Electrocution,

Lightning
Thermal injuries

ELECTROCUTION
„ Main cause of death is Shock.
„ Ordinary domestic line- 100-250 volts
„ 300 volts- similar to lighting stroke
„ Voltage as well as amperage or intensity of the electric current , are the principal factor
in causing injury.
Factors Which Influence the Effect of Electric Shock
1. Personal Idiosyncrasy- Physical Condition
2. Disease- cardiac disease
3. Anticipation of shock
4. Sleep- Increases resistance
5. Electric voltage or tension- 220-250 volts
6. Amperage or intensity of electric current- 70-80 amp or 250 amp in direct current
7. Density of the current
8. Resistance of the body
9. nature of the current- alternating current than direct current
10. earthing- promotes continuous flow of current
11. duration of contact
12. kind of electrodes- free flow of current
13. point of entry- left side of body than right side of the body
Mechanism of Death:
1. Ventricular fibrillation- in low voltage
2. Respiratory failure due to bulbar paralysis in high voltage
3. mechanical asphyxia due to violent and prolonged convulsion

Nature of Electrical Burns:
Electrical burns are sometimes called “Electrical Necrosis” or ”Electric Marks” or “Current Markings”
If death does not occur:
Symptoms:
Ø Skin cold and moistened
Ø Breath is stertorous
Ø Pulse, rapid, filiform, irregular
Ø Pupils dilated, insensitive
Ø Pale face
LOW VOLTAGE DEATH
„ Voltage less than 1.000 volts
„ Cause of death not always obvious
„ Direct contact between victim and the electrical circuit
„ Death primarily due to ventricular fibrillation
„ If low current but great contact time= death may still occur but mechanism of death is by muscle
paralysis with secondary asphyxia
HIGH VOLTAGE DEATH
„ Voltage more than 1,000 volts
 „ Direct contact not necessary as current may arc to victim
„ Electric arc can generate high temp. (4000C)
Death due to respiratory arrest or electrothermal injuries caused by heat generated by current

Metallization
„ A specific feature of electrical injury
„ The metal of the conductor is volatized and particles of the metal are driven into the epidermis
„ Extensive areas of the body may be darkened by metallization (brown to black)
„ If conductor is Iron, yellow brown color, if copper salts , blue mark.


LIGHTNING
„ Is an electrical charge in the atmosphere
„ The flash of lightning
„ Virtually all discharges are negative
„ Direct current (1000 million volts or more)
„ And about 2,000 amperes
Elements of Lightning that Produce Injury
1. Direct effect from electrical charge
2. Surface “flash “burns from the discharge- transformed into heat energy that cause burns
3. Mechanical effect- results to laceration of the body, tearing of of clothing
4. Compression effect- compressed air may produced backward wave “ sledge hammerblow”
Classes of Burns due to Lightning
1. Surface burns- superficial burns under metallic objects worn or carried by victim
2. Linear burns- found in areas offering the least resistance like creases and folds of skin (vary in
length 1-12 inches)
3. Arborescent or Filigree burns- radiating burns from a point , similar to electrocution

Lightning strike
„ Arborescent marks
„ Lichtenberg bodies
„ Filigree burns
„ Which are named after the German physicist Georg Christoph Lichtenberg who originally
discovered and studied them


THERMAL & FIRE INJURY
„ Caused by an appreciable deviation from normal temperature, capable of producing cellular or
tissue changes in the body
„ Thermal death is one primary caused of thermal injuries

Local Effects:
- Frostbite, Immersion foot, Trench foot
Systemic effects:
-there is cold stiffening with blister formation and gangrene
Cause of death: due to decreased dissociation of oxygen from hemoglobin in the RBC and diminished
power of tissue to utilize oxygen
Death or Injury from Heat
General or Systemic Effects:
a. Heat cramps
b. Heat exhaustion
c. Heat stroke
Local Effects:
a. Scald
b. Burns
General or Systemic Effects
a. Heat Cramps (Miner’s cramp, Fireman’s cramp, Stoker’s cramps)- involuntary spasmodic painful
contraction of muscles due to dehydration and loss of chlorides by sweating. Working in rooms
with high temp. and profused perspiration.
b. Heat Exhaustion (Heat collapse, Syncopal fever, Heat syncope, Heat prostration)- due to heart
failure, primarily caused by heat and precipitated by muscular exertion and warm clothing
c. Heat Stroke (Sunstroke, Heat hyper pyrexia, Comatose form, Thermic fever)- usually occurs
among those working in ill-ventilated places with dry and high temp. or due to direct exposure
to sun.

Local Effects of Heat
a. Scald- due to hot liquid, may have distribution called “geographical lesions”(it follows the
portion involved in the splashing of the scalding fluid, together with the pull of gravity. Death is
due to septic complications
b. Thermal burns (dry heat)- application of heat or chemical substance.


CLASSIFICATION OF BURNS ACCORDING TO AGENT
FLAME BURNS
„ Due to direct contact with a flame
„ Severity depends upon the length of time the flame is applied
FLASH BURNS
Variant of flame burn
Caused by sudden ignition or explosion of fine particulate matter or gas
Produces a uniform burn (1st or 2nd degree) of all exposed areas of the skin, singes hair

CONTACT BURNS
„ Occur when skin is in contact with a hot object such as hot iron
„ May have configuration or shape of hot object that was applied to the skin
RADIANT BURNS
„ Occur when skin is exposed to heat waves
„ Contact with heat source is not necessary for a burn to occur
„ May produce blisters & erythema
„ Prolonged exposure may result in charring
SCALDING BURNS
„ When the skin is contacted by a hot liquid
„ Water at 70 C
„ Produce 3rd degree burns in about one second of contact
„ Water at 55 C
„ Almost 25 seconds to produce same burn
 IMMERSION BURNS
„ Accidental / homicidal
„ Homicidal example
„ Child abuse
„ Immersion of child in tub full of scalding water
„ Burns with sparing of knees, popliteal fossae and inguinal regions
SPLASH BURNS
„ Usually accidental
„ Caused by spilling hot liquid over the body
STEAM BURNS
„ Usually accidental
„ Superheated vapor can cause severe injury to the mucosa of the airway
„ Massive laryngeal edema may occur
MICROWAVE BURNS
„ Most are accidental
„ Occur as an individual reaches into a microwave which has not turned off completely or
by ingestion of scalding hot liquid heated in a microwave
CHEMICAL BURNS
„ Strong acids and alkalis
„ Phosphorus, phenols
„ Burns produced slower than by thermal agents
„ Extent of injury depend on:
„ The chemical agent
„ Strength or concentration of agent
„ Duration of contact with the agent
Alkaline agents
„ Tend to cause more severe injury than acid agents
„ Produce burns generally have a pH greater than 11.5
„ Frequent produce full thickness injury
„ Produce burns that appear pale and feel leathery and slippery
Acid agents
„ Produce only partial thickness burns
„ May be accompanied by erythema and superficial erosion


Death due to burn injury
Immediate death may result from
„ Neurogenic shock
„ Direct thermal injury
„ Large amount of fluid loss=hypovolemia = shock, acute renal failure
„ Inhalation injury
„ Soot in nares or mouth
„ Extensive thermal injury of airway mucosa = mucosal necrosis & edema =
bronchospasm or upper airway obstruction due to laryngeal edema
„ Carbon monoxide poisoning
Inhalation injury
„ Other noxious agents
„ Cyanide
 „ Acrolein
„ Reactive aldehyde produced by burning wood & petroleum products
„ Injury by protein denaturation
„ Hydrochloric acid
„ Due to combustion of plastsics, furnishings building components
„ Pulmonary edema may be delayed for 2-12 hours after exposure
„ Tolouene diisocyanate
„ Nitrogen dioxide
Inhalation injury
„ Other noxious agents
„ Tolouene diisocyanate
„ Produced by burning polyurethane
„ May cause severe bronchospasm
„ Nitrogen dioxide
„ Produced in fires involving automobiles or agricultural wastes
„ Even brief exposure could cause broncho/larungeal spasm and
pulmonary edema
„ Chronic interstitial lung disease may be a late complicataion




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