Medicine - Skin Injuries Flashcards
Legal Aspects of Injury (2 statutes)
- CRIMINAL JUSTICE ACT 1988, SECTION 39
- Assault
- Battery
- OFFENCES AGAINST THE PERSON ACT 1986
- Actual Bodily Harm – Section 47
- Grievous Bodily Harm – Section 20
- Grievous Bodily Harm with Intent – Section 18
- Attempted Murder
- Manslaughter
- Murder
Questions to ask for a skin injury (8 points)
- Is it definitely an injury?
- Is it definitely an assault? (accident/self inflicted)
- What was the assault with?
- How much force was used?
- How many impacts/blows/actions?
- Could the injuries have occurred at another time?
- INJURY = WOUND
- Legal Definition – a break in the skin
BUT - Medical Definition – damage due to the application of force
- Not all marks and defects are injuries
- May not be an injury at all
o Post mortem artifacts
o Rashes
o Moles
o Scars
Is it definitely an injury? - documentation (7 points)
- Type – abrasion, bruise, laceration, incised
wound, (uncertain including red marks) - Size – mms, dimensions (large weapon causes large injury, small weapon causes small injury)
- Colour – bruises (caused when blood vessels rupture, bruises are often non-descript and hard to tell what caused them), abrasions
- Position – anatomical landmarks, terminology
- Pattern – abrasions, bruises
- Shape
- Signs of healing
Abrasions (types and importance)
- SCRATCH/GRAZE
- Superficial Injury damaging:
o Epidermis
o Most superficial dermis - TYPES
- LINEAR ABRASION = scratch
o Fingernail scratches
o Restraint – injuries around wrist - BRUSH ABRASION = graze
o Gravel rash – small scratches/dots on skin
o Friction burn - IMPORTANCE
- Pattern
- Direction of force - depending on direction of abrasion
- Means there has been contact at that site
Bruise (Definition, cause, importance)
- CONTUSION
- Leakage of blood into tissues
- Start blue/red – gradually turn purple, brown, yellow depending on how long ago the injury was caused
- Medication people on, age of person etc changes how someone bruises
- If yellow, the bruise is at least 18 hours old
- Can be patterned e.g. tramline bruises – at point of impact between weapon and skin, everything is compressed. At either edge of the impact, blood vessels get stretched and so rupture which leaves the bruises down either side (tramline)
- Bruising can take on pattern of tread of shoe or tyre mark
- CAUSE
- Blunt injury
- Can occur with firm gripping or deeper damage underneath the body, not just infliction of force
- IMPORTANCE
- Rarely patterned
- Mobile
- Take time to appear
- Change with age
Laceration (definition, cause)
- GASH/CUT
- Splitting or tearing of full thickness of skin
- Occur when skin splits and is crushed between object and underlying bone
- Only ever get lacerations over bone
- Tissue bridges across injury – some parts of skin are tougher than others
- Redness around skin – abrasion over wider area (this is often what tells you what the laceration was caused with) e.g. if square abrasion, it is from a square hammer
- CAUSE
- Blunt injury
- Dragging injury
Incised wound (definition, types)
- CUT
- Cutting of skin and tissue by a sharp edge
- Courts look at incised wound more severely than blunt force wounds as it has more intent to do harm
- TYPES
- Slashed wound – e.g. Stanley knife
- Stab wounds – e.g. kitchen knife
- Slashing looked at more severely than stabbing as intending to do more harm
- Knife is often a straight wound whereas broken glass causes a curved wound
Incised wound vs Laceration (5 points)
Edge
- Laceration: irregular
- Incised: sharp
Adjacent Area
- Laceration: Abraded
- Incised: not harmed
Depth
- Laceration: Tissue bridges
- Incised: No bridges
Bone
- Laceration: Maybe fractured
- Incised: Maybe cut
Position
- Laceration: Over bone
- Incised: Anywhere
Is it definitely an assault? - Fall (Victim, assailant, scene, other evidence)
- Victim
o Small number of blunt injuries to ‘bits which stick out’ e.g. front/back of head, knees, elbows, hips
o Small number of injuries to protuberant parts
o Collapse/fall – usually facial injuries
Heart attack – no attempt to get back up
o Simple fall – usually back of head (usually from intoxication)
o Fall downstairs – more complex
o Fall from a height – severe and complex - Assailant
o No injuries - Scene
o Evidence of disturbance e.g. broken vases
o Blood low down – drops and smears - Other evidence
o Alcohol, drugs
Is it definitely an assault? - assault (victim, assailant, scene, other evidence)
- Victim
o Facial injuries
A fall tends to injure upper part of face whereas assault tends to also include lower part of face
Tend to be in areas that are not protected by bone e.g. eyes, mouth
Tend to be from punches, kicks, blows and weapons
89% of bone injuries in assault are on face
56% of soft tissue injuries e.g. bruises are on face
o Neck injuries
Protected by shoulders and jaw so unlikely to get neck injuries from falling so indicates assault
Usually from attempted strangulation etc
o Unusual locations
Inside of elbow shows assault as falling tends to be the actual elbow itself
o Multiple injuries
Could be punched in face and then fall backwards
Struck repeatedly in same way whilst not moving
o Defence injuries
Forearms, hands – natural response of being attacked is to ward off blows with hands and arms
Blunt trauma
Knife wounds
o Specific injuries
Bite marks - Abrasion
- Bruising
- Laceration
- Characteristic appearance
- Site – sexual assault, children
- Forensic dentist
o Cats and dogs have canine teeth that puncture skin and rip whereas a human bite mark is usually ineffective and so leave individual teeth marks, sometimes breaks skin but rarely does anything more than that
o Size of bite mark – a large mark shows adult or older child
o Can match pattern of teeth with individual who did it - To bite something off implies intent -grip and tear
From weapons - Assailant
o Hand injuries
o Facial injuries - Scene
o Blood high up
o Spatters and other patterns - Other evidence
o Witnesses
o CCTV
Is it definitely an assault? - self-inflicted (victim, assailant, scene, other evidence)
- Victim
o Superficial, sharp injuries
Multiple, parallel – often repetitive
Avoid painful areas – e.g. wrists
o Account inconsistent with injuries
o May be used with intent to kill/cause harm
o May be used for self-defence argument in an assault
o May be used for fraudulent reasons e.g. compensation
o Many pin pricks show where someone has tried to find best place to stab – shows self-infliction rather than assault - Assailant
o No injuries - Scene
o Blood low down (if any) - Other evidence
o Psychiatric history
What was the assault with? - punching (3 points)
o Bruising
Black eyes
o Abrasion
o Laceration
Over bony prominences
What was the assault with? - kicking/stamping (6 points)
o Bruising
o Abrasion – shoe is rough and force is more than with punch so large areas of abrasion
o Laceration
o Site
o Pattern – from sole of shoe
o More fracturing of bones as force inflicted is greater
What was the assault with? - blunt weapon laceration (3 points)
o Laceration
o Tramline bruises
o Shapes and patterns
What was the assault with? - sharp weapon knife (4)
o Slashing – serrated knife scraped across skin leaves small abrasions
o Knives – slash vs. stab
o Glass
o Accident vs. Self-inflicted vs. Assault
