Burn / Electric InjuryBurn / Electric Injury

Dr. Gunawan Arsyadi, SpPA(K), SpFDr. Gunawan Arsyadi, SpPA(K), SpF

Heat TraumaHeat Trauma

Definition: Wound by touching outer or inner body Definition: Wound by touching outer or inner body with heat, cold, chemical reagent or electricitywith heat, cold, chemical reagent or electricity

Devided to:Devided to:1. Thermal Burn1. Thermal Burn

a. Colda. Coldb. Heat b. Heat ::

* Scald (moist heat)* Scald (moist heat) * Burn (dry heat)* Burn (dry heat)

2. Chemical Burn2. Chemical Burn3. Electrical Burn3. Electrical Burn

Cold TraumaCold Trauma

General ReactionGeneral Reaction::

• Pale skinPale skin caused by vasoconstruction caused by vasoconstruction reddish due to vasodilatation reddish due to vasodilatation visceral visceral organ congestion organ congestion coma coma

• AutopsyAutopsy: :

* * Heart contains of light red bloodHeart contains of light red blood

* Visceral organ congestion * Visceral organ congestion

* Light red of livor mortis with dark red blood * Light red of livor mortis with dark red blood

rashesrashes

Manner of death:Manner of death:

* Accident* Accident

* Infants murdering* Infants murdering

Cold TraumaCold Trauma

Scald, Moist HeatScald, Moist Heat

- Burn wound by heat liquid / gasses- Burn wound by heat liquid / gasses- 3 grade : - 3 grade :

* Erythema* Erythema * Blister* Blister * Coagulation / necrosis* Coagulation / necrosis

Burn (Dry Heat)Burn (Dry Heat)- There are 4 grades:There are 4 grades:

1. Erythema1. Erythema2. Blister2. Blister3. Necrosis3. Necrosis4. Carbonization4. Carbonization

Chemical BurnChemical Burn- High concentrate acid- High concentrate acid Skin/ tissue Skin/ tissue - Dry- Dry

- Rough- Rough- Dark brown- Dark brown

- High concentrate alkalineHigh concentrate alkalineSkin : - SmoothSkin : - Smooth

- White- White - “Soapy” touch- “Soapy” touch

Manner of deathManner of death::- Usually accidentUsually accident- MurderingMurdering- SuicideSuicide

General reaction of heatGeneral reaction of heat

1. Heat Exhaution1. Heat Exhaution- Increase of thermal body- Increase of thermal body- Irregular pulse- Irregular pulse- Collaps - Collaps death death- Dark colour of heart erythrocyte- Dark colour of heart erythrocyte

2. Heat Stroke2. Heat Stroke Heat causes paralyse of thermal centre Heat causes paralyse of thermal centre

in medullain medulla tacchycardia tacchycardia circulatory collaps circulatory collaps

deathdeath

Autopsy:Autopsy:- Congested organCongested organ- Dark blood in heartDark blood in heart- Brain oedemaBrain oedema occur by increasing of temperature and air occur by increasing of temperature and air

moist.moist.3. Heat Cramps3. Heat Cramps Increasing temperature Increasing temperature more sweating more sweating

increase of ion Cl excretion increase of ion Cl excretion muscular muscular spasmsspasms

General reaction of heatGeneral reaction of heat

Severity of burnSeverity of burn

The severity of thermal injury depend The severity of thermal injury depend on :on :

A.A. The extent of the burned areaThe extent of the burned area

B.B. The severity of the burnThe severity of the burn

C.C. The age of the victimThe age of the victim

D.D. The presence of inhalation injuriesThe presence of inhalation injuries

A. The extent of the burned areaA. The extent of the burned area

Determined by the rules of nine.Determined by the rules of nine.

The head is 9 %The head is 9 %

Upper extremities are each 9 %Upper extremities are each 9 %

The front torso is 18 % The front torso is 18 %

The back is 18 %The back is 18 %

Each lower extremities is 18 %Each lower extremities is 18 %

Perineum is 1 %Perineum is 1 %

B. The severity of the burnB. The severity of the burn

Can be described as :Can be described as :First degree (superficial burns) First degree (superficial burns) The skin is erythematous The skin is erythematous congested congested vessels in the dermisvessels in the dermis

* Second degree burns* Second degree burns- Partial thickness burns subdivided into :Partial thickness burns subdivided into :

1. Superficial1. Superficial2. Deep2. Deep

Second degree burnsSecond degree burns

1.1. SuperficialSuperficial

Destruction of the striatum granulosum Destruction of the striatum granulosum and cornium with the basal layer, not and cornium with the basal layer, not totally destroyed totally destroyed heals without heals without scarring.scarring.

2. Deep2. Deep

Complete disruption of epidermis and Complete disruption of epidermis and destruction of most basal layerdestruction of most basal layer

Coagulation necrosis of the epidermis and Coagulation necrosis of the epidermis and dermis with destruction of the dermal dermis with destruction of the dermal appendages appendages scar scar

Third degree burnsThird degree burns

Incinerating injuries extending deeper than Incinerating injuries extending deeper than the skinthe skin

Fourth degree burnsFourth degree burns

Intravital signs of burn woundIntravital signs of burn wound

- Light red of livor mortis(cherry red) Light red of livor mortis(cherry red) COHbCOHb

- Blister Blister

- Respiratory tract Respiratory tract dusty dusty

- Inflammation of burn wound tissue.Inflammation of burn wound tissue.

Intravital signs of burning casesIntravital signs of burning cases

- Burn wound bullaeBurn wound bullae

- Carbon in respiratory tractCarbon in respiratory tract

- COHb level : above 10 %, heavy COHb level : above 10 %, heavy smoker more than 25 % smoker more than 25 %

Cause of deathCause of death::a. Fasta. Fast: - CO intoxication : - CO intoxication Asphyxia Asphyxia

- Larinx oedema - Larinx oedema - Neurogenic shock- Neurogenic shock

b. Moderate : - Dehydrationb. Moderate : - Dehydrationc. Slow :c. Slow :

- Renal failure - Renal failure Acute tubular necrosisAcute tubular necrosis- C- CÜRLINGÜRLING ulcer ulcer- Sepsis- Sepsis- Auto intoxication- Auto intoxication

Manner of death Manner of death : :

• MurderingMurdering

• AccidentAccident

• Suicide Suicide

PseudoepiduralPseudoepidural

HaematomeHaematome

EpiduralEpidural

HaematomeHaematome

Blood clotBlood clot BrownishBrownish BlackishBlackish

ConsistencyConsistency BrittleBrittle ElasticElastic

Brain shapeBrain shape ShrinkageShrinkage Concave Concave according to according to coagulated coagulated bloodblood

Skull line Skull line fracturefracture

UnidentifiedUnidentified Through medial Through medial meningia artery meningia artery wayway

Electrical BurnElectrical Burn

The factor that influent electrical effect :The factor that influent electrical effect :

1. Voltage Density1. Voltage Density

V = 60 Volt dangerousV = 60 Volt dangerous

2. Current Density2. Current Density

> 65 mA dangerous> 65 mA dangerous

3. Current Path Resistence3. Current Path Resistence

Burn skin Burn skin increasing meassurement increasing meassurement

4. Time Duration of Current Flow4. Time Duration of Current Flow

5. Victim situation5. Victim situation

- Consiousness or not- Consiousness or not

- Victim’s occupation- Victim’s occupation

- Health/sick- Health/sick

Cause of death :Cause of death : Ventrikel fibrillationVentrikel fibrillation Paralyze Centrum medullaParalyze Centrum medulla Paralyze Respiratory muscleParalyze Respiratory muscle

Electrical BurnElectrical Burn

Mechanism of deathMechanism of death

Current Density is the most important factor, Current Density is the most important factor, currents between 75 – 100 mA caused currents between 75 – 100 mA caused ventricular fibrilation. Extremelly high currents ventricular fibrilation. Extremelly high currents 1A/ higher usually cause ventricular arrest.1A/ higher usually cause ventricular arrest.

Paralysis of the muscles usually caused by low Paralysis of the muscles usually caused by low amperage electrocution amperage electrocution asphyxia asphyxia

Paralysis of the respiratory center of the brain Paralysis of the respiratory center of the brain stemp caused by the hyperthermic effect of the stemp caused by the hyperthermic effect of the current (high voltage current)current (high voltage current)

Autopsy findyngsAutopsy findyngs

Electrical burns, could at the point of entry Electrical burns, could at the point of entry or the point of exitor the point of exitAccelerated onset of rigor mortis caused Accelerated onset of rigor mortis caused by the muscle contraction and depletion of by the muscle contraction and depletion of ATP ATP Bone fracture due to generalised muscular Bone fracture due to generalised muscular contractioncontractionHigh voltage current High voltage current third degree burns third degree burnsRhexiss of the heart muscleRhexiss of the heart muscle

Electricution Electricution

Manners of deathManners of death

* Accident* Accident

* Suicides* Suicides

* Homocides* Homocides

Autopsy:Autopsy:

1. Outer examination1. Outer examination

- Electrical marks (current marks)- Electrical marks (current marks)

* * Palm / plantPalm / plant

* Dorsal hand, etc* Dorsal hand, etc

Burnt skin, cloth or burnt hair may Burnt skin, cloth or burnt hair may

occuroccur

2. Inner examination2. Inner examination Heart filled with blood Heart filled with blood Congestion of visceral organsCongestion of visceral organs Lung OedemaLung Oedema Conjunctiva bleeding, pericard bleedingConjunctiva bleeding, pericard bleeding Rhexis of musclesRhexis of muscles ““Pearl like body” on bone. Bone fracturePearl like body” on bone. Bone fracture

Autopsy:Autopsy:

LightningLightningStatic electric content in cloud with voltage up to 1 Static electric content in cloud with voltage up to 1 million volt and current density up to 100.000 million volt and current density up to 100.000 ampere in 1/1000 – 1 second released to earth.ampere in 1/1000 – 1 second released to earth.

Body disorders depends on:Body disorders depends on:

1.1. Electrical ware factorElectrical ware factor

* Signs like electrical injury* Signs like electrical injury

* Arboresscent marking caused by blood vessel * Arboresscent marking caused by blood vessel

dilatation dilatation

* Magnetisation* Magnetisation

2. High temperature factor (Electical 2. High temperature factor (Electical energy)energy)

W = V x A W = V x A heat heat

Heat:Heat:

* Burning wound* Burning wound

* Metalization* Metalization

3. Air exchange/ explotion factor3. Air exchange/ explotion factor blunt blunt traumatrauma