Physical InjuriesPhysical Injuries

PresentedPresentedByBy

Said Said ElshamaSaid Said Elshama

Learning ObjectivesLearning Objectives

1- Types of physical injuries1- Types of physical injuries2- Dry burn 2- Dry burn 3- Moist burn 3- Moist burn 4- Electrocution 4- Electrocution 5- Corrosive burn5- Corrosive burn

Dry Burn Dry Burn DefinitionDefinition Tissues destruction produced by flame (open fire) application or hotTissues destruction produced by flame (open fire) application or hot solid solid

DegreesDegrees1- Redness 1- Redness 2- Vesicles 2- Vesicles 3- Destruction of superficial skin (painful degree)3- Destruction of superficial skin (painful degree)4- Destruction of whole skin 4- Destruction of whole skin 5- Destruction of subcutaneous tissues5- Destruction of subcutaneous tissues6- Complete charring of tissues6- Complete charring of tissues

Another Burn ClassificationAnother Burn Classification

According to the depth , burn is classified into :-According to the depth , burn is classified into :-1- First degree ( superficial )1- First degree ( superficial )Redness- pain- no vesicles – no scar ( sunburn )Redness- pain- no vesicles – no scar ( sunburn )2- Second degree ( partial thickness )2- Second degree ( partial thickness )A- Superficial ( superficial dermis- red -pain )A- Superficial ( superficial dermis- red -pain )B- Deep (deep dermis- red→ white -pain )B- Deep (deep dermis- red→ white -pain )3- Third degree ( full thickness )3- Third degree ( full thickness )All layers of skin- charredAll layers of skin- charred

Characters of Dry BurnCharacters of Dry Burn

1- Spread from below upward1- Spread from below upward2- Vesicles at edges of burnt area2- Vesicles at edges of burnt area3- Singeing and clubbing of hair ( coma shaped)3- Singeing and clubbing of hair ( coma shaped)4- Soot in air passages4- Soot in air passages5- CoHb in the blood5- CoHb in the blood6- Charred scalp and skull rupture (thermal6- Charred scalp and skull rupture (thermal fracture)fracture)7- Shrinkage of brain7- Shrinkage of brain8- Extra-dural hematoma8- Extra-dural hematoma

Factors Affecting Gravity of BurnFactors Affecting Gravity of Burn1- Extent 1- Extent Rule of nine (superficial + more 1/3 of body surface = fatal)Rule of nine (superficial + more 1/3 of body surface = fatal)2- Degree2- Degree Third degree is shocky because of sensory nerve endings Third degree is shocky because of sensory nerve endings exposing exposing 3- Site 3- Site Face, neck, abdomen are than dangerous than limbsFace, neck, abdomen are than dangerous than limbs

4- Age and General health 4- Age and General health Age Extremes tolerate burns more bad Age Extremes tolerate burns more bad

Extent of BurnExtent of BurnRule of nine :- Rule of nine :- • Head = 9%Head = 9%• Two upper limbs = 2*9 = 18 % Two upper limbs = 2*9 = 18 % • Two lower limbs = 2*9*2= 36 %Two lower limbs = 2*9*2= 36 %• Trunk Trunk Front 2*9 + Back 2*9= 18*2=36%Front 2*9 + Back 2*9= 18*2=36%• Genitalia = 1%Genitalia = 1% Total of all body = 100%Total of all body = 100%

Cause of the death Cause of the death 1- Within 6 hours1- Within 6 hoursA.A. Primary neurogenic shockPrimary neurogenic shockB.B. Vital organ injuryVital organ injuryC.C. Inhalation of Co, Co2 and smokeInhalation of Co, Co2 and smokeD.D. Traumatic asphyxia Traumatic asphyxia

2- From 6 hr to 48 hrs2- From 6 hr to 48 hrsA.A. Hypovolaemic shockHypovolaemic shockB.B. Toxic shockToxic shockC.C. Acute odema of glottisAcute odema of glottisD.D. Pulmonary fat embolismPulmonary fat embolism

3- More than two days3- More than two daysKidney, liver, heart damage- suprarenal he, bronchopneumonia, Kidney, liver, heart damage- suprarenal he, bronchopneumonia, septicemia and acute duodenal ulcer rupturesepticemia and acute duodenal ulcer rupture

Ante-mortem Burn Ante-mortem Burn

1.1. HyperemiaHyperemia2.2. Vesicles Vesicles 3.3. Soot (carbon)Soot (carbon)4.4. Co in the bloodCo in the blood5.5. HemoconcentrationHemoconcentration6.6. Sepsis or healing signsSepsis or healing signs7.7. Absence of any other cause of deathAbsence of any other cause of death

Postmortem burnPostmortem burnCharacters of ante mortem burn are absent Characters of ante mortem burn are absent

Age of BurnAge of Burn

A.A. Erythema- 2 daysErythema- 2 daysB.B. Vesicles one week to heal without scarVesicles one week to heal without scarC.C. Sepsis – after 36 hoursSepsis – after 36 hours

Postmortem picture of death in Burn CasesPostmortem picture of death in Burn Cases

1. Pugilistic attitude (boxer )2. Different degrees of ante mortem burn3. Generalized redness (CoHb)4. Soot in air passages (carbon)5. Haemoconcentration 6. Generalized visceral congestion and hge7. Thermal fissure in the skull

Moist Burn (scalds)Moist Burn (scalds)injury by hot liquids or steaminjury by hot liquids or steam

How to differentiate wet burn from dry burn?How to differentiate wet burn from dry burn?

Wet burnDry burn Moist heatDry heat

Above downwards spread in lines of vesicles

Below upwards spread

First and second degree only, vesicles in all affected area

Any degree , vesicles at the edges of affected area

Wet clothes hair is not singed

Dry clothes hair is singed

No soot in air passages No Co in blood

Soot in air passages Co in blood

Healing with thin scar and less disfigurement

ScaldsScalds

Corrosives BurnCorrosives BurnAcid BurnAcid Burn

ElectrocutionElectrocution Exposure to electrical energy may Exposure to electrical energy may result in:- result in:- 1- No 1- No injury at all at all 2- Devastating damage 2- Devastating damage 3- Death. 3- Death. Why ?Why ?

1.1. Type of current Type of current (direct, alternating )2.2. Amount of current Amount of current ( voltage & resistance), Less

than 500 volt = No damage More than 500 volt = Serious damage

3.3. Path of current Path of current ( vital organs “heart”)4.4. Duration of current flowDuration of current flow5.5. Wet surface Wet surface ( dry skin has high resistance )

ElectrocutionElectrocution SymptomsSymptoms

1- 1- littlelittle external evidence of external evidence of injuryinjury 2- 2- BurnsBurns are usually most severe at the points of contact with are usually most severe at the points of contact with

the electrical source and the ground. The hands, heels, and the electrical source and the ground. The hands, heels, and head are common points of contact. head are common points of contact.

3- 3- Muscular contractionMuscular contraction.. Muscle spasm4- 4- PainPain in a hand or foot may in a hand or foot may indicate a possible a possible broken bone broken bone

resulting from the electric shock. resulting from the electric shock. 5-5- Numbness and tingling Numbness and tingling 6-6- Seizures Seizures 7- 7- Unconsciousness Unconsciousness 8- 8- Cardiac arrestCardiac arrest

Cause of death due to electrocutionCause of death due to electrocution 1. Ventricular fibrillation 2. Central asphyxia - Central ( higher centers ) brain- Central ( higher centers ) brain - Peripheral ( chest ) muscles - Peripheral ( chest ) muscles

1. Electric burn

Postmortem picturePostmortem pictureEntry and exit points of currentEntry and exit points of current

Electric BurnElectric Burn

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