Forensic Aspects of Trauma 2

Question 1

What are the two types of defensive type injuries?

Answer 1

Passive - victim raises arms and legs for protection –> sliced/shelved often with skin flaps over backs of hands/forearms

Active - victim tries to grab weapon/attackers hands –> sliced/shelved/incised wounds on palmar aspect/between webbed spaces

Question 2

What type of injury do self-inflicted injuries tend to be?

Answer 2

Sharp force
Tends to be on wrists/forearm/chest abdomen
Tends to have multiple tentative cuts (little cuts around deeper one)

Question 3

What are the consequences of injury dependent on?

Answer 3

Type of mechanical insult (blunt, sharp, accident, homicide etc.)

Nature of target tissue (head vs abdomen)

Forces involved

Number of impacts (e.g. multiple may cause more blood loss)

Question 4

What are the different kinds of skull fracture? How do you get each?

Answer 4

Linear - can get these from falling from own height
Depressed - when head hit with protruding weapon
Ring/hinge - higher energy injuries, e.g. road traffic accident

Question 5

How does amount of blood loss from brain bleeds correspond to symptoms/outcome?

Answer 5

35ml - symptomatic
40-50ml - clinical deterioriation, life-threatening
80-100ml - commonly fatal due to increased ICP and herniation
150ml+ - fatal

Question 6

What is an extradural haemorrhage?

Answer 6

Bleeding into the space between the dura and the skull

Question 7

Where do most extradural haemorrhages occur?

Answer 7

Temporal region where skull fractures have caused a rupture of the middle meningeal artery

Question 8

What are the features of an extradural haemorrhage?

Answer 8

Raised ICP

Lucid interval in some

Question 9

What is a subdural haemorrhage?

Answer 9

Bleeding into the outermost meningeal layer

Question 10

Around what lobes do subdural haemorrhages tend to occur?

Answer 10

Frontal and parietal

Question 11

What is the classical presentation of subdural haemorrhage?

Answer 11

Tends to be older patients, alcoholics

Tends to have slower onset of symptoms as blood accumulates more slowly as it is VENOUS blood

Question 12

How do subarachnoid haemorrhages occur?

Answer 12

Spontaneously in the context of a ruptured cerebral aneurysm

Question 13

What is a subarachnoid haemorrhage?

Answer 13

Blood accumulates along the sulci

Seen mostly in traumatic brain injury

Question 14

What sort of injury causes a traumatic subarachnoid haemorrhage?

Answer 14

Rapid rotational movement of the head, usually due to single punch to upper neck or side of head –> traumatic rupture of BVs at base of brain

Question 15

What is the presentation of traumatic subarachnoid haemorrhage?

Answer 15

Immediately unconscious and in cardiac arrest

Question 16

Define diffuse axonal injury

Answer 16

Clinical term: immediate and prolonged coma with no apparent mass lesion or metabolic abnormality

Question 17

Define traumatic axonal injury

Answer 17

Pathological term: damaged axons due to injury

Question 18

What pattern of injury would be typical from resuscitation?

Answer 18

Bruising of neck, chest, finger marks, bruising/laceration of gums, damage to death, sternal and rib fractures, pleural cavity haemorrhage, lacerations of lung, heart rupture, venepuncture, cannulation

Question 19

What are post-mortem injuries?

Answer 19

Parchmentation

Animal or insect predation