BURN / ELECTRIC

INJURY
THERMAL INJURY
Definition: Wound by touching outer or inner body
with heat, cold, chemical reagent or electricity

Devided to:
1. Thermal Burn
a. Cold
b. Heat :\
2. Chemical Burn
3. Electrical Burn
COLD TRAUMA
General Reaction:
• Pale skin caused by vasoconstruction ➔
reddish due to vasodilatation ➔ visceral
organ congestion ➔ coma
• Autopsy:
* Heart contains of light red blood
* Visceral organ congestion
* Light red of livor mortis with dark red blood
rashes >
-
bercak
meran
gelap
COLD TRAUMA

Manner of death:
* Accident
* Infants murdering

50-year-old alcoholic man who

was found frozen in an open
field
 EPIDIMIOLOGI
Secara demografis, orang yang
mengalami luka bakar di Amerika Serikat
cenderung laki-laki (70%) dan yang
menderita luka di perumahan (43%).
Sekitar 90% luka bakar terjadi di negara
berkembang dan 70% dari ini adalah pada
anak-anak

Herndon, David. Burn. 2007. Online. [cited 2014 Apr 18]. Available
from: http://www.wikipedia.com/freeencyclopedia.
 EPIDIMIOLOGI

Hettiaratchy S, Dziewulski P, Hudspith J, Rayatt S et al.

ABC of Burns. USA: BMJ Books; 2004. 328-329.
 HEAT INJURY
Damage to the skin caused by excessive
heat or caustic chemicals → burns
Kobaran api di tubuh (flame),
Jilitan api ke tubuh (flash),
Terkena air panas (scald),
Tersentuh benda panas (kontak panas),
Akibat serangan listrik,
Akibat bahan-bahan kimia, serta
Sengatan matahari (sunburn)
Beberapa bentuk luka bakar serta
penyebabnya
FLAME
• IN FLAME BURNS, THERE IS ACTUAL CONTACT OF BODY AND
FLAME, WITH SCORCHING OF THE SKIN PROGRESSING TO
CHARRING.
• FLASH BURNS ARE A VARIANT OF FLAME BURN
• SECOND MOST COMMON MECHANISM OF THERMAL INJURY

Cases of suicides by fire (self-immolation). Victims alive during fire (smoke inhalation and elevated
carboxyhemoglobin). Found under hood of burned vehicle in remote area.
FLASH
• EXPLOSION OF NATURAL GAS, PROPANE, BUTANE, PETROLEUM
DISTILLATES, ALCOHOLS, AND OTHER COMBUSTIBLE LIQUIDS,
AND ELECTRICAL ARCS CAUSE INTENSE HEAT FOR A BRIEF TIME
PERIOD → FLASH BURNS
• FLASH BURNS GENERALLY HAVE A DISTRIBUTION OVER ALL
EXPOSED SKIN, WITH THE DEEPEST AREAS FACING THE SOURCE
OF IGNITION.

CONTACT

• CONTACT BURNS INVOLVE PHYSICAL CONTACT BETWEEN THE

BODY AND A HOT OBJECT.
• AT SURFACE TEMPERATURES OF 70°C AND HIGHER, TRANS-
EPIDERMAL NECROSIS OCCURS IN LESS THAN A SECOND
 RADIANT

• RADIANT HEAT BURNS ARE CAUSED BY HEAT WAVES, A TYPE OF

ELECTROMAGNETIC WAVE.
• THERE IS NO CONTACT BETWEEN BODY AND FLAME, OR
CONTACT WITH A HOT SURFACE

DiMaio Vincent J, DiMaio Dominick. Forensic Pathology 2nd Ed. 2001

 ( A and B) Radiant heat burns with erythema, blistering of
skin and skin slippage

DiMaio Vincent J, DiMaio Dominick. Forensic Pathology 2nd Ed. 2001

 SCALDING

Rambut talk
• WOUND CAUSED BY MOIST HEAT (HOT LIQUID OR GASSES) Herbalar -

• MOST COMMON CAUSE OF BURNS IN CIVILIAN PRACTICE.

• EXPOSED AREAS OF SKIN TEND TO BE BURNED LESS DEEPLY THAN
CLOTHED AREAS → CLOTHING RETAINS THE HEAT

(A) and (B) Scalding burns. Deceased fell into vat of hot fluid (160ºF). Hair did not burn.
DiMaio Vincent J, DiMaio Dominick. Forensic Pathology 2nd Ed. 2001
Holmes, James H; Heimbach, David M. Burns in Schwartz’s Manual of Surgery 8th ed. 2006
 Chemical burns

• Wound caused by either acids, alkali or vesicants (blister-

producing substances).
• Alkalies produce more severe injury than acids because they
tend to dissolve protein and saponify fat. They produce a
liquefaction necrosis, permitting deeper invasion of tissue by
chemicals, with deep burns and marked edema.
• In contrast, acids precipitate protein, producing a coagulation
necrosis with a resultant hard eschar, or scab.

This elderly woman was cleaning her

house when she slipped and fell in dilute
household liquid bleach solution (sodium
hypochlorite).

DiMaio Vincent J, DiMaio Dominick. Forensic Pathology 2nd Ed. 2001

Scald, Moist Heat
- Burn wound by heat liquid / gasses
- 3 grade :
* Erythema
* Blister
* Coagulation / necrosis
Burn (Dry Heat)
- There are 4 grades:
1. Erythema
2. Blister
3. Necrosis
4. Carbonization
Chemical Burn
- High concentrate acid
➔ Skin/ tissue - Dry
- Rough
- Dark brown
- High concentrate alkaline
Skin : - Smooth
- White
- “Soapy” touch
Manner of death:
- Usually accident
- Murdering
- Suicide Jarang
->
General reaction of heat
1. Heat Exhaution
- Increase of thermal body
- Irregular pulse
- Collaps ➔ death
- Dark colour of heart erythrocyte
2. Heat Stroke
➔ Heat causes paralyse of thermal centre
in medulla
➔ tacchycardia ➔ circulatory collaps ➔
death
General reaction of heat
Autopsy:
- Congested organ
- Dark blood in heart
- Brain oedema
➔ occur by increasing of temperature and air
moist.
3. Heat Cramps
Increasing temperature ➔ more sweating
➔ increase of ion Cl excretion ➔ muscular
spasms
Severity of burn
The severity of thermal injury depend on
:
A. The extent of the burned area
- -

B. The severity of the burn

C. The age of the victim
-

D. The presence of inhalation injuries

A. The extent of the burned area
Determined by the rules of nine.
The head is 9 %
Upper extremities are each 9 %
The front torso is 18 %
The back is 18 %
Each lower extremities is 18 %
Perineum is 1 %
B. The severity of the burn
Can be described as :
First degree (superficial burns)
The skin is erythematous ➔ congested
vessels in the dermis
* Second degree burns
- Partial thickness burns subdivided into :
1. Superficial
2. Deep
Second degree burns
1. Superficial
Destruction of the striatum granulosum
and cornium with the basal layer, not
totally destroyed ➔ heals without
scarring.
2. Deep
Complete disruption of epidermis and
destruction of most basal layer
Third degree burns
Coagulation necrosis of the epidermis and
dermis with destruction of the dermal
appendages ➔ scar
Fourth degree burns
Incinerating injuries extending deeper than
the skin
 DERAJAT LUKA BAKAR BERDASARKAN
KEDALAMAN LUKA :
Lapisan yang Waktu
Derajat luka
terlibat
Gambaran Tekstur Sensasi
penyembuhan
Komplikasi Gambar

Derajat 1 Epidermis Eritema Kering Nyeri < 1 minggu Tidak ada

Kemerahan
Derajat 2 Dermis
(superfisial) (papillary)
dgn lepuhan Lembab Nyeri 2-3 minggu Selulitis
bening
Kemerahan Skar, kontraktur
Beberapa minggu
Derajat 2 Dermis dan putih dgn (membutuhkan
(profunda) (retikular) lepuhan yg
Lembab Nyeri atau dapat progresif
eksisi dan skin
menjadi derajat tiga
berisi darah graft)

Meluas pada Skar,

Warna Kering, Sedikit Membutuhkan
Derajat 3 seluruh kontraktur,
dermis
putih/coklat kasar nyeri eksisi
amputasi
Meluas di
lapisan kulit, Hitam,
jaringan
hangus Sedikit Membutuhkan Amputasi dan
Derajat 4 subkutan Kering rehabilitasi
sampai dengan nyeri eksisi
jaringan otot eskar
dan tulang
Intravital signs of burn wound
- Light red of livor mortis(cherry red) 
stelch mati
COHb Impossible -

- Blister Vesikel bullae (extravasasi plasma Interstitial

->
,
-

- Respiratory tract → dusty

- Inflammation of burn wound tissue. tract
set z Resp
.

di
Karbon
/gelaga

Evidence that the person w as alive at the time

of the fire includes soot lining the airw ays
↑ -
lidah
Intravital signs of burning cases

- Burn wound bullae

- Carbon in respiratory tract
- COHb level : above 10 %, heavy
smoker more than 25 %
 PATOFISIOLOGI
Suhu tinggi aktivasi Histamin + xantin
merusak komplemen dan oksidase→
lapisan kulit pelepasan ↑aktivitas katalitik
histamin

O2 yang bersifat toksik,

protein terlepas dari
plasma masuk kedalam
ruang ekstraseluler
menyebabkan udem,
penurunan volume darah
dan gangguan sirkulasi
hasil dari xantin
oksidase, termasuk
H2O2 dan hydroxyl
radical merusak endotel
Terjadi dilatasi dan pembuluh darah
permeabilitas
kapiler meningkat

timbul bula di kulit dengan Darah dan cairan akan

membawa serta elektrolit, hilang melalui evaporasi
sehingga terjadi penurunan sehingga terjadi
cairan intravaskuler kekurangan cairan
Cause of death:
a. Fast : - CO intoxication → Asphyxia
- Larinx oedema
- Neurogenic shock
b. Moderate : - Dehydration
c. Slow :
- Renal failure ➔Acute tubular necrosis
- CÜRLING ulcer
- Sepsis
- Auto intoxication
Manner of death :
• Murdering
• Accident
• Suicide
 Dead Burn
~
-

Pseudoepidural Epidural Alive

SKULL
>
-

D
=

Haematome Haematome
Blood clot Brownish Blackish

Consistency Brittle Elastic

Brain shape Shrinkage Concave

according to
coagulated
blood
Skull line Unidentified Through medial
fracture meningia artery
way
the uniformly smooth, dark red appearance of an
antemortem hematoma
↓
antemortem
Blister or bullae on burns wound
 Pemeriksaan kematian pada
korban luka bakar
1. Pemeriksaan pada Tempat Kejadian
Perkara (TKP)
2. Sebab kematian luka bakar
3. Identifikasi korban
4. Autopsi pada korban yang meninggal
karena luka bakar thermik
 1. Pemeriksaan pada Tempat Kejadian Perkara
(TKP)

• Menentukan apakah korban masih hidup atau

sudah meninggal.
Menentukan perkiraan saat kematian.
• Menentukan sebab/ akibat dari luka bakar.
• Membantu mengumpulkan barang bukti.
• Menentukan cara kematian.
 2. Sebab kematian luka bakar
Sebab kematian yang biasanya ditemukan
pada korban yang meninggal akibat luka
bakar antara lain:
1). Shock (hypovolemik maupun neurogenik
shock)
2). Infeksi
3). Akut Renal Failure
4). Larynx oedema
5). Keracunan akut gas CO atau gas-gas
toksik yang lain
 3. Identifikasi korban

Identifikasi pada korban dilaksanakan pada pemeriksaan TKP

maupun pada waktu pemeriksaan jenazah. Identifikasi dapat
diperoleh dengan mencatat hal-hal sebagai berikut:
◼ Catat data-data dari korba, antara lain: tinggi badan, berat badan, jenis
kelamin, umur, Warna kulit, warna mata dan rambut.
◼ Catat tanda-tanda pengenal khusus pada tubuh, seperti jaringan parut
luka, tattoo, kelainan-kelainan kongenital.
◼ Simpan potongan pakaian yang tidak hangus terbakar.
◼ Catat dan simpan barang-barang pribadi milik korban, misalnya: kunci,
uang, KTP dan identitas lain, surat-surat berharga serta perhiasan yang
dikenakan korban.
◼ Kumpulkan dari sampel rambut yang tidak terbakar
◼ Buat pemeriksaan gigi dan bila mungkin buat sidik jarinya
◼ Buat pemeriksaan radiologi
◼ Tentukan golongan darah korban
 4. Autopsi pada korban yang
meninggal karena luka bakar
thermik
Pada kasus luka bakar yang berat, terjadi
kelainan yang luas pada tubuh dan
seringkali tubuh menjadi hangus, sehingga
dapat mempersulit proses penyidikan.
Pada kasus-kasus seperti ini, autopsy
dapat memberikan informasi yang penting.
Perlu dilakukan pemeriksaan luar dan
pemeriksaan dalam pada korban luka
bakar
Electrical Burn
The factor that influent electrical effect :
1. Voltage Density
V = 60 Volt dangerous
2. Current Density
> 65 mA dangerous
3. Current Path Resistence
Burn skin ➔ increasing meassurement
4. Time Duration of Current Flow
Electrical Burn
5. Victim situation
- Consiousness or not
- Victim’s occupation
- Health/sick

Cause of death :
⚫ Ventrikel fibrillation from hands-fantung
-

⚫ Paralyze Centrum medulla from head

>
-

⚫ Paralyze Respiratory muscle from torso/chest

>
-
 Hambatan Jaringan dari yang
Tertinggi ke yang Terendah

Tulang Ifrakturs HIGH

Kulit

Lemak

Saraf

Otot

Darah dan cairan tubuh Low

Mechanism of death
Current Density is the most important factor,
currents between 75 – 100 mA caused
ventricular fibrilation. Extremelly high currents
1A/ higher usually cause ventricular arrest.
Paralysis of the muscles usually caused by low
amperage electrocution ➔ asphyxia
Paralysis of the respiratory center of the brain
stemp caused by the hyperthermic effect of the
current (high voltage current)
 DIAGNOSIS
Anamnesis dan situasi kematiannya
(TKP, kemudian otopsi, dan juga termasuk
alat, peralatan)

Gejala •dicurigai pada kematian di mana individu menggunakan alat listrik dan
mesin atau berada di sekitar perangkat listrik.

TKP •titik kontak dengan sumber energi dan titik kontak dengan tanah

Pemeriksaan •Luka bakar masuk dan keluar

•Luas luka bakar

Luar •Burn marks

•Petir: membran timpani yang pecah dan tanda Lichtenberg

Pemeriksaan •koagulasi nekrosis bergelembung epidermis

Mikroskopis
Autopsy findyngs
Electrical burns, could at the point of entry
or the point of exit
Accelerated onset of rigor mortis caused
by the muscle contraction and depletion of
ATP
Bone fracture due to generalised muscular
contraction
High voltage current ➔ third degree burns
Rhexiss of the heart muscle
L
microscopic
 Electrical burns of hands representing points of Electrocution burns (contact or entry site). (A)Worker’s
entry sett glove. (B) Burn on hands.
↑

entry.
DiMaio Vincent J, DiMaio Dominick. Forensic Pathology 2nd Ed. 2001
Shkrum Michael J, Ramsay David A. Forensic Pathology of Trauma. 2007
 the electrocution burn
on the palm of a victim’s left hand

exit
Site

(C and D) Electrical burns of feet representing exit sites

Dolinak David, Matshes Evan, Law Emma. Forensic Pathology: Principles and Practices. 2005
Electricution
Manners of death
* Accident
* Suicides
* Homocides
Autopsy:

1. Outer examination
- Electrical marks (current marks)
* Palm / plant
* Dorsal hand, etc
Burnt skin, cloth or burnt hair may
occur
Autopsy:

2. Inner examination
- - -

◼ Heart filled with blood

◼ Congestion of visceral organs
◼ Lung Oedema
◼ Conjunctiva bleeding, pericard bleeding
◼ Rhexis of muscles
◼ “Pearl like body” on bone. Bone fracture
Lightning
Static electric content in cloud with voltage up to 1
million volt and current density up to 100.000
ampere in 1/1000 – 1 second released to earth.

Body disorders depends on:

1. Electrical ware factor
* Signs like electrical injury
* Arboresscent marking caused by blood vessel
dilatation
* Magnetisation Periasan logam
~
2. High temperature factor (Electical
energy)
W = V x A ➔ heat
Heat:
* Burning wound
* Metalization
3. Air exchange/ explotion factor➔ blunt
trauma
“Arborescent” burn of lightning.
↳ vasodilatasi
per .
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