5. Injuries - recognising them and interpreting them

Question 1

Injuries variation according to severity (2)

Answer 1

1. major trauma (stabbing, industrial etc.), seen by emergency docs, ITU, forensic pathologists etc.
2. non-fatal trauma (sports, work, home injuries), seen by emergency and family docs

Question 2

Injuries not to be missed (4)

Answer 2

1. bruises and other injuries in children
2. injuries on woman which indicate domestic abuse or sexual assault
3. injuries in a person in care home
4. injuries in a person in police custody

Question 3

Injuries caused by blunt force (3)

Answer 3

1. abrasions
2. bruises
3. lacerations

something solid hitting the person or person hitting something solid

Question 4

Injuries caused by something sharp (2)

Answer 4

1. incised wounds
2. stab wounds

caused by sharp instrument/object cutting or penetrating into skin

Question 5

Other types of injuries (2)

Answer 5

1. gunshot
2. burning

caused by specific mechanisms

Question 6

Abrasions characteristics (3)

Answer 6

• from contact with a rough surface, scraping or crushing the epidermis
• superficial and only on outer layers of epidermis
• do not bleed

Question 7

Clinical and medico-legal importance of an abrasion (3)

Answer 7

• indicates injury has occurred
• indicates exact point of contact
• displays feature or pattern of whatever caused it

Question 8

Types of abrasions (4)

Answer 8

• graze: scraping against rough surface
• scratch: something thin and narrow scraping over skin
• brush abrasion: large areas of abrasion
• imprint/pattern abrasion: from a crushing rather than a scraping force

Question 9

Bruise definition

Answer 9

from crushing of small blood vessels beneath the skin in the dermis and subcutaneous tissue

Question 10

Features of bruises (6)

Answer 10

• shape (usually round)
• size
• site (does not always appear at the site of impact)
• color (blue-brown-green-yellow, imprecise)
• tendency to bruise (elderly, liver disease)
• pattern of group of bruises (cluster from gripping)
• pattern of individual bruises

Question 11

Laceration definition

Answer 11

splitting open of the skin by the impact force, typically where it lies over the bone

Question 12

Laceration characteristics (5)

Answer 12

• full thickness of the skin, therefore there is bleeding
• usually ragged edges with bruising around
• heal with scars
• typically occur over bone and are seen on foreheads, back of the head and lower legs
• most common in falls, road traffic accidents and assaults

Question 13

Sharp force injuries definition

Answer 13

caused by a sharp instrument/object cutting across the skin or penetrating into it; can be accidental, homicidal, suicidal

Question 14

Incised wounds are those cutting in a line ________ skin surface

Answer 14

across

Question 15

Stab wounds are those _________ deep in to the skin and tissues

Answer 15

penetrating

Question 16

Incised wounds vs lacerations (12)

Answer 16

Incised wounds:
sharp instrument
clean cut edge and depth
no abrasion/bruising
anywhere on the body
bleed a lot
can be fatal

Lacerations:
blunt trauma
ragged edges and depths
abrasion and bruising
typically over bone
bleed a lot
usually not fatal

Question 17

Stab wounds characteristics (4)

Answer 17

• single or multiple
• often oval in shape due to skin elasticity
• external may appear minor, more dangerous internal
• most people who die from stab wounds die of blood loss

Question 18

In homicidal stab wounds pathologists are interested in (3)

Answer 18

• length of the skin wound and shape on each end (type of knife)
• internal depth and angle of penetration (length of blade, force and relative positions of victim and assailant)
• internal damage to organs and tissues (indication of survival time and ability to move afterwards)