Thermal Injuries

Thermal injuries are described according to depth and degree of total body surface damaged. The degree of injury is either first- (sunburn), second- (sunburn with blisters), third- (soft tissue injury which heals by scarring), or fourth-degree (charring of the tissues).The total body surface injury is quantitated by physicians according to the rule of nines, which gives a total number of area burned. Younger individuals can withstand more injury than older ones; still, this also depends on the part of the body burned. Burns affecting the airways cause more complications than those areas burned on other parts of the body.

Most fire deaths are due to carbon monoxide (CO) poisoning, not direct thermal injury. Exposure to CO can be fatal within minutes. Thermal effects to the body may be slight or severe. The degree of heat does not dictate how long a person survives during a fire. The extent of damage depends on the length of time a decedent is exposed to flames and how close a body is to a fire.

The most important factor in any fire death investigation is determining whether an individual was dead before a fire started (suspected homicide). This is determined by examining the airway for the inhalation of smoke and the measurement of CO content in the blood. These evaluations can only be determined during and after autopsy.

CO will cause cherry red livor mortis. Occasionally, the CO will be negative as is in an explosion which causes death rapidly. A negative CO might initially be confusing, but a quality scene investigation should resolve any problems.

Individuals may die later in the hospital from complications such as inhalation injuries to the airways, infections, and fluid and electrolyte disorders. Skin burns may range from partial or full thickness to charring and incineration.

Heat artifacts include:

1. Changes in height and weight of the body.

2. Hair color changes — Brown hair may become red and blonde may become gray; black hair does not change color.

3 Thermal fractures — These are difficult to differentiate from antemortem fractures.

4. Skin splits with evisceration of organs.

Most fire deaths should be X-rayed so that foreign objects will not be overlooked. Blood can usually be obtained from a body no matter how badly it is burned.

How Does Gun Shot Wound Miss Organs

figure 10.1 Most thermal injuries occur from structure fires. The most important question to answer is if the decedent was alive or dead during the fire. The answer to this question enables the investigator to distinguish between homicide and other manners of death.

Gunshot Injuries Pictures
figure 10.2 Thermal injuries may be encountered in traffic accidents. The main questions are to decide if the person was alive, dying, or dead at the time of the fire and accident.

The Rule of Nines

The pprcfinl nf mini tmiiy feurnejj ii ij e i f itihiic i] ijy adding up fhË fiumhprs un 1 lig areai of the hiiitij uimch arc burned figure 10.3 Physicians give percentages of total body surface burned based on the rule of nines.

Fourth Degree Burns
figure 10.4 A first-degree burn is similar to a sunburn without blistering. A second-degree burn has blistering. Neither type will heal with a scar.
4th Degree Burns
figure 10.5 Blistering with thickening (induration) of the skin and tissues is a third-degree burn. This will usually heal with a scar.
Induration Wound
figure 10.6 This baby has third-degree burns and some charring (fourth-degree) burns. As a rule, younger individuals can survive more serious burns than older people. Relatively minor thermal injuries can cause death in the elderly.
Fourth Degree Burns
figure 10.7 This is fourth-degree thermal injury. There is diffuse charring of the body. An autopsy should be performed in these cases if warranted.
Autopsy Gunshot WoundsFourth Degree Burns
figure 10.9 Carbon monoxide (CO) poisoning will cause the skin to turn red. Direct thermal injury may also cause the skin to be red. The larynx and/or CO concentrations still need to be checked to determine the cause of death.

figure 10.8 Most people die in fires by carbon monoxide poisoning from inhaling smoke. Smoke in the nostrils and mouth does not prove the person died from inhalation. The larynx must be examined to check for the presence of smoke.

figure 10.8 Most people die in fires by carbon monoxide poisoning from inhaling smoke. Smoke in the nostrils and mouth does not prove the person died from inhalation. The larynx must be examined to check for the presence of smoke.

Cherry Red Carbon Monoxide PoisoningFacial Gunshot Wounds

figure 10.11 This is the larynx (upper arrow) and the trachea (windpipe). The lower arrows point to carbon material in the trachea from inhaling smoke. The presence of smoke in the lower larynx and trachea proves the decedent was alive during the fire.

figure 10.10 The abundant amount of smoke on this man's face suggests he died from inhaling smoke. His face is covered with smoke because of the smoke in the fire. This does not prove he died from smoke inhalation. See next photo.

figure 10.11 This is the larynx (upper arrow) and the trachea (windpipe). The lower arrows point to carbon material in the trachea from inhaling smoke. The presence of smoke in the lower larynx and trachea proves the decedent was alive during the fire.

Gunshot Wound Leg

figure 10.12 Fire will cause the joints to contract. The arms and legs may be bent. This "pugilist" (boxer) appearance makes the decedent appear as if she were fighting at the time of her death. These contractures are all postmortem.

Gun Shot Wounds Arm
figure 10.13 The heat will cause bones to break and skin to split. The presence of postmortem thermal fractures (arrow) should not be confused with antemortem injuries. See next photo.

figure 10.12 Fire will cause the joints to contract. The arms and legs may be bent. This "pugilist" (boxer) appearance makes the decedent appear as if she were fighting at the time of her death. These contractures are all postmortem.

Antemorem Head Trauma
figure 10.14 Thermal fractures may be very difficult to distinguish from antemortem fractures. The pathologist should be conservative when making this distinction.
Antemortem Injuries
figure 10.15 Heat will cause the skull to fracture and come apart. The underlying brain may be fragmented and cooked. This should not be confused with antemortem trauma to the head.
Antemorem Head Trauma

figure 10.18 The multiple cuts across this man's chest and abdomen were caused by the surgeon and not fire. This procedure helps to ease the pressure buildup in the tissues which can cause muscle and nerve damage.

figure 10.17 This body has charring, skin splits, and the pugilistic attitude in the upper extremities.

figure 10.18 The multiple cuts across this man's chest and abdomen were caused by the surgeon and not fire. This procedure helps to ease the pressure buildup in the tissues which can cause muscle and nerve damage.

figure 10.17 This body has charring, skin splits, and the pugilistic attitude in the upper extremities.

Pugilistic Attitude The BodyPostmortem Injuries

figure 10.19 The heat may cause the skin to bubble and blister. These are postmortem injuries.

figure 10.19 The heat may cause the skin to bubble and blister. These are postmortem injuries.

figure 10.20 The heat may cause the external layer of the skin to slip and peel off the body.

figure 10.20 The heat may cause the external layer of the skin to slip and peel off the body.

Charing Skin Splits

figure 10.21 The splitting of the skin and tissue may cause organs to become exposed. This evisceration of organs should not be mistaken for antemortem injuries.

What Fourth Degree Thermal Injuries

figure 10.22 This child was one of two children found dead in a bedroom. The body had thermal injuries to 100% of the total body surface. See next photo.

figure 10.21 The splitting of the skin and tissue may cause organs to become exposed. This evisceration of organs should not be mistaken for antemortem injuries.

figure 10.22 This child was one of two children found dead in a bedroom. The body had thermal injuries to 100% of the total body surface. See next photo.

Gun Shot Bodys
figure 10.23 There was a marked amount of hemorrhage just under the skull. This epidural hemorrhage would be suspicious of blunt trauma injury if the child had not died in a fire. This particular type of hemorrhage is an artifact of the fire. See next photo.
Traumatic Gunshot Wounds
figure 10.25 No matter how badly damaged a body, a blood specimen can usually be obtained. The redness of the tissues in this case suggests the person died of carbon monoxide poisoning. The blood test will confirm this opinion.
Antemortem Injuries
figure 10.24 A closer look shows the hemorrhage distributed over the entire surface of the dura mater. An antemortem epidural hemorrhage is thicker and more of a discrete entity. Subsequent examination of the brain in this case revealed no injury to the brain.
Gunshot Injury
figure 10.26 Organs are still present and can be examined in these badly damaged remains.
Gunshot Wound Child
figure 10.27 Scene photos may be important. This child was still strapped in her car seat when the fire killed her.
Thermal Injury
figure 10.28 This man appeared badly burned, but he died from a reaction to an antibiotic. This reaction, called "toxic epidermal necrolysis," could be mistaken for a thermal injury if the history is not known. See next photo.
What Are Thermal Injuries
figure 10.29 Much of the skin has peeled away from the body due to the drug reaction. See next photo.
Catastrophic Reactions
figure 10.30 Another view of this catastrophic reaction to a drug.
Pics People Dead From Gunshots
figure 10.31 All of these people died suddenly when a fire was started downstairs. Notice there is no fire damage to this room or the bodies. Victims may succumb to other noxious gases besides carbon monoxide.
Disinterred Caskets

figure 10.32 Two bodies were buried in this casket. A father and his son were in a tractor trailer when it was struck by another truck. Eighteen months after burial, they had to be disinterred because of a civil suit. The question was whether they were alive or dead at the time of the accident. See next photo.

figure 10.32 Two bodies were buried in this casket. A father and his son were in a tractor trailer when it was struck by another truck. Eighteen months after burial, they had to be disinterred because of a civil suit. The question was whether they were alive or dead at the time of the accident. See next photo.

Gunshot Injuries Pictures
figure 10.34 This body still had a head and neck while the other's head and neck had been burned away. See next photo.
Gunshot Injuries Pictures
figure 10.36 Fortunately, black pigment could still be found in the trachea (arrow). This proved this man was alive at the time of the fire. See next photo.
0 0

Responses

  • lena
    What is fourth degree thermal injuries?
    3 years ago
  • JAMES ROOF
    Does heat cause problems for gunshot wounds?
    2 years ago
  • logan
    How do thermal injuries cause death?
    2 years ago
  • Jonas Theiss
    WHAT DOES DIED OF THERMAL INJURIES MEAN?
    1 year ago
  • Dominik
    What does autopsy report "combined effects of traumatic and thermal injuries mean?
    1 year ago
  • mehari
    Is someone alive at first if they die from traumatic and thermal injuries?
    1 year ago
  • erik
    What does traumatic and thermol injuries mean in an autopsy report?
    1 year ago
  • Lealdo Marchesi
    What is diffuse charring of the skin?
    12 months ago
  • MITCHELL
    What is diffuse charing?
    12 months ago
  • haben selassie
    What does dying from thermal injuries mean?
    12 months ago
  • abeba
    What does diffuse charring skin meaning?
    12 months ago
  • luciano
    What does diffuse charring of the skin and epidural clotting;?
    12 months ago

Post a comment