Scalding burns are of three types: immersion burns following accidental or deliberate immersion in a hot liquid, usually water; splash or spill burns — usually accidental — and steam burns caused by exposure to superheated steam. Hot water accounts for most of the immersion, spill, and splash burns (Figure 13.9). These may be homicidal or accidental. Scalding of children is a common form of child abuse (see Chapter 12). While most splash burns are accidents, the authors have seen cases where individuals have boiled water, then intentionally thrown it on a victim. These are usually domestic homicides, with the victim the husband. The severe nature of burns from boiling water is appreciated when one realizes that water heated to 158°F can cause a full-thickness burn in adult skin in 1 s of contact.2 Splash burns in accidents tend to be multiple and of varying depths.
Accidental spill burns typically involve children in kitchens who pull a pot, or cup of hot tea, coffee or water down onto themselves. The burns are on the face, neck, upper chest, and arms. Clothing protects the skin from these burns. The hot fluid cools as it falls onto the skin and flows down the body, producing superficial scald burns with a red, moist surface. As the fluid moves down the body, the burns become progressively less severe.
An individual exposed to superheated steam sustains severe scald-like burns of the body. With inhalation, there are laryngeal, tracheal, and respiratory burns. The latter may progress to adult respiratory distress syn-
drome. In some instances, there is massive edema of the larynx, with an asphyxial death.
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