PHYSICAL INJURIESCauses 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- Irradiation radiation burns.

Causes of Burns

• Flame 33%

• Scald 30% 

• Contact 15% 

• spark 10% 

• Electrical l5% 

• Radiation 1% 

Classification of burns: • 1st degree burn consists of an erythema

• 2nd degree characterized 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

5th

3rd

4th

1st 2nd

4th 3rd

Wilsonstates 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

Factors affecting the seriousness of burnsFactors affecting the seriousness of burns::

1.1.Degree of burnDegree of burn

2.Site: burns 2.Site: burns

3.Age of burnt person3.Age of burnt person

4.General health of the person 4.General health of the person

5.The extent of burn 5.The extent of burn

Mechanism of death in burnsMechanism of death in burns..

A- Within 0-6 Hours of burnsA- Within 0-6 Hours of burns: :

1.Neurogenic shock form fear or pain

2.Asphyxia from inhalation

3.Traumatic asphyxia

4.Head injury

B- Death occurring from 6-48 hoursB- Death occurring from 6-48 hours

11 - -Acute edema of the glottisAcute edema of the glottis

22 - -Hemoconcentration due to evaporation of Hemoconcentration due to evaporation of fluidsfluids

33 - -Hematogenic shock due to absorption Hematogenic shock due to absorption

of histamine likeof histamine like

44 - -Fat embolism in the pulmonary arteriesFat embolism in the pulmonary arteries

C- Death occurring from 2-7 daysC- Death occurring from 2-7 days

11 - -Infection and sepsis in the burnt Infection and sepsis in the burnt areaarea..

22 - -Suprarenal hemorrhageSuprarenal hemorrhage..

33 - -Inflammation of serous membranesInflammation of serous membranes..

44 - -BronchopneumoniaBronchopneumonia..

D- Death occurring from 7 days onwardsD- Death occurring from 7 days onwards::

11 - -Rapture of duodenal ulcer (Curling's Rapture of duodenal ulcer (Curling's ulcer)ulcer)

22 - -Liver or kidney failure due to Liver or kidney failure due to absorption ofabsorption of

toxic substancestoxic substances

• 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.

HEAT DISEASESHEAT DISEASES

Three clinical conditions may results from Three clinical conditions may results from exposure to high environmental tempexposure to high environmental temp..

11..Heat cramps (miner's cramps)Heat cramps (miner's cramps)::

22..Heat collapse (heat syncope or heat prostration)Heat collapse (heat syncope or heat prostration) : :

33..Heat hyperpyrexia (heat stroke)Heat hyperpyrexia (heat stroke)::

Factors predisposing to Factors predisposing to heat heat hyperpyrexia (heat hyperpyrexia (heat

stroke)stroke)::: : 11 - -Non-acclimatization to high temperatureNon-acclimatization to high temperature..

22 - -Overcrowding in closed spacesOvercrowding in closed spaces..

33 - -Anti-cholinergic drugs. e.g. atropineAnti-cholinergic drugs. e.g. atropine . .

44 - -AlcoholismAlcoholism..

55 - -Previous affection with heat collapsePrevious affection with heat collapse

Treatment:Treatment:1- Remove the patient to a cool place1- Remove the patient to a cool place..2- Application of cold 2- Application of cold compresses to the skin, ice-bag compresses to the skin, ice-bag to the head and ice-cold rectal to the head and ice-cold rectal

enema.enema.

3- Give fluid and electrolytes3- Give fluid and electrolytes..

DEATH FROM COLDDEATH FROM COLD

11 - -Exposure of the limbs only frost biteExposure of the limbs only frost bite

edema + bullaedema + bulla

22 - -Exposure of the whole body loss of Exposure of the whole body loss of consciousness due to affection of the vital consciousness due to affection of the vital

centerscenters . .

33 - -ELECTRICAL INJURIESELECTRICAL INJURIESFactors affecting electrical injuriesFactors affecting electrical injuries::

.1.1Type of current, Alternating current or Type of current, Alternating current or DCDC

.2.2Strength of the current, 40 (fatal 200volt)Strength of the current, 40 (fatal 200volt)..

.3.3Path of current. Brain or heart it is fatalPath of current. Brain or heart it is fatal..

.4.4Duration of contactDuration of contact. .

.5.5Contact surface areaContact surface area..

Mechanisms of death Mechanisms of death from electric currentfrom electric current::

.1.1Ventricular fibrillationVentricular fibrillation..

.2.2Central respiratory failureCentral respiratory failure..

.3.3Mechanical asphyxiaMechanical asphyxia..

C/P of electrocutionC/P of electrocution

Loss of consciousnessLoss of consciousness Face is congested with cold sweatingFace is congested with cold sweating Convulsion if motor cortex is in involvedConvulsion if motor cortex is in involved Parasthesisa and numbnessParasthesisa and numbness Oliguria or anuriaOliguria or anuria

ComplicationComplication::

11..GangreneGangrene

22 . .HemiplegiaHemiplegia

33 . .AphasiaAphasia

44.. Epileptic fitsEpileptic fits

.5.5CataractCataract

.6.6 Optic atrophyOptic atrophy

TreatmentTreatment::11 - -Current should be switched offCurrent should be switched off..

22 - -Cardiac and respiratory resuscitationCardiac and respiratory resuscitation..

33 - -For cerebral irritation a lumbar puncture may For cerebral irritation a lumbar puncture may be neededbe needed..

44 - -INJURIES DUE TO IONIZING RADIATIONSINJURIES DUE TO IONIZING RADIATIONSAn old and still popular unit of An old and still popular unit of measuring radioactivity is the curie (Ci).measuring radioactivity is the curie (Ci).

Ci = 37 GBqCi = 37 GBq

1 Ci = 1000 mCi; 1 mCi = 1000 µCi1 Ci = 1000 mCi; 1 mCi = 1000 µCi Becquerel Becquerel ((BqBq) ) or Curie or Curie ((CiCi) ) is a measure of the rate is a measure of the rate

((not energynot energy) ) of radiation emission from a sourceof radiation emission from a source..

11 - -SkinSkin erythema, loss of hair, falling of nails erythema, loss of hair, falling of nails

22 - -BloodBlood: : lymphocytopenia, thrombocytopenia, reticulolymphocytopenia, thrombocytopenia, reticulo--cytopenia - anemiacytopenia - anemia..3- Reproductive system3- Reproductive system a- Atrophy of testicles. sterilitya- Atrophy of testicles. sterility b- Affection of ovaries sterility.b- Affection of ovaries sterility.

4- Pregnancy:4- Pregnancy: 2nd - 6th week gives intrauterine fetal death.2nd - 6th week gives intrauterine fetal death. 7th - 15th week Gives mental retardation7th - 15th week Gives mental retardation

5- G.I.T5- G.I.T

6 - Eye6 - Eye

Foot prints are most commonly used Foot prints are most commonly used for:for:aa.. Trailing Trailing the enemies in desert. the enemies in desert.B. None mixing of infants in Hospitals.B. None mixing of infants in Hospitals.C. Solving of crimes.C. Solving of crimes.d. a & b.d. a & b.e. b & ce. b & c..

PM Identification is difficult in cases ofPM Identification is difficult in cases of::

a. severe burnsa. severe burns..

b. severe putrefactionb. severe putrefaction..

c. multiple stab woundsc. multiple stab wounds..

d. complete charringd. complete charring..

e. absence of the head (decapitation)e. absence of the head (decapitation)

The mechanism of death from stab The mechanism of death from stab wounds iswounds isHemorrhage.Hemorrhage.Trauma.Trauma.Shock.Shock.A and b.A and b.b & cb & c

hitting by thick heavy iron bar ( stick) hitting by thick heavy iron bar ( stick) causescauses::A- an abrasionA- an abrasion. .

b. contusionb. contusion..

c. curved contusionc. curved contusion..

d. Lacerated woundd. Lacerated wound..

e. bruisee. bruise

Death certificationDeath certification::

.a.aA patient suffered from acute myocardial infarct (MI) due A patient suffered from acute myocardial infarct (MI) due to Coronary arteriosclerosis (CA).Suddenly the infarct to Coronary arteriosclerosis (CA).Suddenly the infarct

ruptured leading to fatal Hemopericardium .the cause of ruptured leading to fatal Hemopericardium .the cause of death is (MI)death is (MI) ___ ___ …… ___ ___ ……

bb. A farmer has suffered from fatal Hemopericardium due to . A farmer has suffered from fatal Hemopericardium due to

gunshot wound to the chestgunshot wound to the chest..The cause of death is (The cause of death is (fatal Hemopericardiumfatal Hemopericardium))

___ ___ ___ ___

cc The term “cardio-respiratory arrest” is a description of a The term “cardio-respiratory arrest” is a description of a cause of deathcause of death___ ___ ..................___ ___ ..................

d.d. The Manner of Death Explains how the mechanism of The Manner of Death Explains how the mechanism of deathdeath have effect take placehave effect take place ___ ___ …… ........ ___ ___ …… ........

e.e. Fatal mechanisms of death include congestive heart failure, Fatal mechanisms of death include congestive heart failure,

cardiac arrhythmiascardiac arrhythmias........___ ______ ___