PHYSICAL INJURIES

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PHYSICAL INJURIES

• Causes and types
• 1- Dry heat application of the hot
  solid
• 2- Moist heart e.g. hot liquids
  scalds
• 3- Acids and alkalis corrosive burns
• 4- Electricity electric burns
• 5- Irradiation radiation burns.

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Causes of Burns

• Flame 33
• Scald 30 
• Contact 15 
• spark 10 
• Electrical l5 
• Radiation 1 

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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

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3rd
4th
5th
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1st
2nd
4th
3rd
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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

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Factors affecting the seriousness of burns

• Degree of burn
• 2.Site burns
• 3.Age of burnt person
• 4.General health of the person
• 5.The extent of burn

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Mechanism of death in burns.

• A- Within 0-6 Hours of burns

• Neurogenic shock form fear or pain
• 2.Asphyxia from inhalation
• 3.Traumatic asphyxia
• 4.Head injury

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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

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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.

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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

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• 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.

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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)

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Factors predisposing to heat collapses

• 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

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Treatment1- 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.
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DEATH FROM COLD

• 1- Exposure of the limbs only frost
  bite
• edema bulla
• 2- Exposure of the whole body loss
  of consciousness due to affection of the vital
  centers.

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3- ELECTRICAL INJURIES

• Factors affecting electrical injuries
• Type of current, Alternating current or DC
• Strength of the current, 40 (fatal 200volt).
• Path of current. Brain or heart it is fatal.
• Duration of contact .
• Contact surface area.

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Mechanisms of death from electric current

1. Ventricular fibrillation.
2. Central respiratory failure.
3. Mechanical asphyxia.

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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

• 1. Gangrene
• 2. Hemiplegia
• 3. Aphasia
• 4. Epileptic fits
• Cataract
• Optic atrophy

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Treatment

• 1- Current should be switched off.
• 2- Cardiac and respiratory resuscitation.
• 3- For cerebral irritation a lumbar puncture may
  be needed.

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4- INJURIES DUE TO IONIZING RADIATIONSAn 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.
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1- Skin erythema, loss of hair, falling of
nails

• 2- Blood lymphocytopenia, thrombocytopenia,
  reticulo-cytopenia - anemia.
• 3- Reproductive system
• a- Atrophy of testicles.
  sterility
• b- Affection of ovaries
  sterility.
• 4- Pregnancy
• 2nd - 6th week gives intrauterine fetal death.
• 7th - 15th week Gives mental retardation
• 5- G.I.T
• 6 - Eye

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Foot prints are most commonly used fora.
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)

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The mechanism of death from stab wounds
isHemorrhage.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

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Death certification

• A patient suffered from acute myocardial infarct
  (MI) due to 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....___ ___

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