Thermal injuries Hot and Cold Weather Fire Hot

Objectives of this lecture 1. 2. 3. 4. Classification of thermal injuries Severity of

Skin anatomy The skin is the largest organ of the body. It has multiple

Thermal injuries due to heat • Exposure to heat will lead to – Heat

Heat diseases Heat cramps- Heat exhaustion- Heat stroke • • • Heat affects-----Mechanism Clinical

Different types of thermal injuries Dry Burn- Wet Burn • • • Cause Clothes

Severity (Degrees) of thermal injuries • Dupuytren classification • Wilson’s classification

Dupuytren’s classification Wilson’s classification

Dry Burn shows complete charring (carbonization)

9% 18% 9% 9% 18% 1% 9% 9% Extent of the burn Rule of

Extent of the burn Rule of nine Factors affecting severity of thermal injuries 18%

Causes of death from thermal injuries • Immediate causes (6 hours) – Shock, Injury

Difference between A. M & P. M burns Item 1 - Hyperemia 2 -

Difference between A. M & P. M burns Item A. M. burn P. M.

Heat artifacts Pugilistic attitude resemble ------

Heat artifacts Splitting of skin resembles-----

$Heat artifacts Thermal skull fracture with extradural hemorrhage resembles----$

$Heat artifacts Pugilistic attitude resemble ------Splitting of skin resembles-----Thermal skull fracture with extradural hemorrhage$

Death due to cold • More common in children and old people

Electrical burn • Factors affecting severity of electrical burn • Cause of death •

PMP of electrocution No signs Collapsed blister with black Collapsed blister with white skin

PMP of electrocution Marked pallor and adjacent hyperaemia

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Thermal injuries Hot and Cold (Weather, Fire, Hot liquid and Electricity) Dr/Samah Fathy Ibrahim Assistant professor of forensic medicine and clinical toxicology

Objectives of this lecture 1. 2. 3. 4. Classification of thermal injuries Severity of thermal injuries Extent of thermal injuries Factors affecting severity of thermal injuries 5. Causes of death from thermal injuries 6. Difference between A. M & P. M burns

Skin anatomy The skin is the largest organ of the body. It has multiple functions epidermis hypodermis

Thermal injuries due to heat • Exposure to heat will lead to – Heat diseases (hot air) • Heat cramps • Heat exhaustion(syncope) • Heat stroke (hyperpyrexia) – Burn (hot solid/ liquid) • Dry thermal injuries • Moist thermal injuries

Heat diseases Heat cramps- Heat exhaustion- Heat stroke • • • Heat affects-----Mechanism Clinical picture Treatment PMP of heat hyperpyrexia (stroke)

Different types of thermal injuries Dry Burn- Wet Burn • • • Cause Clothes Hair Burn Other systems Soot in air passage COHb in blood • • • Spread Degree Charring Vesicles Healing

Severity (Degrees) of thermal injuries • Dupuytren classification • Wilson’s classification

Dupuytren’s classification Wilson’s classification

Immersion into hot liquid Run hot fluid

Splashed hot droplets

2 nd degree burn

Dry Burn shows all degrees

Dry Burn shows complete charring (carbonization)

9% 18% 9% 9% 18% 1% 9% 9% Extent of the burn Rule of nine

Extent of the burn Rule of nine Factors affecting severity of thermal injuries 18% 14% 18%

Causes of death from thermal injuries • Immediate causes (6 hours) – Shock, Injury and Asphyxia • Rapid causes (6 -48 hours) – Shock, Embolism and Asphyxia • Delayed causes(>2 days) – Injury and infection

Difference between A. M & P. M burns Item 1 - Hyperemia 2 - Vesicles 3 - Soot in air passages 4 - Co. Hb in blood. 5 - Signs of healing or sepsis. 6 - Other cause of death detected. A. M. burn P. M. burn

Difference between A. M & P. M burns Item A. M. burn P. M. burn 1 - Hyperemia 2 - Vesicles Present; tense filled with serum (rich in albumin and chloride). Absent; if present it is soft filled with air; if fluid: poor in albumin and chloride. 3 - Soot in air passages Present Absent. 4 - Co. Hb in blood. Present 5 - Signs of healing or Present. sepsis. 6 - Other cause of death Absent. detected. Absent. Present e. g. , strangulation, head injuries, . . . etc.