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Forensic Pathology > Wounding/ injuries > Flashcards

Wounding/ injuries Flashcards

1
Q

Wound definition

A

Damage to any part of the body due to the application of mechanical force

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2
Q

Classification

A

Abrasions – grazes or scratches
Contusions – bruises
Lacerations – cuts or tears
Incised wounds – cuts, slashes or stabs

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3
Q

Tangential or Brush Abrasions

A

Caused by lateral rubbing action.

Direction of force: tags of epidermis dragged to the terminal end.

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4
Q

Crushing Abrasions

A

Vertical force to the skin.

Epidermis is crushed.

Weapon may stamp its shape or surface pattern on the skin (Imprint abrasion)

Bruising under the dermis often is present.

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5
Q

Fingernail Abrasions

A

Child abuse cases, sexual assaults, and manual strangulation.

Upper arms are a frequent site for gripping and restraint.

Marks may be superimposed

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6
Q

Bruises

A

Caused by blunt force trauma.

Leakage of blood from ruptured blood vessels (veins, venules and small arteries) into the surrounding tissue.

Lies beneath the intact epidermis

May be seen in muscles or any internal organs.

Often associated with abrasions and lacerations

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7
Q

Movement of bruises

A

May appear away from the point of impact.

Extravasated blood tracks along natural/traumatic planes of least resistance influenced by gravity and body movements.

Blow on temple: Bruise on Cheek
Fractured jaw: Bruising on Neck
Fractured hip: Bruise on thigh
Forehead trauma: Black eye

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8
Q

Age and colour changes in bruises

A

Red (fresh) 0-1 day
Bluish brown: 1-3 days
Green: 4-5 days
Yellow: 7-10 days
Disappears: 14-15 days

Degradation of red blood cells in the blood

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9
Q

Patterns of bruising

A

Impact with hard, patterned object with ridges and grooves e.g. tyre mark, shoe mark, car bumper, gun muzzle

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10
Q

Finger pad bruises

A

Round, oval, larger than finger tips.

Due to gripping by fingertips in forceful restraint

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11
Q

Periorbital haematoma (black eye)

A

Blow in the orbit
Fractured skull

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12
Q

Suction bruises (love bites)

A

Small petechiae caused by oral suction on the skin

Common on neck and breast in sexual assault.

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13
Q

Tramline bruises

A

Due to rod shaped weapon or stick

Two parallel lines of bruising with an undamaged zone in the centre

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14
Q

Laceration

A

Full thickness tearing of the skin due to blunt trauma.

Typically seen over bony prominences where tissue is crushed against underlying bone

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15
Q

Laceration characteristics

A

Ragged edges (torn apart), bulging fat, crushed hair bulbs.

Associated bruising and abrasion of skin edges.

Presence of tissue strands across the wound.

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16
Q

Why does a laceration sometimes appear to be a incision?

A

Crushing impact of a blunt object on skin supported by bone

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17
Q

Determining laceration

A

A laceration can be distinguished by:
Bruising or crushed margins
Bridging (presence of tissue strands across wound including vessels and nerves)
Absence of a sharply linear injury in the underlying bone

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18
Q

Incised wounds

A

Injury caused by sharp objects.
Clean division of the full thickness of skin and tissue by sharp edged instruments

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19
Q

Characteristics of incised wounds

A

Clean cut
Everted edges
Linear or elliptical shape, often gapes
No tissue bridges

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20
Q

Anatomy of skin

A

Epidermis
Dermis
Subcutaneous tissue
Deep fascia
Muscle

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21
Q

Cuts and slashes

A

Length is greater than the depth.

Swiping motion rather than a stabbing motion.

Also commonly seen in cases of suicide on the wrists.

Typically they tend to be deepest at point of first insertion and lessen in depth along the length.

22
Q

Self-inflicted cut wounds

A

Commonly seen on:
Wrists, neck, cubital fossa, chest, abdomen, groin

Suicidal cut throat:
Multiple superficial tentative cuts/hesitation marks
Deep cut starting from the left, across the midline, up towards the right ear
Cut slopes upwards and backwards

23
Q

Stab wounds

A

Most common method of homicide.

Depth is greater than the length.

Knives are the weapons most frequently involved

More dangerous than slashed wounds as can penetrate deep into internal organs

24
Q

Description of stab wounds

A

Damage to clothing

Stabs through folds, blood flow, drip pattern

Site in relation to anatomical landmark

Shape

Size: length & width with edges opposed

Direction

Depth and wound track

Damage to tissues along track

Effects: haemorrhage, haemothorax etc.

25
Q

Cleavage lines

A

Langer`s lines.

Direction of collagen fibres

Different appearances even when the same blade is used.

26
Q

Movement of the knife in the wound.

A

Can result in loss of evidence as to the size of the blade.

If knife is wiggled, the wound will be longer than if the blade inserted and removed in the same direction.

Knife is twisted-V shaped wound will result.

27
Q

Injuries from scissors

A

Often seen in domestic disturbances.

Shape of the wound will differ based on whether the scissor was used open or closed.

Typically shaped like a Z

28
Q

Defence wounds

A

Most obvious are those seen in knife attacks.

Fingers, wrists, and forearms

Medico-legal significance, as they indicate that the victim was conscious.

29
Q

Head injury

A

Heaviest part of the body (3-6 kg)

Secured only by the tone of the neck muscles and ligaments.

Scalp is commonly damaged in trauma that causes injury to underlying skull and brain.

30
Q

Facial injuries

A

Common injury

Usually not life threatening

Commonly associated with fatal cranial damage

Haemorrhage-aspiration asphyxia

Others:
Abrasions, bruises, ruptured frenulum
Periorbital haematoma (Black Eye)

31
Q

Falls

A

Combination of injuries can occur

Multiple lacerations.

Multiple fractures (ribs, arms etc.)

Severe abdominal injuries:
Rupture of liver, lung, spleen, heart.

32
Q

Intracranial injuries - Extradural (epidural) haemorrhage.

A

Bleeding between inner surface of skull and dura mater

Usually associated with fracture of the skull. (blow to the side of the head)

15% occurs in intact skull.

Rupture of Middle meningeal artery

33
Q

Intracranial injuries - Subdural Haemorrhage

A

Blood between dura and arachnoid

Not usually associated with fracture

Violent shaking can cause SDH

34
Q

Intracranial injuries - Subarachnoid Haemorrhage

A

More common than SDH

Bleeding between arachnoid and pia

Traumatic or spontaneous

35
Q

Brain Injury

A

Cerebral contusion/bruising

Cerebral laceration

36
Q

Skull Anatomy

A

Skull
Dura
Arachnoid
Pia mater
Brain

37
Q

Mechanism of injury

A

Blast:
Pressure waves causes tissue disruption.
Tears blood vessels and disrupt alveolar tissue.
Traumatic diaphragm rupture.

Crush:
Body is compressed between an object and a hard surface.
Direct injury of chest wall and internal structures.
Laceration of solid organs and blow out of hollow organs.

Penetrating:
Low energy
High Energy

38
Q

Injury to chest wall

A

Contusions or haematomas, rib/sternum fractures (Flail chest), fractures of clavicle and shoulder girdle

39
Q

Rib fractures

A

Ribs 1-3 requires great force to fracture (direct violence from kicking, heavy punching or RTAs)

Ribs 4-9 are most commonly fractured

Ribs 9-12 less likely to be fractured

Transmit energy of trauma to internal organs.
If fractured, suspect liver and spleen injury.

40
Q

Injuries to liver

A

Commonly injured from trauma to the:
8th-12th ribs on right side of the body

Upper central part of abdomen

41
Q

Injuries to lungs

A

Contusions, lacerations, pneumothorax, haemothorax

42
Q

Injuries to the heart

A

Pericardial temponade, myocardial contusion

43
Q

Injury to the spleen

A

Injured from blunt trauma to lower left chest, flank or upper left abdomen

Associated intra-abdominal injuries common

44
Q

Injury to the stomach and intestine

A

Commonly damaged due to penetrating trauma

Small and large intestine: can be by compression force

45
Q

Injuries to the kidney and pancreas

A

Blunt or penetrating

46
Q

Injuries to the pelvis

A

Serious skeletal injury

Potential injury to pelvic organs:
Ureter, Bladder, Urethra, Prostrate, Rectum, Anus

Mechanisms:
Compression in head on collision.
Lateral compression in side impacts.
Vertical shears in fall from heights.

47
Q

Types of blast injuries

A

Primary
Secondary
Tertiary
Quaternary

48
Q

Primary blast injury

A

Unique to high explosives

Due to impact of over-pressurisation wave with body surfaces

Most commonly involve air-filled organs and air-fluid interfaces

Types of injuries:
Blast lung
Tympanic Membrane rupture
Abdominal haemorrhage and perforation
Eye Globe rupture
Traumatic brain injury without physical signs of head injury

49
Q

Secondary blast injury

A

Due to flying debris and bomb fragments

Penetrating ballistic or blunt injuries

Leading cause of death in military and civilian terrorist attacks

50
Q

Tertiary blast injury

A

Due to persons being thrown into fixed objects by wind of explosions

Also due to structural collapse and fragmentation of building and vehicles

Structural collapse may cause extensive blunt trauma

51
Q

Quaternary blast injury

A

Explosion related injuries or illnesses not due to primary, secondary, or tertiary injuries

Exacerbations of pre-existing conditions, such as asthma, COPD, CAD, HTN, DM, etc.

Burns (chemical and thermal)

Toxic inhalation

Radiation exposure

Asphyxiation (carbon monoxide and cyanide)

Forensic Pathology (11 decks)

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