4. COLD INJURY
Hypothermia
• Exposure to cold produce hypothermia which is defined as
core temperature below 35°C.
Effects of hypothermia
• Direct effects are prominent in fatty tissues and myelinated
myelinated nerve fibres.
• Indirect effects are mostly ischemic.
Clinical features
• Dulling of consciousness,loss of reflex,and fall in
respiration, heart rate and blood pressure.
• Red patches and pallor of the skin and edema of the face
5. Chilblain
• These are red, itching,skin lesions, usually in the
extremities,caused by exposure to cold.
• They may be associated with with edema and blistering
and are aggravated by warmth.
6. Immersion syndrome (trench/immersion
foot)
• Immersion foot/hand results from prolonged exposure to
severe cold(<10°C)
• Seen in soldiers during warfare, especially in trenches.
• Extremities are affected in these conditions.
7. Frostbite
• Frostbite is Injury due to freezing and formation of
ice crystals and obstruction of blood supply within
tissues.
• It occurs due to exposure to great extremes of
cold (-2.5°C).
• Typically evident ad blue-black discoloration of
fingers.
• Symptoms are numbness,prickling and itching.
8.
9. PARADOXICAL OR RECIPROCAL UNDRESSING:
• Rare and strange condition linked with accidental
hypothermia, especially in old persons.The person take off
some or all of their clothing.The cause big the condition is not
known,but it may be due to long exposure to severe cold
which causes failure of vasoconstriction of arterioles of the
skin,which results in a flow of blood from the central part of
the body,thus giving an exaggerated sensation of warmth.
Because of the great discomfort,the person may undress
himself.In such case, there may be suspicion of sexual offence.
MEDICO-LEGAL IMPORTANCE
10. The Hide and Die syndrome
• In some cases of hypothermic deaths,the disoriented,dying,
hypothermia victim,who while attempting to protect himself from the
cold may hide himself in corners, cupboards or under piles of furniture
or household goods.
• More commonly,a naked or partly clothed old person is found amid
scene of Utter confusion with furniture pulled over and drawers and
cupboards emptied out.This may lead to suspicion of homicide and
robbery.
11. Neonatal cold injury
• It results from a failure of the metabolism to prevent a fall in temperature
in a body kept in an unsuitable cold environment.
• The symptoms appear usually in the first week of life.
• Rectal temperature – 32°C.
Features
• Swelling and widespread edema of the extremities, particularly the hands
and the feet,and the eyelids.
• Pulsation of peripheral arteries is absent.
• Respiration is shallow,slow and may be irregular.
MLI – It is a method of illegitimate and unwanted infants.
12. HEAT INJURY
1. Heat cramps.
• They are due to fluid and electrolyte depletion.
• Occurs in workers in high temperature
When sweating has been profuse.
• Cramping results from dilutional hyponatremia,as
Sweat losses are replaced with water alone.
Clinical features
• Onset is sudden.
• Severe and painful paroxysmal skeletal muscle contractions.
• Face is flushed and pupils dilated.
• Skin is moist and cool.
13. Treatment
• Patient should be moved into cold environment.
• Given oral saline solution to replace both salt and
water.
• Rest for 1-3days.
14. Heat Exhaustion
• It results from prolonged strenuous activity
With inadequate water or salt intake in a hot
environment.
• Characterized by dehydration, sodium depletion.
Cinical features
• Nausea, vomiting,malaise and myalgia may occur.
• Headache, dizziness, fatigue.
• Anxiety,impaired judgement and occasionally psychosis.
15. Diagnosis
• Prolonged symptoms.
• Rectal temperature>37.8°C
• Increased pulse and moist skin..
Treatment
• Pt is treated in cool environment.
• Adequate hydration (1-2 lit over 2-4 hours)
• Oral salt replenishment and active cooling (ice packs
etc)
• IV fluids if necessary.
16. Heat hyperpyrexia/Heat stroke
• Heat stroke is a life threatening medical emergency
resulting from failure of the thermoregulatory
mechanism.
• Characterized by cerebral dysfunction with
Impaired consciousness,high fever (rectal temp>41°C.
Clinical features
• Onset is sudden, with sudden collapse and loss of
consciousness.
• Skin is hot and initially covered with perspiration,
Later it dries.
• Tachycardia and hyperventilation
• Pupils are contraced.
17. Treatment
• Immediate measures should be taken to lower the
core temperature.
• Pt is unclothed to the minimum.
• Immersion in an ice water bath is very effective.
• Treatment should be continued until the rectal temp
drops to 39°C.
• Chlorpromazine(25-50mg IV) or diazepam (5-10mg
IV)-to control shivering.
• Fluid administration to ensure high urinary output.
• Mannitol administration (0.25 mg/kg) is
recommended.
18. Postmortem findings
Deaths related to hyperthermia have no specific
autopsy.
• Lungs: congested.Intrathoracic petechiae may be
present, particularly in infants and children.
• Heart: subendocardial hemorrhages may be seen.
• Brain: congested and edematous.
Medico-legal aspects
• Deaths are usually accidental.PM is done to rule out
any other cause of death.
19. Heat prostration (heat syncope/collapse)
• It results from Salt depletion and dehydration due
to excess of sweating and cutaneous vasodilation
with consequent systemic and cerebral
hypotension,but without any rise of temperature,
despite exposure to excessive heat.
Clinical features
• Patient suddenly feels weak,giddy and sick.
• Nausea, dizziness, flushed face, throbbing headache
etc.
• Systolic BP<100mmHg
20. BURNS
• Burn is an injury caused by heat,or by a chemical or physical
agent having an effect similar to heat.
Types of Burns
• Contact Burns Chemical Burns
• Flame burns Electric and lighting Burns
• Scalds. Microwave burns
• Radiant heat Burns
• Ionizing radiation Burns(X rays,UV rays)
21. Degree of damage Dupuytren's Wilson’s
Erythema 1° Epidermal
Vesication with blister
formation
2° Epidermal
Destruction of superficial
skin
3° Dermo-
epidermal
Destruction of whole skin
including dermis
4° Dermo-
epidermal
Destruction of deep
fascia, muscles
5° Deep
Complete charring
involving vessels,nerves
6° Deep
Classification of
Burns
22. Effect of Burns
• Degree of heat applied
• Duration of exposure
• Assessing the size(Wallace rule of nine)
• Site
• Age
• Sex
Rule of nine Total
Head 9%
Torso 18%
Back 18%
Each arm 9%
Each leg 18%
Perineum 1%
23. Features First Second Third
Depth Epidermis Epidermis and
dermis
Deeper to dermis
Colour Red/pink Dark red White/grey/black
Pain to stimuli Painful,tender Very painful Painless
Blanching Yes Yes,but slow No
Blisters Not present Present May or may not
Appearance Dry Moist Dry/leathery
Healing time 3-6 days 3 weeks Small areas may take
months,large areas need
skin grafting
Scar No scar Yes Yes
Cause Sunburn,scald etc Scalds,flash Burns Hot liq, chemical,
electric etc
Medico-legal
aspect
Simple Grievous Grievous
25. Postmortem findings
External findings
• Clothing should be removed and examined for presence of kerosene,
petrol etc
• Site, distribution and extent of burning are recorded.
• Face- usually distorted and swollen
• Postmortem staining is cherry red in colour from presence of carbon
monoxide,if the individual was alive and breathing during fire
• Pugilistic attitude (boxing, fencing or defence attitude)
26.
27. Internal findings
• Skull – heat hematoma
• Brain-congested and appears swollen
• Larynx,trachea and bronchioles – contain carbon and
soot particles And the mucosa is congested with frothy
mucus secretions.
• Pluera- congested and inflammed with serous effusion
• Lungs- congested and edematous
• Heart- chamber full of blood,cherry red in colour due
inhalation of CO.
28. MEDICO-LEGAL QUESTIONS
Whether the Burns are suicidal/accidental/homicidal/self
inflicted?
• Suicidal Burns:common among indian women. They pour
kerosene on their heads and cloths before setting fire to
themselves.
• Accidental Burns: common among children and elderly people.
Accidents may results from smoking, stove bursting etc
• Homicidal Burns: quite common in India.Custom of dowry leads
to young brides being murdered by pouring kerosene and
setting on fire.
30. SCALDS
• Definition-A scald is a form of thermal injury which
results from application of liquid >60°C or from
steam,and involves only the superficial layers of skin.
Types of scalds
• Immersion Burns : accidental or deliberate immersion
in hot liquid, usually water.
• Splash or spill Burns: usually accidental.
• Steam Burns: exposure to superheated steam.
31.
32. THANK YOU
Guided by:. Presented by:
Dr Adarsh. Adavayya pujar
Dr Shivanand Shreyas Gowda DC
