Forensic aspects of trauma Flashcards

1
Q

What is the definition of an 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 can excessive mechanical force lead to?

A

> Compression
Traction
Torsion
Tangential (shearing)

Resultant damage depends on type of mechanical insult AND nature of target tissue

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3
Q

Classification of injury?

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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4
Q

What do blunt force injuries lead to?

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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5
Q

Patterned bruises?

A

> Tramline
Finger tips
Other

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6
Q

Factors affecting prominence of bruising?

A
> Skin pigmentation
> Depth and location 
> Fat 
> Age - Child + Elderly 
> Resilient areas
> Coagulative disorders
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7
Q

Factors affecting prominence of bruising - Depth and location?

A

Depth and location – occur more readily over loose skin – eyebrow, scrotum

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8
Q

Factors affecting prominence of bruising - Fat?

A

Fat - ↑ subcut fat bruise more easily

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9
Q

Factors affecting prominence of bruising - Age?

A

Age:
> Children – skin loose and delicate
> Elderly - blood vessels of skin poorly supported + more subcutaneous fat

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10
Q

Factors affecting prominence of bruising - Resilient areas?

A

Buttocks, abdomen – bruise less easily with given impact than areas with underlying bone which acts as an anvil with skin between bone and inflicting object

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11
Q

Factors affecting prominence of bruising - Coagulation disorders?

A
> Thrombocytopenia
> Von Willebrand’s disease
> Haemophilia
> Liver disease (alcoholics)
> Bone marrow disease
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12
Q

Kinetic energy equation?

A

Kinetic energy = ½ mass x velocity2

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13
Q

Which type of injuries are bites?

A

Often a mix of abrasions and lacerations

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14
Q

What can tissue bridges help to determine?

A

Can help to confirm a blunt force laceration versus a sharp force injury

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15
Q

How are sharp force injuries defined?

A

> Superficial or penetrating

> Incised wounds:

  • Superficial sharp force injury caused by slashing motion
  • Longer on the skin surface than it is deep

> Stab wounds:

  • Penetrating injury resulting from thrusting motion
  • Wound depth greater than length on the surface
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16
Q

How do you determine between an incised and a stab wound?

A

The wound depth and length along the surface

Superficial versus deep

17
Q

When looking at a stab wound how is it assessed?

A

> How wide the incision is
The edges of the wound can help to determine the type of weapon
The depth of the wound

18
Q

Defensive type injuries?

A

Blunt and sharp force

Passive – victim raises arms and legs for protection

Active – victim tries to grab weapon or attackers hand

19
Q

Defensive type injuries - Passive?

A

Passive – victim raises arms and legs for protection

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

20
Q

Defensive type injuries - Active?

A

Active – victim tries to grab weapon or attackers hand

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

21
Q

Self inflicted injuries?

A

> Commonly sharp force
Site of election - usually wrists/forearms, chest and abdomen
Parallel, multiple and tentative incisions

22
Q

What determines the consequences of an injury?

A

> Type of mechanical insult – blunt, sharp, homicide, suicide, accident etc

> Nature of target tissue - head, chest, abdomen, fat

> Forces involved – high speed RTC, fall from height, kicking, stamping, punch

> Number of impacts – multiple vs single

23
Q

Head injuries?

A

> Skull fractures – linear, depressed

> Bleeding over brain – subarachnoid, subdural, extradural (amount is critical)
Diffuse Brain injury

24
Q

Moat common type of self inflicted injury?

A

Sharp force

25
Q

Most common sites of self inflicted injury ?

A

Sharp for usually wrists/forearms, chest and abdomen

26
Q

Diffuse axonal injury?

A

CLINICAL TERM – immediate and prolonged coma with no apparent mass lesion or metabolic abnormality

27
Q

Traumatic axonal injury?

A

PATHOLOGICAL TERM – damaged axons due to trauma

28
Q

TAI?

A

focal or diffuse (graded 1-3 depending on severity)

29
Q

Why are tentative incisions good news in self harming?

A

A sign of testing shows a suicidal pattern not a Homicidal pattern.

30
Q

Head injury and blood volume - 35ml?

A

Symptomatic

31
Q

Head injury and blood volume - 40-50ml?

A

Clinical deterioation, life threatening

32
Q

Head injury and blood volume - 80-100ml?

A

Commonly fatal due to an increased in ICP and herniation

33
Q

Head injury and blood volume - >150ml?

A

Fatal

34
Q

Injuries that can occur during resuscitation?

A

Resuscitation – Bruising neck and chest, finger marks, bruising /laceration pf lips and gums, damage to teeth, sternal and rib fractures, pleural cavity heamorrhage, laceration of lung, heart rupture, venepuncture and cannulation