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Systems: MSK AB > Forensic Aspects of Trauma > Flashcards

Forensic Aspects of Trauma Flashcards

1
Q

Injury

A
  • Physical harm or damage to someone’s body caused by an accident or an attack
  • Damage to any part of the body due to the application of mechanical force
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2
Q

What forces does the intensity of injury obey?

A

Laws of physics

  • Force varies directly with mass of the ‘weapon’ and directly with square of velocity of impact
  • Kinetic energy = ½ mass x velocity^2
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3
Q

How does area over which force acts affect injury severity?

A

-Force (same mass and velocity) over a smaller area will deliver a greater impact to any given unit of tissue

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4
Q

How do seatbelts work?

A

Stretching of seatbelt fabric extends time of energy exchange and considerable area of seatbelt surface is preferable to alternative of transferring all kinetic energy via a few cm^2 of the forehead against the windscreen

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5
Q

What can excessive mechanical force cause?

A
  • Compression
  • Traction
  • Torsion
  • Tangential (shearing)
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6
Q

What does resultant damage depend on?

A

Type of mechanical insult and nature of the target tissue

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7
Q

How can injury be classified?

A

Appearance or method of causation:
-Abrasion, contusion, laceration, incised wounds, gunshot wounds, burns

Manner of causation:
-Suicidal, accidental, homicidal

Nature of injury:
-Blunt force, sharp force, explosive

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8
Q

How are blunt force injuries caused?

A

Caused by impact with blunt object (ground, fist, foot, weapon)

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9
Q

Give examples of blunt force injuries.

A

Contusions (bruises)
-Burst blood vessels in skin

Abrasions (graze, scratch)
-Scraping of skin surface

Lacerations (cut, tear)
-Tear/split of skin due to crushing

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10
Q

Give examples of patterned bruises.

A
  • Tramline bruises
  • Finger trip bruises
  • Patterns from objects
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11
Q

What factors affect prominence of bruising?

A
  • Skin pigmentation
  • Depth and location
  • Increased subcutaneous fat
  • Young and old
  • Resilient area such as buttocks and abdomen bruise less easily
  • Areas with underlying bone bruise more easily
  • Coagulative disorders (including alcoholics)
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12
Q

What is a sharp force injury?

A
  • Injury caused by any weapon with sharp cutting edge.

- Can be superficial or penetrating

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13
Q

Give examples of sharp force injuries.

A
  • Incised wounds

- Stab wounds

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14
Q

How do incised wounds occur?

A

Superficial sharp force injury caused by a slashing motion

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15
Q

How do incised appear?

A

Longer on the skin surface than it is deep

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16
Q

How do stab wounds occur?

A

Penetrating injury resulting from thrusting motion

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17
Q

How do stab wounds appear?

A

Wound depth greater than length on the surface

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18
Q

What types of defensive injuries do you get?

A

Blunt and sharp force

19
Q

How do passive defensive injuries occur?

A

Victim raises arms and legs for protection

20
Q

What types of passive defensive injuries can occur?

A

Sliced, shelved often with skin flaps over backs of hands and forearms

21
Q

How do active defensive injuries occur?

A

Victim tries to grab weapon or attacker hand

22
Q

What types of active defensive injuries can occur?

A

Sliced shelved incised wounds on palmer aspect of hands and web spaces between fingers – particularly between thumb and index finger

23
Q

What sites are usually used for self inflicted injuries?

A
  • Wrists/forearms

- Chest and abdomen

24
Q

How do self-inflicted injuries usually appear?

A
  • Commonly sharp force
  • Parallel, multiple and tentative injuries
  • Positioned under clothing
25
Q

What does consequence of injury depend on?

A

Type of mechanical insult
-Blunt, sharp, homicide, suicide, accident

Nature of target tissue
-Head, chest, abdomen, fat

Forces involved
-High speed RTC, fall from a height, kicking, stamping, punch

Number of impacts
-Single vs multiple

26
Q

What can head injuries result in?

A
  • Skull fractures (linear or depressed)

- Subarachnoid, subdural, extradural haemorrhage

27
Q

When will patients start to show symptoms of brain haemorrhage?

A

35ml blood loss

28
Q

How will a patient present with 40-50ml of brain haemorrhage?

A
  • Clinical deterioration

- Life threatening

29
Q

How will a patient present with 80-100ml of brain haemorrhage?

A

Commonly fatal due to increased ICP and herniation

30
Q

How will a patient present with 150ml+ of brain haemorrhage?

A

Proves fatal

31
Q

What is usually the cause of extradural haemorrhage?

A

Rupture of the middle meningeal artery

32
Q

What is usually the cause of subdural haemorrhage?

A

Rupture of emissary

33
Q

What is usually the cause of subarachnoid haemorrhage?

A
  • Contusions of the brain

- Rupture of berry aneurysms

34
Q

What is a common consequence of subarachnoid haemorrhage?

A

Traumatic brain injury

35
Q

How do traumatic subarachnoid haemorrhages occur?

A

-Due to rapid rotational movement of head, usually as the result of a single punch to jaw/ upper part of neck or side of head
-Sudden unexpected twisting movement
Causes traumatic rupture of vessels at base of brain – most frequently distal portion of intracranial vertebral arteries at point where they cross the dura
-

36
Q

What does traumatic subarachnoid haemorrhage result in?

A

Immediate LOC and cardiac arrest

37
Q

Diffuse axonal injury

A
  • Clinical term

- Immediate and prolonged coma with no apparent mass lesion or metabolic abnormality

38
Q

Traumatic axonal injury

A
  • Pathological term
  • Damaged axons due to trauma
  • Focal or diffuse
  • Graded 1-3 dependent on severity
39
Q

What internal damage can blunt force cause?

A

Falls, RTC, kicks, blows

Ribs
-Multiple fractures, flail chest

Lungs
-Contusions, lacerations including vessels

Heart
-Bruising, laceration, common carotids

Aorta
-Deceleration trauma, rupture

Abdomen
-Bowel tears, mesenteric haemorrhage and laceration, liver and spleen lacerations, haemorrhage

40
Q

What internal damage can be caused by sharp force injuries?

A

Stabs

Intercostal vessels, ribs, pneumothorax, haemothorax

Lungs
-Penetration haemorrhage, collapse, through and through

Heart
-Penetration, tamponade, haemothorax

Aorta
-Haemopericardium, haemothorax

Abdomen
-Penetration of bowel, liver, spleen etc. haemorrhage

41
Q

What injuries can occur during resuscitation attempts?

A
  • Bruising to neck and chest
  • Finger mark bruising
  • Bruising/laceration of lips and gums
  • Damage to teeth
  • Sternal and rib fractures
  • Pleural cavity haemorrhage
  • Laceration of lung
  • Heart rupture
  • Venepuncture and cannulation
42
Q

Give examples of other types of injuries.

A
  • Burns
  • Firearm injuries
  • Explosions
43
Q

What post- mortem injuries can occur?

A
  • Parchmentation
  • Animal predation
  • Insect predation

Systems: MSK AB (43 decks)

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