Causes of Death in Burns

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The passage discusses various causes of death from burns like neurogenic shock, hypovolemic shock, electrolyte imbalance, suffocation, circulatory failure, renal failure, adrenal crisis and infection. It also talks about some post-mortem external findings like clothes, smell, identification, cavities and body posture. Finally, it mentions different types of burns - burns, scalds, electric burns, lightening burns and explosive burns and their characteristics.

Some of the major causes of death in burns mentioned are neurogenic shock, hypovolemic shock, electrolyte imbalance, suffocation, circulatory failure, renal failure, adrenal crisis, centrilobular necrosis of liver, tubular necrosis of kidney and infection in the form of septicemia, tetanus and gangrene.

Some of the post-mortem external findings seen in burn victims include clothes that may be partly or totally burnt. There can be a smell of kerosene/petrol. Identification may be difficult in charred bodies. Cranial and abdominal cavities may burst open due to increased pressure. The body may exhibit a boxer's/defensive posture. The face can be swollen and distorted with tongue protruded out and froth/bloody discharge from nose/mouth.

CAUSES OF DEATH IN BURNS

& EXTERNAL FINDINGS


Causes of deaths in burns are due to -

 1. Neurogenic shock (primary shock)


 2. Hypovolemic shock (secondary shock)
 3. Electrolyte imbalance (hypokalemia)
 4. Suffocation- 1.In burning of organic matter (CO&CO2)
2.In burning of nitrocellulose film (NO2&N2O4)
3.In burning of wool/silk (NH3,HCN,H2s,SO2)
 5. Circulatory failure
 6. Renal failure
 7. Adrenal crisis
 8. Centrilobular necrosis of liver
 9. Tubular necrosis of kidney
 10. Infection - 1.Septicemia
2.Tetanus
3.Gangrene
 11. Fat embolism
 12. Increased carboxy haemoglobin levels
 13. Cerebral oedema
 14. Pulmunory oedema
 15. Exhaustion
POST-MARTEM FINDINGS(external
findings)
 1.Clothes
a) May be partly or totally burnt
b) Partly burnt clothes may be on or off the body
c) Silk, polyester & nylon clothes may be sticking to the body
d) There may be kerosene / petrol smell in the clothes
e) Clothes are preserved in glass containers and sent to FSL
 Smell
a) Smell of kerosene/ petrol can be known from clothes, hair,scalp,axilla or
inguinal area
 Identification
Especially in charred body, identification becomes difficult. In such cases
identity is established from partly burnt clothes,teeths,ornaments on body and
bones
 Cavities
Due to increased pressure, cranial and abdominal cavities may burst open
 Boxers /defence/fencing posture
a) Due to denaturation of and coagulation of proteins , there results flexion at
all joints and clawing of fingers, giving the body a typical posture
b) This phenomenon occurs both in antemortem and postmortem burns
 Face
a) Hair- hypopigmented
b) Face – swollen, sometimes distorted
c) Tongue – protruded out
d) Nose and mouth – froth or bloody discharge present
 Artefacts
a) Cracks on skin
b) Blisters due to scalds
c) Fracture skull or other bone
d) Heat hematoma
e) Injuries due to building collapse
f) Charring of body
 P.M Lividity
a) In burns – dark red
b) In death due to suffocation – cherry red
 External injuries – it depends upon source of heat
A) In burns
I. Singeing of hair
II. Superficial or deep burns
III. Coagulation necrosis
IV. Red line of demarcation – due to reaction at junction of burnt & unburnts part is
5-25 mm wide
V. In kerosene burns black sooty and smell may be present
VI. Body may be charred
VII. Bones may be expose
VIII. Burns may be less severe in folds of skin
IX. In delayed deaths pus or partial healing may be seen
B) Scalds
I. No singeing or charring
II. Within 2/3 hours there is formation of blisters
C) Electric burns
I. Erythema
II. Sloughing ulcers
III. Blindness due to laser beams
IV. Scar formed is radiant
V. Prolonged exposure may lead to malignancy
D) Electric burns
I. Typical wound entry is a crater formation ie wound is depressed thick hard
leathery cauliflower like and non bleeding
II. Typical wound of exit is a bleeding laceration
E) Lightening burns
There may be no external injury or there may result complete charring or
mutilation of the body
F) Explosive burns (due to heat mechanical force and blast wave)
I. Burns
II. Mutilation of body by blast wave
III. Extensive blackening and tattooing
IV. Suffocation due to fumes
V. Rupture of viscera
VI. Injuries may be accidental homicidal or suicidal
VII. Bombs may be explosive nulclear or biological

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