Download 7Physical inj2011-09

PHYSICAL INJURIES
Causes and types:
1- Dry heat
application of the hot solid
2- Moist heart e.g. hot liquids
3- Acids and alkalis
scalds
corrosive burns
4- Electricity
electric burns
5- Irradiation
radiation burns.
Causes of Burns
•
•
•
•
•
•
Flame
Scald
Contact
spark
Electrical
Radiation
33%
30%
15%
10%
l5%
1%
Classification of burns:
• 1st degree burn consists of an erythema
• 2nd degree characterized by the formation of vesicles
• 3rd degree destruction of the full thickness and nerve endings
•
4th degree. destruction of the dermis and
SC tissues
• 5th degree burn, the muscles are involved in.
• 6th degree complete charring of the affected area
3rd
5th
1st
2nd
4th
Wilson
states that Dupuytern's classification is of
limited practical value. He classify burns
into:
1-Epidermal burns: characterized by erythema with or
without vesicles or bullae.
2-Dermo-epidermal burns: the epidermis and dermis are
separated .
3- Deep burns: the skin is destroyed and the underlying
tissues
Factors affecting the seriousness of burns:
1.Degree of burn
2.Site: burns
3.Age of burnt person
4.General health of the person
5.The extent of burn
Mechanism of death in burns.
A- Within 0-6 Hours of burns :
1.Neurogenic shock form fear or pain
2.Asphyxia from inhalation
3.Traumatic asphyxia
4.Head injury
B- Death occurring from 6-48 hours
1- Acute edema of the glottis
2- Hemoconcentration due to evaporation of fluids
3- Hematogenic shock due to absorption of
histamine like
4- Fat embolism in the pulmonary arteries
C- Death occurring from 2-7 days
1- Infection and sepsis in the burnt area.
2- Suprarenal hemorrhage.
3- Inflammation of serous membranes.
4- Bronchopneumonia.
D- Death occurring from 7 days onwards:
1- Rapture of duodenal ulcer (Curling's ulcer)
2- Liver or kidney failure due to absorption of
toxic substances
• Scars of burns are usually red
and may stays up to 2 months,
• it is coppery in color for 6 months
• It fades gradually or leads to
• contracture,
• disability ,
• Keloid
• even malignant transformations.
HEAT DISEASES
Three clinical conditions may results from
exposure to high environmental temp.
1.Heat cramps (miner's cramps):
2.Heat collapse (heat syncope or heat prostration):
3.Heat hyperpyrexia (heat stroke):
Factors predisposing to heat
hyperpyrexia (heat stroke): :
1- Non-acclimatization to high temperature.
2- Overcrowding in closed spaces.
3- Anti-cholinergic drugs. e.g. atropine.
4- Alcoholism.
5- Previous affection with heat collapse
Treatment:
1- Remove the patient to a cool place.
2- Application of cold
compresses to the skin, ice-bag
to the head and ice-cold rectal
enema.
3- Give fluid and electrolytes.
DEATH FROM COLD
1- Exposure of the limbs only
edema
frost bite
+
bulla
2- Exposure of the whole body
loss of
consciousness due to affection of the vital
centers.
3- ELECTRICAL INJURIES
Factors affecting electrical injuries:
Type of current, Alternating current or DC .1
Strength of the current, 40 (fatal 200volt). .2
Path of current. Brain or heart it is fatal. .3
Duration of contact . .4
Contact surface area. .5
Mechanisms of death from
electric current:
Ventricular fibrillation. .1
Central respiratory failure. .2
Mechanical asphyxia. .3
C/P of electrocution
Loss of consciousness
Face is congested with cold sweating
Convulsion if motor cortex is in
involved
Parasthesisa and numbness
Oliguria or anuria
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Complication:
Gangrene 1.
2. Hemiplegia
3. Aphasia
Epileptic fits 4.
Cataract .5
Optic atrophy .6
Treatment:
1- Current should be switched off.
2- Cardiac and respiratory resuscitation.
3- For cerebral irritation a lumbar puncture may
be needed.
4- INJURIES DUE TO IONIZING
RADIATIONS
An old and still popular unit of
measuring radioactivity is the curie (Ci).
Ci = 37 GBq
1 Ci = 1000 mCi; 1 mCi = 1000 µCi
Becquerel (Bq) or Curie (Ci) is a measure of the
rate (not energy) of radiation emission from a
.
source
1- Skin
erythema, loss of hair, falling of nails
2- Blood: lymphocytopenia, thrombocytopenia, reticulo-cytopenia - anemia.
3- Reproductive system
a- Atrophy of testicles.
b- Affection of ovaries
sterility
sterility.
4- Pregnancy:
2nd - 6th week gives intrauterine fetal death.
7th - 15th week Gives mental retardation
5- G.I.T
6 - Eye
Foot prints are most commonly used for:
a. Trailing the enemies in desert.
B. None mixing of infants in Hospitals.
C. Solving of crimes.
d. a & b.
e. b & c.
PM Identification is difficult in cases of:
a. severe burns.
b. severe putrefaction.
c. multiple stab wounds.
d. complete charring.
e. absence of the head (decapitation)
The mechanism of death from stab wounds is
Hemorrhage.
Trauma.
Shock.
A and b.
b&c
hitting by thick heavy iron bar ( stick)
causes:
A- an abrasion .
b. contusion.
c. curved contusion.
d. Lacerated wound.
e. bruise
Death certification:
A patient suffered from acute myocardial infarct (MI) due to .a
Coronary arteriosclerosis (CA).Suddenly the infarct ruptured
leading to fatal Hemopericardium .the cause of death is (MI) ……
___
___
b. A farmer has suffered from fatal Hemopericardium due to gunshot
wound to the chest.
The cause of death is (fatal Hemopericardium)
___
___
c The term “cardio-respiratory arrest” is a description of a cause of
death..................
___
___
d. The Manner of Death Explains how the mechanism of death have
effect take place........ …… ___
___
e. Fatal mechanisms of death include congestive heart failure,
cardiac arrhythmias....___
___