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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 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....___ ___