Physical Injuries

These are injuries resulting

from exposure to several
physical agents

Heat Cold Electricity

Starvation Pressure
 Types of heat injuries

• Burns
Local

• Cramps and
Systemic Exhaustion
• Stroke
 (I) Local
(A) Burns

• Types of burns:
1. Dry burns
2. Wet burns (Scald)
3. Chemical burns
4. Radiation burns
5. Electric
 1-Dry burn
• Dry burn is Heat applied to the body surface
by flame , flash, direct contact, radiant heat.
1.Flame: direct contact with fire.
2.Flash: Variant of flame , short duration.
3.Contact burn: contact between body and hot
object.
4. Radiant heat: heat waves or electromagnetic waves,
no direct contact.
Skin appears erythematous ,blistered with area of skin
slippage.
If duration or time of exposure increase charring may
occurs.
 2- Wet burns (scalds)
Scalding refers to tissue damage from hot
liquids, usually water. Other hot fluids
include oils , liquid chemicals and steam
There are 3 methods of scalding:
• Immersion: in hot liquid usually water,
accidental or homicidal (child abuse).
• Splash or spill: homicidal or accidental in
children.
• Steam: Scald like.
 3-Chemical Burns

• sulphuric , nitric and hydrofluoric acid

Acids resulting in coagulative necrosis ending in
thick scar taking the color of the acid.

• More dangerous resulting in liquifactive

AlKalis necrosis leading to deep invasion

• e.g. gasoline high lipid solubility ,

Hydrocarbons dissolution of fatty tissues leading
to partial thickness burn
Classifications of the severity of burns

1- 0ld
classification 2-Surgical 3- Wallace's
(Dupuytren) (Wilson) Classification
(rule of nine)
6 degrees 3 degrees according to the
according to according to percent of
tissues prognosis. affected surface
destruction
Old classification
1st= redness
2nd=vesicles
3rd= superficial layer
4th degree = all skin thickness
5th degree =S.C tissues and muscles

6th degree = complete charring

 Classification of severity of burns
(Surgical classification )

First degree: erythema and blistering without loss

of dermis . Capillary dilatation and transudation of of
fluid into the tissues causing swelling. A split may
occur in the epidermis to form a blister with an
upper cap of pale skin enclosing fluid, surrounded by
a zone of hyperemia.
Second degree: Destruction of the full thickness of
skin. The epidermis is coagulated or charred, and a
central zone of necrotic tissues surrounded by zone
of hyperemia. The central zone slough , the
epidermis grows in from the margins.
Third degree: Destruction of deeper tissues
below the skin. This can be damage of
subcutaneous fat, muscle bone and even
whole limb.
If the burns are widespread, large areas of skin
may be damaged and functionless. A large
area involved may be more dangerous than a
deeper more localized burn. 30-50 per cent of
total body surface is incompatible with life.
 Rule of nine
The area involved is estimated according to this
rule
First degree burn
 First degree burn blistering
• Steam burn
2nd degree burn
Deep burn
3rd degree burn
Burn due to corrosives
 Relation between degree of burn and
clinical prognosis
Degree of Type of prognosis
burn destruction
First Superficial burn. Complete healing
Epidermis is without scar
intact

Second whole skin Heal with scar,

destruction causing surface
distortion graft is
needed

Third Destruction of Major surgical

deep tissues interference
Factors affecting the prognosis of
burns

Extent of burn
Degree of
Site
burn
General
Age Sex
health
 Picture at autopsy
Dry burn Wet burn Corrosives
Clothes Burnt or discolored Wet Wet, eroded or
discolored

Hair Singed or clubbed ends wet Wet and discolored

Skin color Red or discolored due to red Discolored according

smoke to the type of
corrosion

Degree of burn Any degree of burn Reddening and Any degree except
blistering only 2nd

Vesicles Bright red base ,small or Usually big allover the absent
large. area

spread From below upwards or From above downwards in streaks incase of

contact splashing .
Well line of demarcation in case of immersion.

Charring May occurs in deep burn Never In sulphuric acid

when muscles or even
bones are affected

Scar According to the degree Thin Thick and colored

 Differentiation Between Ante mortem and
postmortem burns
Ante mortem Post mortem
Vesicles Tense , rich in If present, small, contain
Chloride and gas, little fluid, poor
albumin albumin and chloride

Hyperemia Present absent

Hemoconcentration Present absent

Soot in air passages Present in open fire absent

CO-Hb Present in open fire absent

Sepsis or healing Present if death is

delayed
absent

Cause of death The burn or its

complications
The original cause of
death may be detected
 Differences between thermal and
traumatic hematomas
Thermal hematoma Traumatic hematoma

Cause Boiling of blood outside sinuses Trauma

or diploic spaces due to
exposure to high temperature.
Scalp Burnt Injuries of any type or intact
Skull Usually charred Fractures of any type or intact
Dura Shrunken Intact or lacerated
Brain Compressed cooked mass compressed towards the other
side
Hematoma color chocolate brown Red
Hematoma site Usually bilateral Usually unilateral
Carboxy-hemoglobin absent Present same level as blood

PMP of burn present absent

 Causes of death from burns

(A) Immediate or very

rapid

Neurogenic shock Asphyxia, traumatic, Injury of vital organ

Sympathetic or Co, toxic gas, Brain , heart
Parathympathetic pulmonary edema Abdomen
 (B) Rapid causes

Hypovolemia
@hemoconcentration

Pulmonary
edema@ edema Fat embolism Histamine Shock
of the glottis

Infection
 Acute
renal
failure
Curling’s Hepatic
ulcer necrosis

(C) Delayed
causes
 (II) Systemic (Heat diseases)
Heat • Excessive loss of NaCl
Cramps
• Affection of cardiac muscle
Heat @heart failure
exhaustion
• Degenerative change in brain
cell of heat regulating center,
Heat Stroke disturbance of body
temperature
 Post mortem picture of heat Stroke

Delayed Rapid Early

cooling rigor putrefaction Generalized
mortis congestion and
edema of the
brain
 Electrocution
• Definition
• Methods of exposure
1.Accidental
2.Homicidal, suicidal rare
3.Judicial
 Factors affecting the severity and
prognosis
Ear thing The Voltage
body form a
part of the and
circuit amperage

Duration
of passage Resistance
of the of the skin
current PHYSICAL
FACTORS
Amperage = amount of current flow = Ampere
Voltage = electrical force = volt
Resistance = the force opposed by the skin to the flow of
electric current
A=V/R ampere = volt/Ohm
• As voltage is fixed (110-120 volt) So resistance of the skin is
the main controlling factor
• Resistance of dry skin = 100.000 ohms
• Resistance of dry callous skin = 1 million ohms
• Moist skin = 1000 ohms
• In case of low voltage we need direct contact with the
circuit
• In case of high voltage(> 600-750 V) electric current arc may
jump from the line to the body severe thermal injury or
respiratory arrest.
 Age State of
Children more
susceptible health
PHYSIOLOGICAL
FACTORS
Passage of the
Subcutaneous fat current through
vital organ
Inlet and exit of electric Current
Severe burn due to electrocution
 Ventricular
fibrillation
Violent
asphyxia
Direct
Central
asphyxia
CAUSES OF Electric
DEATH burn
Falling
from
Indirect height
Setting
Fire
Post mortem picture of
electrocution
Burn at entry or
exit

PMP of asphyxia

Non specific
generalized petechia
Microscopic examination
of the skin