Burns by himasri reddy

this includes various types of burns & classification of burn injuries along with their antemortem & postmortem findings

1. burns By HimaSri Reddy

2. Introduction:- Heat is form of energy which when transferred to body produces thermal injury in the form scalds &burns. Scalds :- produced due to application of moist heat to body. The Boiling liquids that can scald include water ,milk, oil etc. Burns:- produced due to application of dry heat. min. temp for producing burn is 44 c for exposure of about 5 to 6 hours while 65 c for 2 seconds is sufficient to cause burns .

3. Definition:- A burn is an injury which is caused by application of heat / chemical substance to external or internal surface of body

4. Various types of burns:- Burns due to solid objects Burns due to flames Burns due to oil

5. Burns due to X-rays Burns due to cross over substance Electrical burns

6. Classification:- Based on depth Based on surface area Based on depth – 1)Hebra’s classification 2)Wilson’s classification 3)Dupuytren’s classification

7. Dupuytren’s classification Classified depending on severity of burns. First degree- erythema then desquamation of superficial layer of epidermis. Second degree- blister formation Third degree- destruction of epidermis Fourth degree- destruction of whole thickness of skin Fifth degree- destruction of muscles Sixth degree- destruction of bone,nerve trunks etc.

8. In practical situations Dupuytren’s classification is limited to three degrees. First degree : Epidermal burns In this the lesion is confined to the epidermis. There may be Blistering without lose of epidermis . If the blister bursts reddened base is seen.

9. Second degree : Dermoepidermal burns There is a destruction of full thickness of the skin. The epidermis is coagulated or charred. There is a central zone of necrotic tissue surrounded by first degree burns/ hyperaemia . Scarring is in evitable & is due to formation of contractures, there is disfiguration.

10. Third degree burns : Deep burns There is a destruction of deeper tissues below the skin surface. The skin is totally destroyed, though in some deep burns, islands of intact dermis may be found. Damage to subcutaneous fat & loss of muscle, bone etc., is seen.

11. Classification Based on surface area:- The rule of nines Body part effected % of burns Head & neck 9 Rt upper limb 9 Lt upper limb 9 Rt lower limb 18 Lt lower limb 18 Front of trunk 18 Back of trunk 18 Genitals 1

12. Burn injury is more severe if heat applied is of great intensity & exposure to heat is for long time. It also depends on area involved. Burns to face, genital, lower part of abdomen is more dangerous. Infants & elderly people are more susceptible to complications of burns.

13. COMPLICATIONS OF BURNS:- Heat haematoma :- Haematoma may form in extra dural space between skull & dura mater when cranium is exposed to severe heat. Heat rupture:- Heated skin contracts & splits .It is usually seen on elbows, knees & head Brain haematoma Heat rupture

14. Heat rigor:- It is observed mainly in muscles. There is generalized flexion of trunk , arms &legs .upper limbs held out with fingers curled inwards assembling attitude of boxer {pugilist} .This is refers as pugilistic attitude. Heat fracture:- Due to intense heat bones get fractured especially cranial vaults & limb bones. Pugilistic effect

15. Management of burns Mild or moderately severe- First aid- Cool area with running water for 20 min. For chemical and eye burns, irrigate with copious volumes of water. Pain relief- Paracetamol,codeine,morphine Airway and breathing should be ensured Circulation- signs for circulatory obstruction should be checked .

16. Severe Airway and breathing- In case of airway burn and lung injury,arrange intubation before airway swelling occurs. Circulation- If > 10% body surface involved,commence fluid resuscitation. If > 10% deep partial thickness or full thickness burns,start feeding within 6-18 hrs. Analgesia should be adequate. Closed dressing recommended for partial thickness burns.

17. Causes of death in burns Primary shock or neurogenic shock Secondary shock due to fluid loss Smoke inhalation Toxaemia Septicaemia biochemical disturbances Acute renal failure oedema of glottis & pulmonary oedema Malignant transformation of burns scar { marjolin’s ulcer} after years of recovery

18. Autopsy findings:- External :- The body may demonstrate the pugilistic attitude. Antemortem burns appear reddened & blistered. Hair is signed or burnt. Blisters may be seen , but they also in postmortem burns, even in a putrefying body.

19. Often there may be Signs of gross infection of burns on a dead body with discoloration & pus formation. Burning of clothes, singeing of hair, charring of the body etc., are also seen , which are not seen in scalds. Heat ruptures may be evident , which must not be confused with the antemortem incised wounds. Infected burns

20. Internal :- Blood may be cherry red in colour , due to the presence of carboxyhaemoglobin . Extra dural heat haematoma may be seen Soot particles or carbonaceous material may be seen in the respiratory passages due to smoke inhalation. Curling’s ulcers may be seen on stomach are duodenum. Serous pleural are common. Lungs are congested & appear “cooked” Spleen & adrenal gland may be enlarged, congested & softened.

21. References:- V.v.pillay Text book of Forensic science & Toxicology. Dr. Ks. Narayan Reddy The synopsis of Forensic Science & Toxicology .

22. THANK YOU….