CAUSES OF DEATH IN BURNS

& EXTERNAL FINDINGS

Causes of deaths in burns are due to -

 1. Neurogenic shock (primary shock)

 2. Hypovolemic shock (secondary shock)
 3. Electrolyte imbalance (hypokalemia)
 4. Suffocation- 1.In burning of organic matter (CO&CO2)
2.In burning of nitrocellulose film (NO2&N2O4)
3.In burning of wool/silk (NH3,HCN,H2s,SO2)
 5. Circulatory failure
 6. Renal failure
 7. Adrenal crisis
 8. Centrilobular necrosis of liver
 9. Tubular necrosis of kidney
 10. Infection - 1.Septicemia
2.Tetanus
3.Gangrene
 11. Fat embolism
 12. Increased carboxy haemoglobin levels
 13. Cerebral oedema
 14. Pulmunory oedema
 15. Exhaustion
POST-MARTEM FINDINGS(external
findings)
 1.Clothes
a) May be partly or totally burnt
b) Partly burnt clothes may be on or off the body
c) Silk, polyester & nylon clothes may be sticking to the body
d) There may be kerosene / petrol smell in the clothes
e) Clothes are preserved in glass containers and sent to FSL
 Smell
a) Smell of kerosene/ petrol can be known from clothes, hair,scalp,axilla or
inguinal area
 Identification
Especially in charred body, identification becomes difficult. In such cases
identity is established from partly burnt clothes,teeths,ornaments on body and
bones
 Cavities
Due to increased pressure, cranial and abdominal cavities may burst open
 Boxers /defence/fencing posture
a) Due to denaturation of and coagulation of proteins , there results flexion at
all joints and clawing of fingers, giving the body a typical posture
b) This phenomenon occurs both in antemortem and postmortem burns
 Face
a) Hair- hypopigmented
b) Face – swollen, sometimes distorted
c) Tongue – protruded out
d) Nose and mouth – froth or bloody discharge present
 Artefacts
a) Cracks on skin
b) Blisters due to scalds
c) Fracture skull or other bone
d) Heat hematoma
e) Injuries due to building collapse
f) Charring of body
 P.M Lividity
a) In burns – dark red
b) In death due to suffocation – cherry red
 External injuries – it depends upon source of heat
A) In burns
I. Singeing of hair
II. Superficial or deep burns
III. Coagulation necrosis
IV. Red line of demarcation – due to reaction at junction of burnt & unburnts part is
5-25 mm wide
V. In kerosene burns black sooty and smell may be present
VI. Body may be charred
VII. Bones may be expose
VIII. Burns may be less severe in folds of skin
IX. In delayed deaths pus or partial healing may be seen
B) Scalds
I. No singeing or charring
II. Within 2/3 hours there is formation of blisters
C) Electric burns
I. Erythema
II. Sloughing ulcers
III. Blindness due to laser beams
IV. Scar formed is radiant
V. Prolonged exposure may lead to malignancy
D) Electric burns
I. Typical wound entry is a crater formation ie wound is depressed thick hard
leathery cauliflower like and non bleeding
II. Typical wound of exit is a bleeding laceration
E) Lightening burns
There may be no external injury or there may result complete charring or
mutilation of the body
F) Explosive burns (due to heat mechanical force and blast wave)
I. Burns
II. Mutilation of body by blast wave
III. Extensive blackening and tattooing
IV. Suffocation due to fumes
V. Rupture of viscera
VI. Injuries may be accidental homicidal or suicidal
VII. Bombs may be explosive nulclear or biological