Professional Documents
Culture Documents
OF PHYSICAL INJURIES
REPORTERS:
LUISITO CORPIN
JERRY TONGZON
Physical injury : is the effect of some of
stimulus on the body.
Stab wound the effect is immediate but
a blunt object is delayed production on
the contusion.
Causes
1.
2.
3.
4.
5.
6.
7.
of Physical Injuries
Physical violence
Heat or cold
Electrical energy
Chemical energy
Radiation by radioactive substances
Change of atmospheric pressure
Infection
a. Kinetic energy
= __________
2
`Velocity component is the important
factor:
M16 rifle with a velocity of 3200 ft/ sec
causes damage more
than a heavier .38 caliber.
b. Time
= The shorter the period of time needed for the
transfer of energy,the greater the likelihood of
producing damage.
= If a person is hit on the body and the body
moves towards the direction of the force
applied, the injury is less as when the body is
stationary.
= The longer the time of contact between the
object or instrument causing the injury, the
greater will be the dissipation of energy
c. Area of transfer
= The larger the area of contact
between the force applied on the body,
the lesser the damage to the body.
= By applying an equal force, the
damage caused by stabbing is greater
compared to a blunt instrument.
d. Other factors
= The less elastic and plastic the tissue , the
greater that a laceration will result.
= Elasticity :
Ability of the tissue to return to its normal sizes
and shape after being deformed by a pressure.
= A force transmitted through a tissue
containing fluid will force the fluid away from
the area of contact in all directions equally,
frequently causing the tissue to lacerate.
VITAL REACTION
= It is the sum total of all reactions of tissue or
organ to trauma, either observed micro or
macroscopically.
a. RUBOR - redness or congestion of the area due to an
increase of blood supply as a part of the reparative
mechanism.
b. CALOR - Sensation of heat or increase in temperature.
c. DOLOR - pain due to involvement of the sensory nerve.
d. LOSS OF FUNCTION - due to trauma, the tissue may
not function.
CLASSIFICATION OF WOUNDS:
1. AS TO SEVERITY
a. Mortal wound - caused immediately after
infliction that is capable of death.
Parts of body that are mortal - heart,
vessels, CNS, lungs, other organs.
b. Non-mortal wound - Not capable of
producing death after infliction.
4. AS REGARDS TO THE
DEPTH OF THE WOUND
a)
b)
6. AS TO REGIONS OR ORGANS OF
THE BODY INVOLVED
Injuries in various parts of the body
TYPES OF WOUNDS
( MEDICAL CLASSIFICATION)
Contusion
Cuticle was probably abraded by the
same violence that produced the
bruise. In small punctures such as fleas
bites, this is not observed.
Post-mortem hypostasis
Cuticle unabraded, because the
hypostasis is a mere sinking of the
blood,there is no trauma.
Contusion
A bruise appears at the seat of and
surrounding the injury. This may or
may not be a dependent part.
Post-mortem hypostasis
Always in a part which for the time of
information is dependent.
Contusion
Often elevated because elevated blood
and subsequent inflammation swell
the tissues.
Post-mortem hypostasis
Not elevated, because either the blood
is still in the vessels or at most has
simply soaked into and stained the
tissues.
Contusion
Incision shows blood outside the
vessels. This is the most certain test of
difference and can be observed even in
very small bruises.
Post-mortem hypostasis
Incision shows the blood is still in its
vessels and if any oozing occurs drops
can be seen issuing from the cut mouths
of the vessels.
Contusion
Color variegated. This is only true of
bruises that are the same days old due to
the changes in the hemoglobin produced
during life.
Post-mortem hypostasis
Color is uniform. The well known change
in color produced in blood . Extravasated
Into living tissues does not occur in dead
tissues with the same regularity.
Contusion
If the body happens to be constricted at or supported
on a bruised place, the actual surface of
contact may be a little lighter than the rest of the bruise
but will not be white.
Post-mortem hypostasis
In a place which would otherwise be the seat of
hypostasis pressure of any kind even simple
support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling
with blood.
White lines or patches of pressure bordered by the dark
color of hypostasis are produced and marks
of floggings, strangulation, etc. are thus sometimes
simulated
Contusion
If the body happens to be constricted at or supported
on a bruised place, the actual surface of
contact may be a little lighter than the rest of the bruise
but will not be white.
Post-mortem hypostasis
In a place which would otherwise be the seat of
hypostasis pressure of any kind even simple
support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling
with blood.
White lines or patches of pressure bordered by the dark
color of hypostasis are produced and marks
of floggings, strangulation, etc. are thus sometimes
simulated
a.3 HEMATOMA
-is the extravasation or effusion of
blood in a newly formed cavity
underneath the skin. When theblunt
instrument hit a hard part of the body
like a bony part which is superficially
located.
Force causes the subcutaneous tissue
to rupture on account of the presence
of a hard structure
MUSCULO-SKELETAL INJURIES
1. Sprain - partial or complete
disruption in the continuity os a
muscular or ligamentous support of a
joint, due to a blow, kick or torsion
force.
2. Dislocation - displacement of the
articular surface of bones entering into
the formation of a joint.
INTERNAL HEMORRHAGE
-rupture of blood vessels which may
cause hemorrhage due to the
following:
a. Traumatic intracranial hemorrhage.
b. Rupture of parenchymatous organs.
c. Laceration of other part of the body.
CEREBRAL CONCUSSION
( COMMOTIO CEREBRI )
- THE JARRING OR STUNNING OF THE BRAIN
CHARACTERIZED BY MORE OR LESS
COMPLETESUSPENSION OF ITS FUNCTIONS AS
A RESULT OF INJURY TO THE HEAD WHICH
LEADS TO SOME COMMOTION OF THE
CEREBRAL SUBSTANCE.
- is more severe when the moving or mobile
head struck a fixed hard object as compared
when the
head is fixed and struck by a hard moving object
2.OPEN WOUNDS
a. Abrasion ( Scratch, graze, impression mark,
friction mark )
- it is an injury characterized by the removal of the
superficial epithelial layer of the skin caused by
a rub r friction against a hard rough object.
Characteristics of abrasion:
1. It develops at the precise point of the
force causing it.
2. Grossly or with the aid of a hand
lens the injury consists of parallel linear
injuries which
are in line with the direction of rub or
friction causing it.
3. It may exhibit the pattern of the
wounding material.
4. Usually ignored by attending
physician.
Medico-legal viewpoint
= abrasions caused by fingernails may indicate
struggle or assault and are usually located
in the face, neck, forearms and hands.
= abrasions resulting from friction on rough
surfaces are located in bony parts and are
usually associated with contusion or laceration.
= nature of the abrasion may infer degree of
pressure, nature of the rubbing object and
the direction of movement.
5. Abrasion heals in a short time and leaves no scar
unless if not
infected or if the whole thickness of the skin is
involved.
Forms of abrasion
1. Linear abrasion - appears as a single line,
straight or curve.
= pinching with fingernails = curve a.
= sliding the point of a needle = straight
linear ab.
2. Multi-linear - develops when the skin is
rubbed on a hard rough object producing
several
linear marks parallel to one another.
Example: MVA
Types of abrasion
1. Scratch - caused by sharp pointed object which
slides across the skin, like pin, thorn or fingernail.
Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of
commencement with tailing at the end.
2. Graze - usually caused by forcible contact with
rough, hard objects resulting to irregular removal
of the skin surface.
= course indicated by a clean commencement and
tags on the end.
Differential diagnosis:
1. Dermal erosion - gradual breakdown
or very shallow ulceration of the skin
which involves only the epidermis and
heals without scarring.
2. Marks of insects and fishes bites skin injury is irregular with no vital
reaction and usually found on angles of
the mouth, margins of nose, eyelids and
forehead.
3. Excoriation of the skin by excreta found in infants and the skin lesions
heals when the cause is removed.
No apparent history of rubbing trauma
on the affected area.
4. Pressure sore - usually found at the
back at the region of bony prominence.
History of longstanding illness, bed
ridden.
ANTEMORTEM POSTMORTEM
ABRASION
ABRASION
COLOR
reddish-bronze due
to slight
exudation of blood
LOCATION
any area
VITAL
with intravital
reaction
may show remains
of damaged
Epithelium
Suicidal wounds
- usually located in peculiar parts of the
body, accessible to the hand.
- the most common site is the wrist,
radial artery and the neck.
Homicidal wounds
-usually deep, multiple and involve
both accessible and non-accessible
parts.
-clothings are usually involved
-defense and other forms of wounds are
present
Accidental wounds
SUICIDAL
WOUNDS
HOMICIDAL
WOUNDS
DIRECTION
SEVERITY
SUPERFL
CUT
POSITION
OF THE
WOUNDING
WEAPON
SUICIDAL
WOUNDS
HOMICIDAL
WOUNDS
Weapon is absent
BLOOD
History of mental
depression,
Financial, social
problems, alcoholism
PREVIOUS
HISTORY
of SELF-
May be present
Always absent
DESTRUCTION
Characteristics:
1. The opening of the skin is very small,
wound is much deeper than it is wide.
2. External hemorrhage is limited than
internally may be severe.
3. Sealing of external opening is
favorable for the growth and multiplication
of anaerobic organism like bacillus tetani.
Homicidal
1. multiple and usually located in different
parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of struggle in the crime scene.
Suicidal
1. located in areas of the body where the vital organs
are located.
2. usually singular, if multiple located in one area.
3. parts of body involved is accessible by the hand of
the victim.
4. clothing usually not involved.
5. wounding is made while the victim is in sitting or
standing position , bleeding is towards the
lower part of the body or clothing.
6. no disturbance in the crime scene.
7. wounding instrument found near the body.
Characteristic:
1. shape and size of the injury does not correspond to the
wounding instrument
2. tear on the skin is rugged with extremities irregular, illdefined.
3. injury developed where the blunt force is applied.
4. borders of the wound are contused and swollen.
5. developed in areas where the bone is superficially
located.like scalp.
6. examination with the aid of hand lens shows bridging
tissue joining the edges and hairs bulbs
are intact.
7. bleeding is not extensive due to blood vessels are not
severed evenly.
8. healing process is delayed and has a tendency to develop
a scar.
3. Grinding compression
-the weight and the grinding movement may
cause separation of the skin with the
underlying tissues.
4. Tearing
-this may be produced by a semi-sharped edged
instrument which causes irregular edges on the
wound like hatchet and choppers.
Lacerated wounds are rarely suicidal.
INCISED
WOUNDS
LACERATED
WOUNDS
No contusion or swelling
around the
Incised wounds
INCISED
WOUNDS
LACERATED
WOUNDS
healing is delayed
caused by a blunt
instrument
GAPING OF WOUND
Separation of the edges especially in deep
wound may be due to the following:
1. mechanical stretching or dilatation
the presence of a mechanical device on
the edges to prevent coaptation will cause
separation.
Example: drain in an abscess, retractor
during operation.
9%
9%
18%
18%
9%
9%
1%
9%
18%
18%
18%
18%
18%
1%
Causes of hemorrhage:
a. trauma - destruction of its blood vessel
wall
b. natural causes
- intracerebral hemorrhage(apoplexy)>
lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage >
saccular berry aneurysm
- rupture of arteriosclerotic aneurysm
TOXIN.
1. snake bites> 2 punctured wds at the
center of the reddened affected area. The
venom is injectedthrough its fangs which is
connected to the poison gland.
2. Scorpion venom
- venom has toxic, hemolytic, hemorrhagic
- one punctured wound on the center of a reddened
area
pain, edema and reddening
3. Coelenterate sting ( jellyfish )
- tentacles penetrate into the skin and cause
explosion of the nematocyst and liberation of the
venom.
- extreme pain. Urticarial rash, dilated pupils,
paleness, labored breathing
HEALING OF WOUNDS
1. Power of the human tissue to regenerate
-replaced the destroyed tissue by newly
formed similar tissue.
Regenerates rapidly : C.T., blood forming
tissues,surface epith. Skin
Slow to regenrate:sm. Muscles, neurons of
CNS, highly specialized glandular tiss.
3. Examinations of wound
- character of wound : abrasion, hematoma,
laceration etc
- location of wound : from some fixed area
> to determine trajectory/course
- depth of wound : not in the living , only if
the outer and inner are fixed
- conditions of locality
a. degree of hemorrhage
b. evidence of struggle
c. information as to the position of the
body
d. presence of suicide note
e. condition of the weapon
HEMORRHAGE
SIGNS OF
INFLAMMATION
ANTE-MORTEM
WOUNDS
POST-MORTEM
WOUNDS
No spouting of blood
Clotted blood
None
ANTE-MORTEM
WOUNDS
POST-MORTEM
WOUNDS
SIGNS OF
REPAIR
Fibrin formation
No time of repair
growth of epithelium
Scab or scar formation
No time of repair
RETRACTION
OF THE EDGES
HOMICIDAL
ABRASIONS
CONTUSION
INCISED
SUICIDAL
ACCIDENTAL
Extensive
abrasions MVA
4. testimony of witness
GUNSHOT WOUNDS
Death or physical injuries brought about by
powdered propelled substances:
1. Firearm shot
= the injury is caused by the missile propelled
by the explosion of the
gunpowder located in the cartridge shell and
the rear of the missile.
2. detonation of high explosives - grenades
= explosion inside the metallic container will
cause fragmentation of the container.
I. FIREARM WOUND
= Firearm : is an instrument used for the
propulsion of a projectile by the expansive
force of gassescoming from the burning of
gunpowder. (technical definition)
= includes rifles, muskets, shotguns, revolvers,
pistols, other deadly weapons which a bullet,
ball, shell or other missile may be discharged by
means of gunpowder or other explosives.
= includes air rifle except of small calibers and
limited range.
= the barrel of any firearm shall be considered
as a complete firearm for all purposes thereof.
3. as to manner of firing
= pistol fired with a single shot
Ex. Revolver
= rifle may be fired from the shoulder Ex.
Shotgun
ENTRANCE WOUND
EXIT WOUND
Absent
Absent
2. internal examination
a. actual dissection and tracing the course of
the wound at autopsy
b. fracture of bones and course in visceral
organs
c. location of bone fragments and lead particle
X-ray
SHOTGUN WOUNDS
Is a shoulder fired firearm having a barrel that is
smooth-bored and is intended for the firing of a
changed
compound of one or more balls or pellets.
Measure the distance between the two farthest
shot(pellets) in inches and subtract one, the
number obtained will give the muzzle-target distance
in yards.
Importance:
2. On clothings
Walkers test ( C-acid test, H-acid test)
= glossy photographic paper fixed in hyposolution for
20 min to
remove the silver salts and washed for 45 min. and
dries.
Effects of COLD:
A. Local effect ( Frostbite, Immersion foot, Trench
foot )
1st- Blanching , paleness of the skin due to vascular
spasm.
2 nd - Erthyma, edema, swelling due to vascular
dilatation, paralysis and
increased capillary permeability.
3rd - Blister formation
4 th - Necrosis, vascular occlusion, thrombosis and
gangrene.
Microscopically: Vacuolization, degeneration of
epidermal cells
: Necrosis of the collage of the SQ tissue
: Occlusion of the vessels due to clumping of RBC
Effects of COLD:
A. Local effect ( Frostbite, Immersion foot, Trench
foot )
1st- Blanching , paleness of the skin due to vascular
spasm.
2 nd - Erthyma, edema, swelling due to vascular
dilatation, paralysis and
increased capillary permeability.
3rd - Blister formation
4 th - Necrosis, vascular occlusion, thrombosis and
gangrene.
Microscopically: Vacuolization, degeneration of
epidermal cells
: Necrosis of the collage of the SQ tissue
: Occlusion of the vessels due to clumping of RBC
B. Systemic effects:
- Reflex in nature due to the stimulation and paralysis
of the nerves
- Pulmonary ,Cardiac action is slowed down due to
cerebral anoxia>
resulting to lethargy, delirium, convulsions, coma or
death.
b) Local effects:
b.1 Scalding
b.2 Burns
= Thermal
= Chemical
= Electrical, lightning
= Radiation
ERYTHEMA
2nd degree
VESICLE FORMATION
3rd degree
Destruction of the
cuticle,part of
skin,painful
4th degree
5th degree
6th degree
BURNS
SCALDS
CAUSE
LOCATION
AT OR ABOVE TE SITE
OF CONTACT
OCCURS AT OR BELOW
SINGEING
OF HAIR IS PRESENT
ABSENT
BOUNDARY OF
NORMAL
NOT CLEAR
DISTINCT
INJURY
SEVERE
LIMITED
CLOTHINGS
INVOLVED
NOT BURNED
1.
2.
3.
4.
BURNS
ANTE-MORTEM
BURNS
POST MORTEM
BURNS
BLISTER
ABUNDANT ALBUMIN /
CHLORIDES
SCANTYALBUMIN/
CHLORIDES
AREA OF
INFLAMMATIO
N
BASE OF THE
VESICLE
AROUND THE
ANTEMORTEM BURN
ABSENT
RED
TRACHEOBROCHIAL
LUMEN
BLOOD
ABSENT
3. Chemical burns
- heat by the size, distribution
- Hx of application of heat
Characteristics of lesions:
a. Absence of vesication
b. Staining of the skin or clothing by the chemical
c. Presence of the chemical substance
d. Ulcerative patches of the skin
e. Inflammatory redness of the skin surface
f. Delayed healing
CHEMICAL
BURNS
THERMAL
BURNS
BLISTER
ABSENT
PRESENT
SKIN /
CLOTHINGS
STAINED
CHEMICALS
NO STAINING
ANALYSIS OF
SUBSTANCE
SHOWS
CHEMICAL
CORROSION
BORDERS ARE
DISTINCT
ABSENT
LESION
DIFFUSED
b. Nitric acid
= Clothing is destroyed, brown
= yellow or yellowish brown slough
c. Hydrocloric acid
= not so destructive
= intense irritation, localized ulceration red or
reddish-gray.
d. Caustic soda and Potash
= Corrosive action on the tissues with bleached
appearance
- Henrys Law
- At constant temperature, the amount of gas
dissolved in a liquid is directly proportional to
the pressure
DEATH BY ASPHYXIA
Asphyxia - Applied to all forms of violent death
due to interference with process of respiration
- Conditions in which the supply of O2 to the
blood or tissues or both has been reduced
below normal
level.
Types of asphyxial death:
1. Anoxic death
- Failure of arterial blood to be normally
saturated with O2 due to:
a) Breathing in an atmosphere with insufficient
O2- High altitude
e) Shunting of blood
Classification of Asphyxia:
1. Hanging
2. Strangulations: by ligature, manual
strangulation, spl forms -palmar
3. Suffocation: choking
4. Asphyxia by drowning
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirable gasses
Hanging is ante-mortem:
Vital reaction= principal criterion
1. Redness or ecchymosis at the site of ligature.
2. Ecchymosis of the pharynx and epiglottis.
3. Line of redness or rupture of the intima of the
carotid artery
4. Subpleural hges.
STRANGULATION
HYOID BONE
FREQUENTLY INJURED
FREQUENTLY SPARED
DIRECTION OF
LIGATURE MARK
INVERTED V-SHAPE
USUALLY HORIZONTAL
LIGATURE LOCATION
BELOW LARYNX
LIGATURE LOCATION
UNIFORM DEPTH
VERTEBRAL INJURY
FREQUENTLY OBSERVED
NOT OBSERVED
Post-mortem findings:
1. External findings
a) Wet clothes, pale face, F.B. clinging on skin
surface
b) Cutis anserine or goose flesh -skin is pale ,
contracted
NOT Dxtic
c) Washerwomans hands and feet - skin of hands &
feet:bleached NOT Dxtic
d) Postmortem lividity - marked in the head, neck
and chest.
e) Presence of firmly-clenched hands with objects Person was alive at first
f) Physical injuries for struggle
2. Internal findings
A. RESPIRATORY SYSTEM
1. Emphysema aquosum - Lungs are distended
overlapping the heart
= Due to irritation made by the inhaled water on
the mucous membrane of
the air passage which stimulate the secretion of
mucous.
2. Edema aquosum- Due:Entrance of water into
air sacs, Lungs are doughy
3. Champignon docume - whitish foam
accumulates in the mouth/nostrils
= Due: abundance of mucous secretion
= One of the indications that death was due to
drowning.
Gettlers Test:
- Quantitative determination of the chloride
content of the blood in the right and left
ventricle of the heart.
:Difference of at least 25 mg.
C. STOMACH
Presence food in the stomach but absence of
water.
> Death is rapid or submersion made after
death.
Impossible for water to get into the stomach if
body is submerged afterdeath.
E.COMPRESSION ASPHYXIA
( TRAUMATIC CRUSH ASPHYXIA )
F. ASPHYXIA BY BREATHING
IIRESPIRABLE GASES
1. Carbon monoxide silent
killer, colorless, insoluble in
water and alcohol.
- formed by the incomplete combustion of carbon
fuel.
2. ENVIRONMENTAL FACTOR
Poor visibility, poorly maintained roads, rain,
blind intersection
3. MECHANICAL FACTOR: Poor brake, worn out
tires
4. SOCIAL FACTOR: Speed, insurance
5. PEDESTRIAN
Pedestrian-Vehicle Collision:
Death or Physical Injuries to pedestrian
1.Primary impact - Contact with vehicle
2. Secondary impact - Subsequent impact of the
pedestrian to the ground
- Accounts for the multiple injuries
3. Run over Injuries
end