Iatrogenic pulmonary edema as a cause of death in burns

Abstract

Global mortality from the burn is decreasing while in Iraq is still rising. This study was designed to determine the paucity of data regarding the cause of death in the burn, which may be a participating factor and should eliminate it. A post-mortal field study was conducted in the Department of Forensic Medicine in the province of Babylon, Iraq, for a year period, from the 1st of January 2017 to the 1st of January 2018. The total deaths were 1310, and the whole number of deaths by burn accidents in Babylon, Iraq, was 81(6.18% of all causes of death in a year). 65 were females (80.24%), 16 were males (19.75%). Deaths with no history of admission more than 3day in burn units, age over 45years, cardiovascular diseases patients, heavy smokers, inhalational injuries victims, all were excluded, so 68 burn victims were subjected to a full, typical autopsy at the Department of Forensic Medicine in the province of Babylon for one year period, with all necessary laboratory tests, in order to diagnose the direct cause of their death. For assessing small size area burn, we used small paper the size of the victim whole hand (represent 1% of TBSA), for a larger area, the Lund and Browder chart was used. Deaths were divided into 2 groups according to the period of admission at the burn unit. The first group (3-7 days of admission) with 60 victims, and the second (more than 7 days) with 8 victims. 17 victims with in the first group, had no prominent autopsy findings, but severe pulmonary edema, edema of other organs, no pathogenic organisms were isolated, the laboratory tests were accepted. Their medical records in the burn unit showed overestimation in the assessment of burn area size above the actual percentage by (20-35%). The major causes of death in the first group were septicemia 42.46%, pneumonia 32.35% and primary pulmonary edema 25%, caused mainly by overloading the circulation with fluids. Precise assessment of burn area size, ensuring proper fluid replacement and lowering the mortality rate.