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Thermal injuries

Thermal injuries. Presented by Dr.Jashwant Guidance by Dr. Ganesh Govekar Dr. S.D. Kalele. Classification Due to exposure to extreme cold a)General effects: Hypothermia b)Local effects: Frost bite, Trench foot 2.Due to exposure to extreme heat

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Thermal injuries

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  1. Thermal injuries Presented by Dr.Jashwant Guidance by Dr. Ganesh Govekar Dr. S.D. Kalele

  2. Classification • 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Medico legal importance: -Accidental -Homicidal -Suicidal not common

  8. 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

  9. 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

  10. Causes : -Flame -Hot liquids -Chemical, corrosive -X rays -U.V. rays • Electric(Joule) • Flash burn • Explosions • Brush burns, friction burns • Cement (concret) burns

  11. 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.

  12. Blister

  13. 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

  14. 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

  15. Causes of death: • 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

  16. 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

  17. Difference

  18. 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

  19. 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

  20. 3.Brain : -Shrunken, firm, yellow to light brown -Dura leathery 4.Trachea : carbon particles 5. Organs: Congested 6.Liver:Centrilobular necrosis

  21. Difference :

  22. Scald

  23. Medico legal importance: 1.Actual cause of death 2.Accidental, suicidal, or homicidal 3.Postmortem burning 4.Indentification 5.Preternatural combustion

  24. 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

  25. Entry wound

  26. -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

  27. 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

  28. Exit wound

  29. -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

  30. Causes of death: 1.Very low intensity→ VF 2.Paralysis of respiratory centre 3. Paralysis of respiratory muscles 4.Mechanical injury

  31. “Factors Affecting fatality”:- • 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

  32. 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 -

  33. Medicolegal importance: -Accidental -Suicidal -Homicidal -Judicial

  34. 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.

  35. - 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

  36. 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

  37. 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

  38. 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

  39. -

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