Burn / Electric Injury

Dr. Gunawan Arsyadi, SpPA(K), SpF

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

Devided to: 1. Thermal Burn a. Cold b. Heat :

* Scald (moist heat) * Burn (dry 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

Cold Trauma
Manner of death: * Accident * Infants murdering

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

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 : The extent of the burned area The severity of the burn The age of the victim The presence of inhalation injuries

A. B. C. D.

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

Intravital signs of burn wound

- Light red of livor mortis(cherry red) COHb - Blister - Respiratory tract dusty - Inflammation of burn wound tissue.

Intravital signs of burning cases

- Burn wound bullae - Carbon in respiratory tract - COHb level : above 10 %, heavy smoker more than 25 %

Cause of death: a. Fast : - CO intoxication Asphyxia - Larinx oedema - Neurogenic shock b. Moderate : - Dehydration c. Slow : - Renal failure Acute tubular necrosis - CRLING ulcer - Sepsis - Auto intoxication

Manner of death : Murdering Accident Suicide

Pseudoepidural Haematome Blood clot Consistency Brain shape Brownish Brittle Shrinkage

Epidural Haematome Blackish Elastic Concave according to coagulated blood Through medial meningia artery way

Skull line fracture

Unidentified

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 - Victims occupation - Health/sick Cause of death : Ventrikel fibrillation Paralyze Centrum medulla Paralyze Respiratory muscle

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)

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

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

2. High temperature factor (Electical energy) W = V x A heat Heat: * Burning wound * Metalization 3. Air exchange/ explotion factor blunt trauma