This is appt presentation done by me and my colleagues Bahaa , Anas , Sara , Eman , Shimaa , Fawzy , Zakaria Abdul-Nasser and Seham ( agroup of medical undergarduates , school of Medicine, Ain-shams university , Cairo , Egypt ) ... This work was presented at the end of our Forensic medicine and toxicology round .. I Hope every one to get the best out of the presentaion ..Any commentaries are even more appreciated :)

2. PHYSICAL INJURIES
 physical agents that can cause non-kinetic
injuries to the body
 Heat
 Cold
 Electricity

3. INJURIES DUE TO HEAT
 The extent of the damage depends on time
of damage and type of tissue
 The heat source may be
Dry Burn
wet scalding

4. COLD INJURIES (HYPOTHERMIA)
 most deaths from hypothermia are seen in
old people and in some children
 Predisposing factors to hypothermia
 Extremes of age
 Phenothiazine drugs
 Myxoedema patients
 drunken people

5. ELECTRICAL INJURIES
 Injury and death from the passage of an
electric current through the body
 common in both industrial and domestic
circumstances.

6. BURN
 A burn is a type of injury to flesh caused
by
heat
radiation electricity
light chemicals

7. TYPES OF BURN
Superficial burns
Partial-thickness burns
Full-thickness burns

8. PATHOPYSIOLOGY OF BURN INJURIES
Mechanisms of Injury Local Response Systemic Response
Zone of
Thermal Cardiovascular
coagulation
Electrical Zone of stasis Respiratory
Zone of
Chemical hyperaemia
Hematological
Radiative Immunological

9. 
Scald “ Moist
Burn “ Contact Flame
* About 70% of * commonly seen in * 50% of adult
burns in children people with burns
* Immersion epilepsy or those *cause burns
, Splash & steam who misuse alcohol directly or due to
burns or drugs radiation of the
* superficial heat.
dermal burns

10. 
 An electric current will travel through the body from one point to another,
creating “entry” and “exit” points. The tissue between these two points can be
damaged by the current
 The voltage is the main determinant of the amount of heat generated and
hence the degree of tissue damage
• Low voltages tend to cause small, deep contact burns at the exit
Domestic and entry sites.
electricity • The alternating nature of domestic current  Arrhythmias
• The voltage is 1000 V or voltage greater than 70 000 V is fatal
High tension • There is extensive tissue damage and often limb loss.
injuries • Rhabdomyolysis, and renal failure may occur
• Arc of current from a high tension voltage source
“Flash” • The heat from this arc can cause superficial flash burns to
injury exposed body parts

11. 
 Acids
 Coagulation necrosis ( limits burn damage )
 Form a thick, insoluble mass where they
contact tissue.
 Alkalis
 Destroy cell membrane through liquefaction
necrosis
 Deeper tissue penetration and deeper burns

12. 
Zone of
Zone of Stasis Zone of Hyperaemia
Coagulation
• Central zone • Intermediate zone • outer zone
• white or charred • Red then white • Deeper red color
• point of maximum • decreased tissue • intact circulation
damage perfusion
• coagulation of the • potentially • Tissue will recover
constituent proteins salvageable unless there is
causes irreversible severe sepsis or
tissue loss • ↓BP , infection, or prolonged
edema convert this hypoperfusion
zone into an area of
complete tissue loss

13. 
♥ ↑ Capillary permeability  loss of proteins and fluids into
the interstitium
♥ ↓ Myocardial contractility + fluid loss  ↓BP  Shock
RTN
Asphyxia : which could be
1- Anoxic anoxia 2- Anemic Anoxia
3- Histototic Anoxia 4- Stagnant Asphyxia
Anemia : due to
1- Hemolysis  RTN 2- B.M depression due to sepsis
GIT ulcers
Hepatic cetrilobular necrosis
Non-specific down regulation of the immune response
occurs, affecting both cell mediated and humoral pathways

14. SEVERITY OF BURN INJURIES
 Severity depends on
Age of
The extent The degree The site the
victim
Individual General
Sex
susceptibility health

15. CAUSES OF DEATH FROM BURNS
 Immediate causes
 Rapid causes
 Delayed causes

16. DEGREES OF BURN
Layer Appeara Texture Sensatio Time To Complic Example
Nomencl
Involved nce n ations
Ature Healing
Painful None
FIRST Epidermis Redness 1wk or
DEGREE
(erythema) Dry less

17. Second Extends Red with
degree into clear
(superfi superfici blister. Local
2-
cial al Blanche Moist Painful infection/cell
3wks
partial (papillar s with ulitis
thicknes y) pressure
s) dermis
Second Extends Red-and- Painful Wee Scarring, c
degree into white ks - ontractures
(deep deep with may (may
partial (reticula bloody prog require
thicknes r) blisters. ress excision
Moist
s) dermis Less to and skin
blanchin third grafting)
g. degr
ee

18. Painless
(Third Extends Stiff and Dry, Requires Scarring,
degree through white/bro leathery excision contractu
(full entire wn res, ampu
thicknes dermis
tation
s
Extends
through
skin,
subcutan Charred Amputatio
Fourth eous n,
with
degree tissue Dry Requires significant
eschar Painless
and into excision functional

19. •Extent of a Burn:
The extent of a burn is expressed as
the total percentage of body surface
area (TBSA) affected by the injury.
Accurate estimation of the TBSA of a
burn is essential to guide management.
Multiple methods have been
developed to estimate the TBSA of
burns. These methods are not used for
superficial burns.the best known
method,the rule of nines, is
appropriate in use in all adults and
when quick assessment is needed for
children.

20. for small or scattered burns,or for assessing the amount of
unburnt skin in very extensive burns,the person's palmar
surface(including fingers) can be used as a guide.
it is equivalent to around 1% of the person's total body
surface area.

21. For small children, the head represents a greater portion
of the body mass than adults.
Lund and Browder first described a method for
compensating for the differences and
the Lund and Browder Chart is used to calculate Body Surface Area (BSA) in
children.
If the chart is
unavailable, one can estimate
body surface area
and adjust for age, as
follows

22. In children < 1 year, the head is 18% and
each leg is 14%
- The torso and arms the same percentages
as in the adult
- For each year over 1, add 1/2 percent to
earepresent ch leg and
- decrease the percent for the head by 1%,
until adult values are reached

23. POST MORTUM SHANGES
1. Blister have amore aquous fluid
2. Change in color of skin
Cherry red
Carboxy_hb
Black
Pink carbon
unreduced particles in
larynx trachea
oxyhb bronchi

24. POST MORTUM SHANGES
3-Surface of body has been damaged
4- blurred margins over joints
5- puterfuction

25. CHEMICAL BURNS
Chemical burns can be caused by acids or bases that come into contact with tissue.
Both acids and bases can be defined as caustics.
Causes
Acids (Sulfuric acid, Nitric acid, Hydrochloric acid, Phenol and cresols)
Bases (Calcium hydroxide, Ammonia, Sodium hydroxide and potassium hydroxide)
Oxidants (Bleaches and Chlorites, Peroxides, Chromates, Manganates)
Vesicants (sulfur, nitrogen mustards, arsenicals, phosgene oxime )
Other substances (White phosphorus, Metals, Hair coloring agents , Airbag injuries)
Chemical Burn Symptoms
Redness, irritation, or burning at the site of contact
Pain or numbness at the site of contact
Formation of black dead skin at the contact site
Vision changes if the chemical gets into your eyes
Cough or shortness of breath

26. Treatment
Prehospital Care
1-Prevent contaminated irrigation solution from running onto unaffected skin.
2-Remove contaminated clothes.
Emergency Department Care
1-secure the airway
2-Large surface burns require the same fluid therapy
Consultations
1-Ophthalmologic consultation is recommended for patients with ocular burns
2-Caustic ingestions may require multiple specialties
3-Consult a psychiatrist for cases of attempted suicide

27. Medication
1- Topical antibiotic therapy is usually recommended for dermal
and ocular burns.
2- Calcium or magnesium salts are used for hydrofluoric acid
burns.
3- Steroid therapy is controversial for caustic ingestions but may be
helpful for treating upper airway inflammation.
4- Non steroidal anti-inflammatory agents provide some
degree of pain relief for mild burns by inhibition of prostaglandin
mediators.
5- Topical and ophthalmic antibiotics are routinely used for
dermal and ocular burns, respectively. The injured tissues lose many of
their protective mechanisms and are at increased risk of infection.

28. Prevention
 All chemicals should be stored in a locked cabinet.
 Avoid mixing different products that contain toxic chemicals
 Avoid prolonged (even low-level) exposure to chemicals
 Avoid using potentially toxic substances in the kitchen or around
food
 It Is important to read and follow label instructions, including any
precautions of toxic products .
 Never store household products in food or drink containers.
 Store chemicals safely immediately after use.
 Use paints, petroleum products, ammonia, bleach, and other
products that
 give off fumes only in a well-ventilated area.

29. INVESTIGATIONS OF PATIENTS WITH
BURN INJURIES :
1-Arterial blood gases
2-CBC
3-Chest –x ray
4-Kidney function
5-Liver function
6-Urine analysis
7-Serum immunoglobulins

30. MANAGEMENT OF BURN
Assessment of :







31. MANAGEMENT OF MINOR BURNS
MANAGEMENT OF MAJOR BURNS

32. REFERRAL TO A SPECIALIST BURNS UNIT
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