Burns:Cause of death & Important postmortem findings

Burns:Cause of death & Important postmortem findings

Cause of Death in Burn Injuries: More than 50% burns lead to fatality. Cause of death varies depending upon survival period of victim. Some of the causes are:-

1. Immediate Causes

1. Neurogenic Shock.
2. Suffocation:

2. Early Causes         

1. Hypovolumic Shock,
2. Pulmonary edema,
3. Electrolyte ,

3. Late/Delayed Causes

1. Toxaemia,
2. Septicaemia,
3. Renal Failure,
4. Gastro-intestinal Ulceration,
5. Anaemia and Hypoproteinaemia.

lmportant  postmortem  findinqs  in  burns:

• The nasal and oral cavities may show presence of carbon soot and are inflamed.
• There  is  increased  carbory-hemoglobin  which  gives  cherry red  colour to  post mortem lividity.
• Presence  of  carbon  particles  (soot)  in  respiratory  passages  and  elevated  level  of carboxy-hemoglobin  confirms  that  victim  was  alive when the  burn  occurred,  i.e.  ant-mortem  burn.

• Laryngeal edema  which is caused by passage of hot gases into respiratory  tract.
• Raised carboxyhaemoglobin  level in the blood; exceeding 10%. Chain smokers may develop blood level upto 8%-10%; therefore it needs careful interpretation in such cases.
• Various  levels  of  cyanide  is  found  in  blood depending upon  the  materials  burning in  fire. But the  levels  are  less than  0.3%  mg (normal  is  zero
• postmortem  blister  contains  air and thin  clear  fluid with hard,  dry and yellow  base),   there  is  increase enzymatic  reaction and sulphhydrayl  (-SH)  group in  periphery  of burns. 
• Pugilistic attitude (bortng/fencing/defence  attitude):  It  is  heat stiffening  caused by  denaturation  and coagulation of proteins.It  is  indicative  of exposure to  intense  heat..  There is  flexion  at  all joints and  clawing  of  fingers.  This phenomenon  occurs both  in antemortem  and postmortem  burns.
• Heat ruptures  (heat  splits  or  fissure: skin  splits  frequnetly  especially  over extensor  surfaces  (e.g. thigh,  back  of arm) and joints (several  centrimeters  in  length). 

• Presence  of intact  nerves,  blood  vessels and connective  tissue  in  the  floor  of  rupture.
• Absence  of  bleeding  in  the  wound, Irregular  matgins, Absence  of bruising  or other  vital reactions  in  margin.
• Heat  hematoma : extradural hematoma, soft, friable,chocolate  colored,  and  sickle shaped  with honeycomb  appearance 

Exam Important

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