burn injuries - Copy.pptx

burns

1. Thermal injuries Dr Rupesh ASSISTANT PROFESSOR

2. Classification Thermal deaths may result from 1. Extreme Heat 4. Scalds 2 . Extreme Cold 5. Electrical 3. Burns 6 . Lightning

3. Due to heat

4. Due to cold

5. Definition It is an injury which is caused by the application of heat, chemical substances to the external or internal surfaces of the body causing tissue destruction . Exclusion --?

6. Temp req - Min time- 44-51 65- >>70 –

7. Varieties of burns Chemical UV RAYS Electrical x rays Explosions Flame Heated solid body Infrared rays Laser Microwave burns

8. Classification Dupuytren W ilson Hebra

9. Hebra and wilson Epidermal Dermo - epidermal Deep

10. Clinical classification Partial thickness Full thickness

11. Effects of burns Surface area The degree of heat Duration of exposure Age Sex Site of burns

12. Surface area Rule of wallace Rule of five

13. Rule of palm Lund and browder chart

14. Cause of death Immediate – neurogenic, Co monoxide intox , acute respir intox . Late – gangrene, embolism, biochemical disturbances, secondary shock Very late – marjolins ulcer

15. Scene of death PM appearances – external Clothes, position of body, facial features, Crows feet

16. Pugilistic attitude Causes Mechanism Features Interpretation d/d

17. PM appearences Burnt areas- irregular, blisters, microscopy Flash burns Heat rupture Hair - Internal findings 1. heat hematoma Heat fractures GIT Viscera Blood

18. S.no Feature Heat rupture Lacerated wound 1 Cause Exposure to intense heat Blunt force 2 Site Fatty tissue Anywhere 3 Bleeding Absent Present 4 Margins No bruise and vital reactions Present 5 Floor Intact nerves and vessels Nerves and vessels cut 6 Associated findings Of burns Of trauma

19. S.NO Trait Heat hematoma EDH 1 CAUSE INTENSE HEAT BLUNT TRAUMA 2 LOCATION PARIETO TEMPORAL AT THE SITE OF TRAUMA 3 DISTRIBUTION DIFFUSE LOCALISED 4 MECHANISM EXPANSION OF BLOOD IN DIPOLE RUPTURE OF MMA 5 Appearance Honey comb Rubbery 6 CNS No injury Injury present 7 Co in clot Yes no

20. Establishment of identity Teeth Finger prints Gums Autopsy findings

21. Age of burns Immediate – erythema 1 hour- vesication 6 hours – epidermis thinned out, inflammatory reaction in dermis 12-24 hours –exudate will begins to dry 36 hours – pus formation (if not healthy) 2-3 weeks – granulation tissue occurs Several weeks to months- scar formation 10-25 yrs – ulcer

22. s.No Trait AM BURNS PM BURNS 1 LINE OF REDNESS PRESENT ABSENT 2 BLISTERS BASE IS RED AND INFLAMED EXUDATE –RICH IN PROTIENS AND CHLORIDES BASE IS PALE,DRY AND HARD CONTAINS AIR 3 VITAL REACTION MARKED NONE 4 ENZYMES INCREASED ENZYMES NO SUCH 5 Co Hb Present Absent

23. MLI OF BURNS BRANDING MANNER OF INFLICTION NECKLACING SCTION 285 IPC

24. Cold injuries

25. Definition – a condition in which core temperature <35* c Stages of hypothermia 1 st stage 2 nd stage 3 rd stage

26. Types – primary , secondary - acute, chronic Local effects Frost nip Frost bite

27. With out tissue freezing Trench foot Chilblains

28. Treatment External rewarming Internal rewarming Iv fluids, humidified o2, peritoneal lavage etc Antibiotics

29. PM appearances External – Skin- White death Internal – skull Heart- Stomach – wischnewski erosions Fat necrosis

30. Mli of hypothermia Paradoxical undressing Neonatal cold injury Accidental hypothermia

31. Heat Factors affecting heat loss Hot and humid conditions Heavy tight waterproof clothes Diseases- CF, psoriasis, eczema etc Obesity -

32. Heat cramps Heat syncope Heat exhaustion Heat stroke

33. Heat cramps Muscle spasm resulting from combination of Prolonged excercise , Heavy sweating Excessive water repalacement in extreme heat Pathophysiology -? Symptoms Treatment

34. Heat syncope Def - is a condition resulting from ? NEITHER WATER OR SALT DEPLETION Predisposing factors- sudden change in environ prolonged standing Signs and symptoms Management

35. Heat exhaustion Is a condition resulting from severe Dehydration after a huge amount of Sweet has been lost Pathophysiology Thermo regulation is maintained Sequelae – Management – cold water with salt

36. Heat stroke Heat hyperpyrexia, siriasis , sun stroke, thermic fever Complete break down of TR mechanisms Complete loss of sweating Temp >41 *c

37. Signs and symptoms

38. PM Appearences Brain – petechial hemorrhages on white matter Degeneration of neurons- GP Diffuse proliferation of microglia Swollen dendrites Cerebellum – purkinje layer- edema Purkinje cells- degeneration Hypothalamus- edema of nuclei

39. Heart – sub epicardial and sub endocardial Lungs Liver Kidneys Adrenals -

40. MLI DEATHS IN PRISONS WORK ENVIRONMENT