 2- Suprarenal hemorrhage. 3- Inflammation of serous membranes. 4- Bronchopneumonia.

18. D- Death occurring from 7 days onwards: 1- Rapture of duodenal ulcer (Curling's ulcer) 2- Liver or kidney failure due to absorption of toxic substances

19. Scars of burns are usually red • and may stays up to 2 months, • it is coppery in color for 6 months • It fades gradually or leads to • contracture, • disability , • Keloid • even malignant transformations.

22. HEAT DISEASES Three clinical conditions may results from exposure to high environmental temp. 1.Heat cramps (miner's cramps): 2.Heat collapse (heat syncope or heat prostration): 3.Heat hyperpyrexia (heat stroke):

23. Factors predisposing to heat hyperpyrexia (heat stroke): : 1- Non-acclimatization to high temperature. 2- Overcrowding in closed spaces. 3- Anti-cholinergic drugs. e.g. atropine. 4- Alcoholism. 5- Previous affection with heat collapse

24. Treatment:1- Remove the patient to a cool place.2- Application of cold compresses to the skin, ice-bag to the head and ice-cold rectal enema. 3- Give fluid and electrolytes.

25. DEATH FROM COLD 1- Exposure of the limbs only frost bite edema + bulla 2- Exposure of the whole body loss of consciousness due to affection of the vital centers.

26. 3- ELECTRICAL INJURIES Factors affecting electrical injuries: • Type of current, Alternating current or DC • Strength of the current, 40 (fatal 200volt). • Path of current. Brain or heart it is fatal. • Duration of contact . • Contact surface area.

27. Mechanisms of death from electric current: • Ventricular fibrillation. • Central respiratory failure. • Mechanical asphyxia.

28. C/P of electrocution • Loss of consciousness • Face is congested with cold sweating • Convulsion if motor cortex is in involved • Parasthesisa and numbness • Oliguria or anuria

29. Complication: 1. Gangrene 2. Hemiplegia 3. Aphasia 4. Epileptic fits • Cataract • Optic atrophy

31. Treatment: 1- Current should be switched off. 2- Cardiac and respiratory resuscitation. 3- For cerebral irritation a lumbar puncture may be needed.

32. 4- INJURIES DUE TO IONIZING RADIATIONSAn old and still popular unit of measuring radioactivity is the curie (Ci).Ci = 37 GBq1 Ci = 1000 mCi; 1 mCi = 1000 µCi Becquerel (Bq) or Curie (Ci) is a measure of the rate (not energy) of radiation emission from a source.

33. 1- Skin erythema, loss of hair, falling of nails 2- Blood: lymphocytopenia, thrombocytopenia, reticulo-cytopenia - anemia. 3- Reproductive system a- Atrophy of testicles. sterility b- Affection of ovaries sterility. 4- Pregnancy: 2nd - 6th week gives intrauterine fetal death. 7th - 15th week Gives mental retardation 5- G.I.T 6 - Eye

36. Foot prints are most commonly used for:a. Trailing the enemies in desert.B. None mixing of infants in Hospitals.C. Solving of crimes.d. a & b.e. b & c. PM Identification is difficult in cases of: a. severe burns. b. severe putrefaction. c. multiple stab wounds. d. complete charring. e. absence of the head (decapitation)

37. The mechanism of death from stab wounds isHemorrhage.Trauma.Shock.A and b.b & c hitting by thick heavy iron bar ( stick) causes: A- an abrasion . b. contusion. c. curved contusion. d. Lacerated wound. e. bruise

38. Death certification: • A patient suffered from acute myocardial infarct (MI) due to Coronary arteriosclerosis (CA).Suddenly the infarct ruptured leading to fatal Hemopericardium .the cause of death is (MI) …… ___ ___ b. A farmer has suffered from fatal Hemopericardium due to gunshot wound to the chest. The cause of death is (fatal Hemopericardium) ___ ___ cThe term “cardio-respiratory arrest” is a description of a cause of death.................. ___ ___ d. The Manner of Death Explains how the mechanism of deathhave effect take place........ …… ___ ___ e.Fatal mechanisms of death include congestive heart failure, cardiac arrhythmias....___ ___