Thermal Injury

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PDFelement
Thermal injury
Def : Thermal injury is defined as
tissue injury due to application of
heat in any form to the external or
internal body surfaces
PDFelement
Thermal injuries result from

Due to heat-
• Dry heat-by application of hot subs
by application of flame
• Moist heat-scalds
• Chemicals-corrosive burn
• Radiation burn-x-ray, ultraviolet rays, laser
• Electric burn-electric contact, flashes of
lightning
PDFelement
Cont.
Due to cold
• Trench foot
• Immersion
• Frost bite
PDFelement
Burn
• Def: A burn is an injury which is caused
by application of dry heat or chemical subs
to the external or internal surface of the
body which causes destruction of tissue.
PDFelement
Classification
Wilson’s classification
1. Epidermal burn(1st degree)
• The affected part is erythematous.
• Threre is blister covered by pale avascular
epidermis which is surrounded by a thin
bright red area of inflammation.
• Singeining of hair is present.
• These burns are very painful.
• Repair is complete without scar formation.
• There is partial loss of skin
PDFelement
2. Dermo-epidermal burn(2nd )
• The whole thickness of skin is destroyed.
• The lesion have a dry white leathery
appearance.
• The necrosed tissue separates usually within a
week, leaving an ulcer which heals with scar
formation.
• The scar may contract causing disfigurement
and impairment of function, according to the site
and size of the burn.
• These burns are associated with considerable
pain and shock
PDFelement
3.Deep burn(3rd degree)

• Gross destruction of skin, subcutaneous
tissue, muscles and bones.
• Affected area is completely charred,
• Nerve endings are destroyed.
• The burns are relatively painless.
PDFelement
Rule of nine
• Head -9%
• Right upper limb-9%
• Left upper limb-9%
• Front of right lower limb-9%
• -- -- left -- -- -9%
• Back of right lower limb-9%
• -- -- left -- -- -9%
• Front of the chest-9%
• Back -- -- -- -9%
PDFelement
Cont.
Front of abdomen-9%
Back -- -- -9%
External genitalia -9%
PDFelement
Significance of rules of nine

• To determine the extent of surface burn &
replacement of fluid accordingly.
• The area of the burning may be more
dangerous to life than the depth(degree).
• Involvement of 30% body surface/area will
proved fatal even when the burns are only
of the 1st degree.
PDFelement
Causes of death in burn

1. Primary neurogenic shock-occurs
instantaneously from pain/fear.
2. 2. secondary shock-due to exudation of
serum from burnt area and consequent
depletion of blood volume.
3. Asphyxia –due to inhalation of smoke
containing co, carbondioxide. Traumatic
asphyxia.
PDFelement
Cont..
• Accidental injuries-from falling structures
while trying to escape from a burning
house or by injuries due to falling
masonry, timber or other structures on the
body.
• Delayed death-due to complication.
Acute tubular necrosis
Septicemia(most important factor, occurring
4-5days)
Intercurrent disease
PDFelement
Cont. delayed cause

Curling’s ulcer
Tetanus
Gangrene
Gross hypoprotienaemia.
Pulmonary embolism-from thrombosis of
vein of leg due to tissue damage &
immobility.
PDFelement
Difference between
antemortem & postmortem burn
Trait -- ante mortem-- postmortem
• Line of present -- absent
redness
• Vesicles--contain albuminous--contain air
fluid
• Infection –pus & sloughing-- absent
• Soot in upper
respiratory tract--present --- absent
PDFelement
Cont..
• Carboxyhaemoglobin—present--absent
in blood
• Vital reaction-marked cellular
exudation& --absent
reactive change
in the tissue cell
present.
• Enzyme –increase in enzyme---no such
increase
PDFelement
Scalds
Def : A scaled is an injury resulting from
application of liquid at or near boiling point
or from steam.
In scalds only superficial layers of the skin
are affected, scars of scalds are much
thinner than those of burn and cause less
disfigurement and contraction.
PDFelement
Differences between burn and

scald and chemicals
Burn-
1) Cause- Flame,heated solid subs or radiant
heat.
2) Skin- Dry,shrivelled charred.
3) Vescicles- At circumference of burnt area.
4) Singeing- Present.
5) Red line- Present.
6) Trickle marks-Absent.
7) Scar- Thick and causes disfigurement.
PDFelement
Cont…
Scald-
1) Cause- Steam or any liquid.
2) Skin- Sodden and bleached.
3) Vescicles- Most marked over burnt area.
4) Singeing- Absent.
5) Red line- Present.
6) Trickle present- Present.
7) Scar- Thin and causes less
disfigurement
PDFelement
Cont..
Chemicals-
1) Cause- Corrosive and alkalis.
2) Skin- Stained corroded.
3) Vescicles- Rarely found.
4) Singeing- Absent.
5) Red line- Absent.
6) Trickle marks- Present.
7) Scar- Keloid scar and much
disfigurement.
PDFelement
Thermal injuries due to heat
Three clinical conditions may result from

exposure to high environmental
temperature. miners cramp stokers cramp firemans
cramp
1) Heat cramps : they are caused by a rapid
dehydration of body through the loss of
water and salt in sweat, severe and painful
paroxysmal cramps affecting the muscles
of the arms, legs and abdomen occur.
eg.-in workers , face flushed, pupils dilated,dizziness
INTRAVENOUS injection of saline gives rapid relief
PDFelement
Cont…
heat exhausastion heat syncope heat collapse
2) Heat prostration : heat prostration is a
condition of collapse without increase in
body temperature, which follows exposure
to excessive heat.
This occurs due to closed environment of
high temp. Due to the effect of heat on the
nervous system in such circumstance
there may be failure of heart and
circulatory system.
patient feels weak giddy and sick ,face pale skin cold temp subnormal pulse small and
thready :recovers of placed at rest but may die of heart failure
PDFelement
Cont…….
There are fall of blood pressure, thready
weak pulse, fall of body temperature,
headache, giddiness.
• Relieved by removing the person from the

place and resuscitation.
PDFelement
Cont.
sunstroke ,
3) Heat hyperpyrexia or heat stroke: thermic fever
Heat stroke is a condition characterized by

rectal temperature greater than 41 degree
Celsius and neurological disturbances
such as psychosis, delirium, stupor, coma
and convulsion.
This is attributed to on impaired functioning
of the heat regulatory mechanism caused
by failure of cutaneous circulation and
sweating. The temperature rises to 40-43ċ
or more.
PDFelement
Factor responsible for heat

stroke
• High temperature
• Increased humidity
• Minor infection
• Muscular activity
• Old age
• Pre existing disease
• Alcoholism
• Obesity
PDFelement
Symptoms
• Onset may be sudden but usually there
are prodromal symptoms-
• Headache
• Nausea
• Vomiting dizziness
• Weakness in the legs
• Excessive desire to micturate
• Sudden unconsciousness.
PDFelement
signs
• The face is flushed
• The skin is hot and dry, as if sweat cooling
has failed
• The pulse is full and rapid
• Respiration are stertorous
• Pupil constricted
• The temp rises as high as 43ċ
PDFelement
Treatment
• It can be prevented by giving saline water
to drink.
• Sedative may be necessary to relieve the
pain due to cramps
• Supportive treatment –
e.g glucose, saline, sodium bicarbonate
reducing the temperature by every
means available such as cool or ice water
sponging, till the body temp drops to 38ċ
PDFelement
Postmortem findings
External
• The temperature remains high after death
or may rise further.
• Eyes open will show such changes as
drying of the cornea.
• Sinking of the eyeballs
• Rigor mortis set in early and disappear
early
• Putrefaction is rapid
• Lividity is marked
PDFelement
Internal findings
• Degeneration of neuron in the cerebral
cortex, cerebellum and basal ganglia is
common
• Visceral congestion is usually well marked
• Petechial hemorrhages are found in the
skin, viscera and in the walls of the third
and 4th ventricles.
PDFelement
Medico-legal aspects of heat

stroke
• When a worker dies at his work place
where adequate facilities for temp
regulation are not provided, adequate fluid
intake some how impeded compensation
is being claimed.
• It is accidental
PDFelement
Injury due to cold

Frost bite
• This refers to tissue necrosis from
vascular spasm or thrombosis.
• It is the of local effect of cold on exposed
parts of the body such as the tip of the
nose, ears, fingers and toes.
• The skin on exposed parts is patchy-red
with a general pallor else where
PDFelement
Trench foot
• This refers to a form of cold injury to the
foot occurring after prolong sustained
exposer to cold injury to most conditions
as typically experienced by soldiers during
winter warfare, specially in trenches.
PDFelement
Immersion syndrome
• This refers to a form of cold injury to foot
occurring after prolonged exposure to cold
water as typically experienced by soldiers
when shipwrecked in arctic waters.
PDFelement
Hypothermia
Def: this refers to a condition which is the
result of exposer to cold in which oral or
axillary temperature less than 35ċ.
Cause of death
Cessation of vital function.
Pulmonary edema
PDFelement
Cont.
Clinical feature
• Blanching & paleness of the skin due to
vascular spasm
• The skin is icy cold to touch.
• There is generalized muscular stiffness
• The pulse rate is slow
• The blood pressure tends to be low
• Reflexes are depressed
• In extreme cases suspended animation
may occur.

Thermal Injury

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Thermal Injury

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Remove Watermark Wondershare

Thermal injuries result from

3.Deep burn(3rd degree)

Significance of rules of nine

Causes of death in burn

Cont. delayed cause

Differences between burn and

Thermal injuries due to heat

Three clinical conditions may result from

• Relieved by removing the person from the

Heat stroke is a condition characterized by

Factor responsible for heat

Medico-legal aspects of heat

Injury due to cold

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