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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 …

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 :)

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  • 1. PHYSICAL INJURIES physical agents that can cause non-kinetic injuries to the body Heat Cold Electricity
  • 2. 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
  • 3. 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
  • 4. ELECTRICAL INJURIES Injury and death from the passage of an electric current through the body common in both industrial and domestic circumstances.
  • 5. BURN A burn is a type of injury to flesh caused by heat radiation electricity light chemicals
  • 6. TYPES OF BURNSuperficial burnsPartial-thickness burnsFull-thickness burns
  • 7. PATHOPYSIOLOGY OF BURN INJURIESMechanisms of Injury Local Response Systemic Response Zone of Thermal Cardiovascular coagulation Electrical Zone of stasis Respiratory Zone of Chemical hyperaemia Hematological Radiative Immunological
  • 8.  Scald “ Moist Burn “ Contact Flame* About 70% of * commonly seen in * 50% of adultburns in children people with burns* Immersion epilepsy or those *cause burns, Splash & steam who misuse alcohol directly or due toburns or drugs radiation of the * superficial heat.dermal burns
  • 9.  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 fatalHigh 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
  • 10.  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
  • 11.  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
  • 12.  ♥ ↑ 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
  • 13. SEVERITY OF BURN INJURIES Severity depends on Age ofThe extent The degree The site the victim Individual General Sex susceptibility health
  • 14. CAUSES OF DEATH FROM BURNS Immediate causes Rapid causes Delayed causes
  • 15. DEGREES OF BURN Layer Appeara Texture Sensatio Time To Complic ExampleNomencl Involved nce n ations Ature Healing Painful None FIRST Epidermis Redness 1wk orDEGREE (erythema) Dry less
  • 16. Second Extends Red withdegree into clear(superfi superfici blister. Local 2-cial al Blanche Moist Painful infection/cell 3wkspartial (papillar s with ulitisthicknes y) pressures) dermis Second Extends Red-and- Painful Wee Scarring, c degree into white ks - ontractures (deep deep with may (may partial (reticula bloody prog requirethicknes r) blisters. ress excision Moist s) dermis Less to and skin blanchin third grafting) g. degr ee
  • 17. Painless (Third Extends Stiff and Dry, Requires Scarring, degree through white/bro leathery excision contractu (full entire wn res, amputhicknes dermis tation s Extends through skin, subcutan Charred Amputatio Fourth eous n, with degree tissue Dry Requires significant eschar Painless and into excision functional
  • 18. •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.
  • 19. for small or scattered burns,or for assessing the amount ofunburnt skin in very extensive burns,the persons palmarsurface(including fingers) can be used as a guide.it is equivalent to around 1% of the persons total bodysurface area.
  • 20. For small children, the head represents a greater portionof the body mass than adults.Lund and Browder first described a method forcompensating for the differences and the Lund and Browder Chart is used to calculate Body Surface Area (BSA) inchildren.If the chart isunavailable, one can estimatebody surface areaand adjust for age, asfollows
  • 21. In children < 1 year, the head is 18% andeach leg is 14%- The torso and arms the same percentagesas in the adult- For each year over 1, add 1/2 percent toearepresent ch leg and- decrease the percent for the head by 1%,until adult values are reached
  • 22. POST MORTUM SHANGES1. Blister have amore aquous fluid2. Change in color of skin Cherry red Carboxy_hb Black Pink carbon unreduced particles in larynx trachea oxyhb bronchi
  • 23. POST MORTUM SHANGES3-Surface of body has been damaged4- blurred margins over joints5- puterfuction
  • 24. CHEMICAL BURNSChemical burns can be caused by acids or bases that come into contact with tissue.Both acids and bases can be defined as caustics.CausesAcids (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 SymptomsRedness, irritation, or burning at the site of contactPain or numbness at the site of contactFormation of black dead skin at the contact siteVision changes if the chemical gets into your eyesCough or shortness of breath
  • 25. TreatmentPrehospital Care1-Prevent contaminated irrigation solution from running onto unaffected skin.2-Remove contaminated clothes.Emergency Department Care1-secure the airway2-Large surface burns require the same fluid therapyConsultations1-Ophthalmologic consultation is recommended for patients with ocular burns2-Caustic ingestions may require multiple specialties3-Consult a psychiatrist for cases of attempted suicide
  • 26. Medication1- 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.
  • 27. 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.
  • 28. INVESTIGATIONS OF PATIENTS WITHBURN INJURIES : 1-Arterial blood gases 2-CBC 3-Chest –x ray 4-Kidney function 5-Liver function 6-Urine analysis 7-Serum immunoglobulins
  • 29. MANAGEMENT OF BURNAssessment of :