THERMAL INJURIES & MISCELLANEOUS😊

TRAUMATOLOGY: THERMAL INJURIES & MISCELLANEOUS

Transportation Injuries

Injury to Pedestrians

• Bumper injuries
• Seen in primary impact injury.
• Abrasion.
• Contusion.
• Laceration.

• Bumper fracture:
• M/C lateral condyle of tibia.
• Helps determine direction of force.

Injury to Vehicle Occupants

• Aortic injury (Ladder rung tears)
• Transverse tear

• Days within which death attributed to RTA:
• 30 days

Waddles triad

Impact Injuries

Thermal Injuries

Hypothermia

• Body core temperature <35°C.

• Commonly affects:
• Elderly.
• Newborns.
• Alcoholics.
• Hypothyroid patients.
 

• Measurement: Rectal temperature (best for core temperature)

• Rewarming: Cardiopulmonary bypass machine (best for severe hypothermia)

Classification in adults:

1. Cold Stress: > 35°C.

2. Mild: 32 - 35°C.

3. Moderate: 28 - 32°C.
• <30°C hypothalamus stops functioning.
• Shivering stops
• Reflexes are low.
• Osborn J waves in ECG → Indicate severity
• Paradoxical undressing 
• Severe cold exposure → failure of thermoregulation → ↑ blood flow → failure of Vasoconstriction → ↑ sense of warmth → undressing → death
• Kills the patient & can mimic sexual offense
• Hide & die syndrome/terminal burrowing.

4. Severe: <28°C.
• No motion, Absent reflexes & shivering, Coma
• Osborn J waves in ECG → Indicate severity

Autopsy findings:

• White deaths.

• Pink hypostasis.

• Wischnewski’s bleeding spot in stomach.

• Note : Pink hypostasis also seen in refrigerated body.

Frost Bite

• Cause: Prolonged exposure to dry cold

• Pathophysiology:
• Ice crystals form in tissue
• Membrane damage + microvascular damage

• D/t exposure to freezing temperature.

• Site: Periphery (Finger, feet, tip of nose/ear lobes).

• Rx: Gradual rewarming at 40°C.
• Rewarming → Re-perfusion injury

• Grading after rewarming

Trench Foot

• Cause: 
• Prolonged exposure to cold + moisture (tissue remains wet)

• Pathophysiology:
• Microvascular damage
• Stasis & occlusion

Management of Frost Bite and Trench Foot

• Rapid re-warming of affected leg (water: 40°C)
• Beware of re-perfusion injury

• Do not rub the tissues (causes severe pain)

• Hyperkalemia, acidosis can occur

• If gangrene + → Wait for demarcation line → Amputation

Burns

Autopsy Findings in Antemortem Burns:

Non-specific findings (Heat artefacts):

• Mnemonic: “Heat” = Non specific = can be seen in post-mortem as well as in antemortem

• Heat stiffening:



• Mechanism: Muscle exposed to heat >65°C → Protein coagulation → Stiffening.
• AKA Boxer’s attitude/Pugilistic attitude/Fencer’s attitude.

• Heat rupture:



• Mechanism: Skin exposed to heat → Cracking & splitting of skin.
• Difference from incised wound:
• Large & irregular.
• Intact vessels & nerves.
• Pale.

Heat hematoma:

• EDH with honeycomb appearance - B/L and diffuse

• Chocolate brown.

• Honey comb appearance.

• Mnemonic: chuudu chocolate il honey ozhich kazhich

Heat fracture:

• Fracture of long bone/skull bones.

• Street & avenue fracture.

• Outward elevation

• Other fracture → Inward elevation

Specific signs:

• Seen in antemortem exposure

External signs:

• Mnemonic: Crow FIRE.



1. Crow feet sign:
• Features of antemortem burns.

2. Fluid in blisters.

3. Inflammation signs
4. Redness/redline/repair
5. Enzymes ↑↑

Internal signs: 3 Cs:

1. Carbon deposition (Soot) in airway.

2. ↑ Cyanide

3. ↑ CO → CarboxyHb in blood
• >10 g%

Burns, scalds, chemical burns:

• Burns (Fire - Dry heat)
• Charring & singeing
• Clothing's burnt

• Scalds (Moist heat)
• Soddened & bleached skin
• Lines of blisters

• Chemical burns (Corrosive)
• Ulceration
• Clothings → Staining of acid ±
• Only in Formic acid
• Lines of blisters
• Mnemonic: Formic acid forms blisters

1. Blisters are present

2. Ulcerated patches are present

3. Absence of singeing of hairs

4. Coagulation necrosis occurs at the site of burn
ANS

1. Absence of singeing of hairs

Electrical & Lightning Injuries

Electrocution

Factors affecting:

• Type of current: AC more harmful than DC.

• Voltage.

• Amperage: m/c cause of death in electrocution
• → Tetanoid/Withhold spasms → Death.
• Mnemonic:
• Tight Holding (Tetanoid/Withhold) karanam death undavunnath
• Withhold spasm

• Voltage & Amperage
• Directly proportional to magnitude of injury.

• Resistance:
• Inversely proportional to magnitude of injury.
• Dry skin (Maximum R) > bone > moist skin (No entry wound).

Causes of death:

• Cardiac arrhythmias
• M/C

• Respiratory failure.

Electrical Injury Burns:

Burns of low voltage current:

• Firm contact.

• Mnemonic: Jolik (Joule) poyapo Metalil (Metallization) pidichapo current (current pearl) adich

• Joule burn
• Aka endogenous burn:
• Entry wound → due to heat and resistance
• Central depressed area.
• Peripheral raised margins.

• Metallization:
• Deposition of metallic ions in the entry wound.
• Can involve subcutaneous tissue
• Current Pearl

Burns of high voltage current:

• Loose contact.

• Exogenous burns:
• Flash burn: Diffuse burn.
• Keratin nodule: D/t spark.
• Crocodile burn: Multiple punctate lesions.

• Mnemonic: Flash () Keeettu (Keratin) → Crocks (crocodile) itt oodi → purathottu

Bone:

• Bone pearls/wax drippings.

• Passage of high voltage current through bone → Molten calcium phosphate.

Lightning Injuries

Filigree burns:

• Burns d/t lightning injury.

• Also known as:
• Lichtenberg marking.
• Arborescent burns.
• Keraunographic markings.
• Feathering.
• Ferning.

• Mnemonic: Fern (ferning) bird was sittting in an arborescent () tree → Lightening (lichtenberg) struck → feathers (feathering) splashed

Filigree burn vs marbling:

• Filigree burn
• Red/pink
• Does not follow blood vessel

• Marbling



• Green
• Follows blood vessels

Torture Methods & Explosion Injuries

Declaration of Tokyo

• Istanbul protocol
• Deals with reporting & treatment of torture victims.

Various Torture Methods:

• Cattle’s prod: Electric shock to genitalia.

• Telefono: Repeating slapping over the ears.

• Falanga/Falaka/Bastinado: Beating over the soles.

• Wet submarine: Forced immersion of head under water.

• Black slave: Insertion of hot metal rod into anus.

• Dunking: Forced immersion of whole body under water.

• Saw Horse: Forced straddling.

• El Planton: Prolonged standing.

• Dry submarine: Plastic bag asphyxiation.

• Parrots perch: Tying upper & lower limb with suspension of body.

• Hog tying: Tying wrist and ankle together in prone position.

Explosion Injuries

Molotov’s cocktail:

• Petrol bomb
• Bottle filled with petrol/kerosene, and a rag to serve as a wick