L4: Wounds Flashcards
1
Q
Def of Wounds
A
- Breach of the normal continuity of tissue by application of mechanical violence
2
Q
Classification of Wounds
A
- Legal (based on the severity of the injury)
- Medicolegal
- Mechanical (Physical) (based on causative instrument)
- Based on time of infliction
2
Q
what are wounds legally classified according to?
A
severity of injury
3
Q
Legal classification of Wounds
A
- Simple
- Dangerous
- Mortal
4
Q
Characters of simple wounds
A
- It is a superficial wound
- which heals rapidly within 20 days
- without leaving a permanent infirmity.
5
Q
Characters of dangerous wounds
A
- It is a serious injury
- which takes more than 20 days to heal
- may leave a permanent infirmity
5
Q
What is a permanent infirmity?
A
- It is a serious complication which may follow injuries.
- It means loss of a functioning organ or loss of the function of this organ (partially or completely).
5
Q
Characters of mortal Wounds
A
- It is a fatal injury.
- which causes death either immediately or after a short time
6
Q
What is a Disfigurement?
A
- It means loss of a non-functioning organ
E.g. loss of part from external auricle of the ear.
6
Q
Medicolegal classification of wounds
A
7
Q
Mechanical (physical) classification of wounds
A
7
Q
Mechanical (physical) classification of wounds is based on …..
A
causative instrument
8
Q
Classification of Wounds based on time of inflection
A
- Antemortem
- Postmortem
9
Q
Def Abrasions
A
- Superficial injury involves only outer layers of the skin.
9
Q
Characters of Abrasions
A
It bleeds very slightly and heals rapidly without leaving any scar.
10
Q
Types of Abrasions
A
- Scratch Abrasions
- Sliding Abrasion (Graze or Grinding Abrasions)
- Pressure or Contact Abrasions
11
Q
Description of Scratch abrasions
A
- It is a linear injury produced by sharp object
12
Q
Examples of tool causing Scratch abrasions
A
- sharp object, Such as pins or fingernails running across the skin.
12
Q
Characters of Scratch abrasions
A
- The object causing the scratch carries torn epithelium in front of it.
- The direction of injury is indicated from torn epithelium at end of abrasions.
13
Q
What are another names of sliding abrasion?
A
(Graze or Grinding Abrasions)
14
Q
Def of sliding abrasions
A
It is an injury that occurs due to friction of a broad area of skin against a rough surface
15
Q
What causes sliding abrasions?
A
traffic accidents or when body has been dragged.
15
Q
what are another names for pressure abrasions?
A
Contact Abrasions
15
Q
Characters of Sliding abrasions
A
- They show longitudinal parallel lines, which indicate
- direction of the sliding from torn epithelium at end of abrasions.
16
Def of **Pressure abrasions**
- It is an injury that occurs due to pressure with some objects which cause crushing of cuticle and reproduction of its shape on the skin as "Patterned abrasions".
17
Examples of **Pressure abrasions**
- Ligature mark in "hanging and strangulation"
- Fingernails and thumb marks in throttling and smothering"
- Teeth marks in "biting".
17
MLI of Abrasions
1. They are sure signs of violence and struggle.
2. They may be the only external sign of a serious internal injury e.g. ruptured viscera.
3. Identification of type of the crime
4. Identification of causative instruments from their shape
5. Direction of injury
6. Time passed since infliction of abrasions
7. Difference between antemortem and postmortem abrasions which occur when a body is dragged after death against a hard surface
17
identification of type of the crime through abrasions
18
Identification of Causative instrument through abrasions
- In strangulation and hanging where rope leaves its pattern on skin of neck "Ligature mark".
- In accident where the impact of a motorcar tyre takes place and leaves its pattern on the victim's skin "Tire mark".
19
Identification of Direction of injury through abrasions
- From the torn epithelium at end of abrasions
20
Why is it important to determine time past since the inflection of abrasions?
to see whether it corresponds with date of a crime.
20
age of abrasions
- Fresh: Bright red "oozing serum and blood"
- 2 Days: Exudation dries to form a "reddish soft scab"
- 3 days: Scab dries to form "reddish-brown dry scab"
- One week: Scab shrinks and falls leaving a red surface
- Two weeks: Healing usually completed from periphery to center
21
abrasions after 2 days
Exudation dries to form a "reddish soft scab"
21
Fresh abrasions
Bright red "oozing serum and blood"
22
abrasions after 3 days
Scab dries to form "reddish-brown dry scab"
23
abrasions after 1 week
Scab shrinks and falls leaving a red surface
23
abrasions after 2 weeks
Healing usually completed from periphery to center
24
compare between antemortem and postmortem abrasions in terms of:
- Site
- Color
- Exudate
- Healing Process
- Vital Reaction
25
Def of **Bruises (Contusions)**
- Extravasation of blood into tissues following rupture of blood vessels
- Due to application of blunt instrument (e.g., a stick, stone)
- Giving bluish purple discoloration and swelling of involved area with intact skin.
26
what causes **Bruises (Contusions)**?
- Due to application of blunt instrument (e.g., a stick, stone)
27
Shape of **Bruises (Contusions)**
- Giving bluish purple discoloration and swelling of involved area with intact skin.
28
Classification of **Bruises (Contusions)**
**Bruise is classified into three types depending on its situation:**
- Intradermal bruise
- Subcutaneous bruise
- Deep bruise
28
Characters of **Intradermal Bruise**
- Site
- Cause
- Shape
- Bruise lies in subepidermal layer.
- It is made by impact with patterned object.
- Hemorrhage is sharply defined.
28
Characters of **Subcutaneous Bruise**
- Site
- Cause
- Shape
- It is situated in subcutaneous tissue, often in fatty layer.
- Caused by blunt object.
- Appears soon after injury as dark red swelling.
29
What is the most common type of bruises?
Subcutaneous bruise
29
Site of **Deep Bruise**
Bleeding deeper to subcutaneous tissues.
30
what demonstrates **Deep Bruise**?
Infrared photography may demonstrate such bruises, if suspected initially.
30
time of appearence of **Deep Bruise**
- May take hours to 1-2 days to appear at surface.
(Delayed bruising).
- Therefore, another examination should be carried out 1-2 days after first examination.
31
MLI of **Bruises**
1. Identification of the causative instrument (patterned bruises)
2. Identification of type of crime: From site of bruises on the body (as in abrasions).
3. Time passed since inflicted injury
32
rounded small bruises are caused by .....
Produced by tips of the fingers.
32
Elongated bruise of the same Thickness of stick **Railway Line** is caused by .......
blow with a stick
33
Thin linear parallel bruises run over body curvature are caused by ......
A blow with a whip
34
Two Curved rows of bruises are caused by .......
In case of human bite (Elliptical shape).
34
Two parallel rows of bruises are caused by .......
In case of animal bite (U shape).
35
what causes color changes in bruises?
Bruises pass through a series of color changes due to destruction blood corpuscles by hemolysis.
36
Color Changes in Bruises
- Fresh bruises are red in color (oxyhemoglobin)
- Then changed within fow hours to become blue in color (deoxyhemoglobin).
- As hemoglobin is broken down, some of its iron is released forming iron containing pigments blue-black to brown in color (hemosiderin),
- It is then changed to green (biliverdin)
- Then yellow (bilirubin).
37
Difference in time between each color change **Bruises**
- Each change in colour takes about 2-3 days
- Until color fades in about 2-4 weeks when pigments are removed by phagocytes.
38
pattern of color change in Bruises
- Color change starts at periphery and extends inwards to center.
39
Exeption to color changes in bruises
- Sub-coniunctival hemorrhage does not show similar color changes owing to
- its hemoglobin being kept oxygenated by air until finally disappear.
40
What would bruises be differentiated from?
- It must be differentiated from postmortem lividity
41
Def of **Incised (Cut) Wounds**
They are wounds caused by drawing edge of a sharp instrument
* (e.g., razor, knife) along surface of the skin.
42
Shape of **Incised (Cut) Wounds**
Usually spindle shaped.
43
Edges of **Incised (Cut) Wounds**
- It has sharp regular edges with clean cut base.
- No bridging of tissues or abrasions nor confusions around them.
- Hair is sharply cut.
44
what causes irregular edges of **Incised (Cut) Wounds**?
- The skin is loose and corrugated. (e.g., axilla, neck or scrotum).
- The wound is caused by pieces of glass as broken bottles, wounds are usually irregular have a satellite appearance and foreign particles may be found inside them.
45
Length of **Incised (Cut) Wounds**
- Greater than its depth and width.
46
Width of **Incised (Cut) Wounds**
- Greater than edge of weapon causing it due to retraction of the elastic tissues.
47
Hemorrhage pf **Incised (Cut) Wounds**
- Bleeding is profuse and escapes freely because blood vessels are cut across and not torn.
47
Sepsis & Healing in **Incised (Cut) Wounds**
- Less liable to sepsis because of minimal tissue destruction.
- It usually heals by first intention, leaving a thin scar.
48
Def of **Contused Wounds**
They are wounds in which the tissues are split or torn caused by heavy blunt instruments,
* E.g.. heavy sticks, iron bars or stones or by falls on rough objects
48
Shape of **Contused Wounds**
may not correspond with instrument produced them.
49
Edges of **Contused Wounds**
- They are irregular and often bruised.
- It may be surrounded by bruises and abrasions with bridges of tissues across edges
- Due to incomplete separation of tissues.
- Hair is crushed.
49
Depth of **Contused Wounds**
- Shows bridges of tissues, blood vessels and nerves across interior of wound.
50
Hemorhhage of **Contused Wounds**
- External hemorrhage from lacerated wounds is slight because blood vessels are usually crushed.
- Internal hemorrhage from ruptured viscera may be severe and lead to death.
51
Sepsis & Healing in **Contused Wounds**
- More liable to sepsis because of excessive tissue destruction
- so they take longer time to heal, usually heal by second intention leaving thick permanent scar.
52
Types of **Contused Wounds**
**They Depend on manner of their production:**
- Ordinary Confused Wounds.
- Split wounds (incised like wounds)
- Torn wounds or flap wounds
- Crushed wounds (Avulsions)
- Lacerated wounds
52
what is another name for **Split wounds**?
Incised like wounds
52
Site of **Split wounds**
- These are usually found in parts overlying bones, e.g., on scalp, faco, hands and over the tibia
- The skin splits and injury may simulate incised wound in appearance.
53
what causes **Split wounds**?
The injury is due to splitting of the skin between two hard objects (underlying bone and blunt instrument)
54
how to differentiate between split and cut wound?
Differentiation will be easy by examination of wound by a hand lens
- Which will show irregularity and abrasions of edges and hair crushed
54
Cause of **Crushed (Avulsion) Wounds**
- These are due to grinding compression of tissues to an extent that skin is separated from deeper structures and underlying muscles are crushed.
- Commonly produced by passage of lorry wheel over a limb
54
Cause of **Torn (Flap) Wounds**
- These wounds are due to overstretching of skin till produce a flap that indicates direction of force, Such injury produced by running belt of a machine
55
Compare between **Cut wound** & **Contused Wound**
55
Describe **Lacerated Wounds**
- When bone is fractured, and fragments of bone are pushed through skin
56
Types of **Stab Wounds**
- Penetrating stab wounds
- Perforating stab wounds
56
Def of **Stab Wounds**
They are wounds caused by forcing sharp pointed instrument (knife, dagger, sword) deep through skin
57
Def of **Penetrating stab wound**
- When the weapon enters a body cavity as thorax or abdomen, producing only one wound.
58
Def of **Perforating stab wound**
- When the weapon after penetrating tissue, comes out from other side making an exit wound.
59
Shape of **Stab wounds**
Slit-shaped with two angles
60
Shape of **Stab wound** with single sharp bladed instrument (Knife)
Wound has only one sharp acute angle
61
Shape of **Stab wound** with double sharp bladed instrument (dagger)
Wound has two sharp acute angles (elliptical wound).
61
What causes atypical appearance of **Stab wounds**?
If knife is twisted during withdrawal from tissue
e.g: Triangular or Cruciate
62
Length of **Stab wound**
- Relatively correspond to breadth of blade of instrument
- but wound may be enlarged on withdrawing instrument.
63
Edges of **Stab wound**
- Regular, sharp edges, and usually no abrasion or bruising.
64
Width of **Stab wound**
- More than thickness of instrument due to gaping.
64
Depth of **Stab wound**
- The greatest dimension.
- It may correspond to length of blade of instrument.
64
Sepsis of **Stab wound**
**Hemorrhage:**
- External hemorrhage is usually limited in amount
- Serious internal hemorrhage may result from penetrating wounds of the thorax and abdomen
**Sepsis**
- Stab wounds are more dangerous than previous types because
- They may injure internal organs, introduce sepsis to deep organs and their depth makes them difficult to clean.
65
Def of **Punctured Wound**
These are caused by pointed-end instruments with no sharp edge
* (Nail, poker, or closed scissors).
66
Def of **Defense Wounds**
- Wounds of the extremities which result from immediate and instinctive response of victim toward off an attack.
66
Characters of **Punctured Wound**
- It may be rounded, triangular or star shaped according to cross section of causing instrument without loss of tissues.
66
Shape of **Defense Wounds**
- Their shapes usually depend on type of instrument.
67
Types of **Defense Wounds**
- Active defense injuries (A)
- Passive defense injuries (B)
67
Active defense wounds
- They are seen when the victim tries to seize weapon and injuries are sustained on grasping weapon
- Injuries are usually located on the palms.
68
Passive defense wounds
69
Def of **Fabricated wounds**
- These are self-inflicted or Self-suffered wounds.
70
Causes of **Fabricated wounds**
- To accuse an enemy.
- To claim that a crime was committed during a self-defense.
- To allege ill-treatment by police authorities.
- To get transferred to hospital to avoid hard labor "In prisoners".
- To try to escape from military service.
71
Characters of **Fabricated wounds**
- Superficial and not dangerous.
- Within the reach of hand of fabricator.
- In a safe site as extremities,
- The clothes are usually removed before fabrication, so it will show absence of tearing opposite the wound.
72
Difference between antemortem and postmortem wounds
72
Causes of death in case of Wounds
**Immediate Causes**
- Hemorrhage
- Embolism
- Traumatic Shock
**Delayed Causes**
- Infection
- Surgical Interference
73
Immediate causes of death in case of wounds
- Hemorrhage
- Embolism
- Traumatic Shock
74
Hemorrhage as an immediate cause of death due to wounds
- Hemorrhage is a common and often serious complication of wounds.
- It may be external or internal, may lead to death from a hemorrhagic shock.
74
What does the gravity of hge depend in?
- Age and general condition of the patient.
- The amount of blood loss (especially in external hemorrhage).
- Rate & site of hemorrhage (especially in internal hemorrhage).
75
How much loss of blood causes death?
- Few ml of extradural or subdural hemorrhage will lead to cerebral compression
- 250 ml of blood in pericardial sac will cause death due to cardiac tamponade.
- Collapse of lung and displacement of mediastinum from hemothorax.
75
what is embolism?
- Embolism means partial or complete obstruction of some parts of vascular system by any mass carried in circulation.
75
Types of embolism in cases of wounds
Emboli following wounds are as (air embolism) and (fat embolism).
76
Characters of pulmonary (air - fat) embolism
77
types of traumatic shock due to Wounds
**Primary or Neurogenic Shock:**
- Parasympathetic stimulation
- Sympathetic shock
**Secondary or Haematogenic Shock:**
77
Characters of Systemic (air - fat) embolism
77
Types of primary or neurogenic shock due to wounds
- Parasympathetic stimulation
- Sympathetic shock
78
causes of parasympathetic stimulation in wounds
- Sudden stimulation of one of trigger areas with abundant parasympathetic supply, Such as trauma to (larynx, pericardium, epigastrium, and genital organs)
- It occurs also after minor operations,
e.g., during passage of a uterine sound or urethral catheter, tapping of ascetic fluid or pleural effusion.
79
Characters of Parasympathetic stimulation in wounds
- Reflex stimulation of vagus nerve, consequent paralysis of cardiac and respiratory centers.
- The condition is very rarely fatal because ventricles rapidly escape vagal tone and regain their own rhythm thus restoring circulation.
79
What causes sympathetic shock in wounds?
results from painful stimuli (after serious wounds).
80
What causes secondary or hemogenic shock in wounds?
- It is caused by increased capillary permeability and loss of capillary tone
- Due to toxic histamine-like substance absorbed from site of wound.
81
Characters of secondary or Hematogenic shock in wounds
- Signs and symptoms are due to reduction of intravascular volume causing collapse and death.
- It has a gradual onset.
82
Delayed causes of death in wounds
- Infection
- Surgical Interference
82
Types of infections that Cause death in wounds
- Local sepsis
- Systemic sepsis
- Spreading sepsis
- Tetanus
83
**Local Sepsis** as a cause of death in wounds
Due to contamination of wound with staph. Or streptococcus.
84
**Systemic Sepsis** as a cause of death in wounds
Due to septicaemia, pyaemia from diffuse cellulites.
84
**Spreading Sepsis** as a cause of death in wounds
- Infective process in internal organs with penetrating wounds,
- Resulting into pneumonia, empyema, pericarditis, peritonitis, and meningitis.
85
**Tetanus** as a cause of death in wounds
May occur after short incubation period in Egypt "usually less than one week".
86
**Surgical Interference** as a cause of death in wounds
- Death of victim may indirectly occur from injury due to operation needed for treatment
- The assailant is responsible for result of operation.
