May 25, 2023
Thermal burns are heat-related skin injuries that commonly result from coming into touch with hot objects, hot liquids, steam, or flames. The majority of burns are small and can be treated locally or as an outpatient procedure. Treatment in specialized burn centers is provided to about 6.5% of all burned patients. The amount of body surface area damaged, the depth of the burns, and specific patient characteristics like age, prior injuries, or other health issues are taken into consideration when deciding whether to transfer and receive treatment at burn centers.
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It is a condition when the temperature goes below 35°C. It happens in old age people, alcoholic people, and in people with certain diseases.
Signs of hypothermia include clouding of consciousness, Disorientation, Loss of Reflex and Respiratory rate, heart rate, and blood pressure becomes low.
It is also known as immersion foot. It is caused due to a moist cold. It occurs in soldiers, sailors and people in the trenches. The area becomes red, cyanosis, pulsations are absent, necrosis and gangrene formation occurs. It is seen at 5 to 8°C. If the hands are immersed in cold places, it is known as trench hands.
It is the first effect produced by dry cold and has a nonfreezing effect. It is a superficial injury and has non-permanent damage. The mechanism is vasoconstriction.There will be numbness, pall and burning sensation. The most common sites are the nose, ear, and face. Skin becomes hard and black in two weeks. It is always an antemortal injury.
Treatment includes rewarming at 42-44° C, protection from cold, and if there is an infection in the frostbite antibiotics and anti-tetanus treatment.
It is the second effect produced by dry cold and has a freezing effect. It can be superficial as well as deep injury and could be permanent damage. A mechanism is formation of ice crystals (because frostbite is seen at a freezing temperature of -2.5° c, so that will cause freezing effect and there will be the formation of ice crystals and which will produce ischemia as well as gangrene)
Superficial Frostbite- In this Numbness,Burning sensation and Blisters with Clear fluid and itching may be present.
Deep frostbite- In this Blisters with hemorrhagic fluid become black because of necrosis and gangrene.
Heat cramp- It is also known as a miner's cramp or fireman’s cramp. If there will be excessive heat outside, there will be a loss of electrolytes (sodium and potassium) and water, Because of this there will be muscle cramps in the hands, legs, and abdomen. It is common in people working in miners and fire industries. For Treatment fluids, and electrolytes are given.
It is also known as heat syncope or heat prostration. When there is excessive heat, sweating increases and there will be a loss of electrolytes and fluid(because of this there will be decreased venous return and it will cause decreased cerebral Perfusion ). Clinical features include fainting, dizziness, and lightheadedness. Pupil will be dilated and Skin remains cold and moist. Cause of death is vascular collapse or syncope. Treatment includes fluid therapy and elevation of the leg to increase the venous return.
It is also known as sunstroke or thermic fever or heat hyperpyrexia. It is common; if you are working in sunlight, if you have increased muscle activity, if you have some infection, and if you have a very humid temperature. If your body temperature goes above 104°f /45° C, in this case, your sweating will stop and you will get a heat stroke because the thermo regulatory center stopped and the hypothalamus stopped working. Clinical features include altered mental status, disorientation, loss of consciousness. Pupils are constricted. Skin is dry and hot. Sweating is stopped which is known as anhidrosis.
Treatment - Remove the clothes, bath with ice water, ice pack, and oral and IV fluid, and use AC and fan to decrease the temperature.
It occurs in Minimum Temperature of 44oC for upto 5 to 6 hours and 65oC for upto 45 Sec
Dry Heat Flame
Moist heat scald Liquid/ Steam
Scald is a liquid or stem over the body more than 60 °C. If scald is a liquid or stem over the body more than 70 °C, it is called whole thick skin scald.
Ulcerated patches which are free from blisters. In this Hairs are not singed and the Red line of demarcation is absent. It Shows distinct coloration
|Cause||Dry heat||Moist Heat||Chemical|
|Site||At and above contact||Below the site||Below the site|
|Skin||Dry, wrinkled||Sodden, Bleached||Destroyed|
|Vesicles||At the circumference||Over the burnt area||Rare|
|Scar||Thick, contracted||Thin, less contracted||Thick, contracted|
|Clothes||Burnt||Wet, non burnt||May be burnt|
Burns are classified according to Wilson’s classification:
|Erythema (redness)||Present||Present||Skin and tissue become white and yellow coloured or black chairing of tissue forms eschar.|
|Healing||Spontaneous and complete (takes 1 week)||If it involves the papillary dermis it takes 2 weeks. It is the reticular dermis, it takes 3 weeks.|
It is a homicidal burn,A method of homicide in South Africa. For killing, a tyre is used around and chest and an inflammable material. It is a burn Injury.
It is used for ESTIMATION OF TOTAL BODY SURFACE AREA IN BURNS. It is Done mainly to calculate amount of IV fluid to be given for resuscitation.
For total body surface area, Rule of 9 also known as Wallace rule is used.
11 × 9 i.e., 99%.
1% is for genitalia and Perineal.
In children's till infant age, modifications are there.
For children: Lund-browder's chart is used .
|Body part||0 yr||1-4 yr||5 - 9 yr||10-14 yr||15 yr onwards|
|a=½ of head||9 1/2||8 1/2||6 1/2||5 1/2||4 1/2|
|b=½ of 1 thigh||2 3/4||3 1/4||4||4 1/4||4 1/2|
|C=½ of 1 lower leg||2 1/2||2 1/2||2 3/4||3||3 1/4|
It is used for patchy burns. Palm converse 1% body surface area this is called the rule of palm.
Post Mortem finding in burn cases are:
|Lines of redness||Present||Absent|
|Vital Reaction||Present (both positive or negative )||Absent|
|Enzymatic reaction||Present (both positive or negative )||Absent|
|Blister||Albumin protein + chloride||Air +thin fluid|
|CO-HB||ELevated Level (more than 10%)||Normal level|
|Cyanide||Increased level||Normal level|
|Carbon particle /soot particle||carbon particle in trachea (most characteristic )||Absent|
|Curling ulcer||Most common site is 1st part of duodenum||Absent|
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It can be found in antemortem and Postmortem and is caused by heat.
It is also known as boxing attitude, fencing attitude, and heat stiffening. It is a contraction of muscles that causes a specific posture. It is seen when the temperature gets more than 65°C. Above this temperature coagulation and denaturation of muscle protein occurs. It can be mistaken as the rigour mortis.
It is mainly due to dehydration, coagulation of the skin. Skin and underlying tissues are ruptured. Extensor, fleshy, joint area is involved. Blood vessels and nerves are intact. Bleeding, bruise, vital reactions are absent. It can be mistaken as incised if it has a regular margin and it can be mistaken as lacerate. if it has an irregular margin. In incised and lacerated , the hair bulb will be crust and blood vessels and nerves will be crust and bleeding, bruise, vital reactions are absent.
It is seen in the brain. In this blood vessels are contracted and blood excludes out from the venous sinus. It is above dura so it can be mistaken as an extradural or epidural hematoma.
So to differentiate It is chocolate brown in color and shows a honeycomb structure.
It is also known as thermal fracture and is seen in the skull and long bones. If it is seen in long bones it is street Avenue fracture. Mechanism is Dehydration or drying of the bones or skin. Because of this skull will burst and when the skull will burst this will be skull fracture. It can be mistaken as a traumatic fracture. This thermal fracture can cross the suture line but does not involve the suture line.
The internal organ of the body shrunken, firm, and fixed due to extreme heat.
It is mostly accidental and sometimes it can be homicidal or suicidal. Judicial electrocution seen in some states of the USA. Alternating current (AC) is more dangerous than direct current (DC) (4 to 5 times) because it causes tetanic contraction. The fatality of electrocution or the number of injuries of electrocution is directly proportional to the voltage and amperage. (Amperage is more important). Holding on spasm( tetanic spasm) will cause more injury. Resistance is inversely proportional to fatality or injury.
Electrocution most commonly passes through the heart and causes ventricular fibrillation and cardiac arrhythmia. If it passes through the brain stem it will cause respiratory failure.If it passes through the diaphragm it will again cause muscle contraction and respiratory failure. Most resistant tissue is dry skin then bone and then moist skin. Electrocution has an entry and exit point, it claims to be the most dangerous circuit when the entry point is the right hand and exit point is the left foot. Point of contact is entry whereas Point of grounding is exit
Rigor mortis comes early. Local hemorrhages and tears of muscles are present. Pit-like defects in the superficial surface of hair because of arching of current.Due to electrodes or wire the molten metal that is the current pearl goes deep into the soft tissue. Molten calcium phosphate from bone called bone pearls or wax drippings are detected in radiological investigations. When electricity goes in muscles it causes rhabdomyolysis and myoglobinuria.
It is seen in low voltage electrocution and with firm contact. It is an entry wound seen at the site of entry.
It is known as joule burn. After touching wire, electricity goes inside the body and heat is produced in the body and because of the heat it is an endogenous burn. It can be of oval shape or round shape. It is like a crater, the central area is depressed or compressed and the peripheral area is raised, it is pale and areola. Mechanism is coagulation of dermis and elongation of epidermal cells.
Loose contact with air gap: It produces an exogenous burn known as flash burn or spark. (Patchy area)
Loose contact with high voltage: It is an arc dance. It produces multiple pitted/punched out burns known as crocodile flash burns. (Circulated area)
It is an electric discharge from clouds. It is mainly direct current but is more dangerous because this direct current has high voltage. It is accidental. It is known as kerauno graphic marking/ filigree burn/ arborescent marking and lichtenberg margin. It is a ferning pattern and is of pink color. It has an erythematous and branching tree patternI(ferning). Its mechanism is denaturation of RBC which causes hemoglobin staining of the blood. It is seen upto 24 hours. The most common site is shoulder flings and abodemen folds.
Lightning can hit directly, from side, indirectly.
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