Wounds

Question 1

اللهمّ أكرمني بجودة الحفظ وسرعة الفهم وثبات العقل والذهن والذاكرة بحق قولك: «الرَّحْمَـنُ، عَلَّمَ الْقُرْآنَ، خَلَقَ الْإِنسَانَ، عَلَّمَهُ الْبَيَانَ، الشَّمْسُ وَالْقَمَرُ بِحُسْبَانٍ».

Answer 1

❤️

Question 2

Abrasions

Answer 2

destruction of the superficial layers of the skin either epidermis alone, or involves the upper dermis due to pressure or friction with a rough blunt object.

Question 3

Graze is synonymous with abrasion while, a scratch is a

Answer 3

linear abrasion produced by drawing a sharp point over the surface

Question 4

Types of abrasions

Answer 4

• Pressure abrasions: Nail abrasions and ligature (rope) mark in hanging and strangulation.
• Sliding (dragging or friction) abrasions: e.g. Car accidents and nail abrasions.

Question 5

________take the shape of the causal object

_______ denote resistance as in cases of rape and murder

Answer 5

Abrasions

Question 6

Rope if horizontal ▶️_________

And if oblique ▶️________

Answer 6

1- قتل

2- انتحار

Question 7

Age of abrasions can be compared with the
date of a crime.
Site of abrasions denotes the sort of the crime.
It helps to identify the assailant.
Gives us an idea about the direction of the
assailant.
Abrasions differentiate cut from contused
wounds
Abrasions differentiate hypostasis from
bruises
A.M. abrasions must be differentiated from P.M. Abrasions )Redness, Bruises &Vital reaction(

Answer 7

،،

Question 8

Contusions (bruises)

Answer 8

Extravasations of blood into tissues following rupture of blood vessels by the application of blunt force.

Question 9

Superficial bruise is slightly raised above the surface of the skin. A deep bruise may take 1- 2 days to appear

Answer 9

a second examination 2 days later to bruises is needed in living persons.

Question 10

– Bruising is most commonly seen in the skin, but it can also occur in the deeper tissues, including _________________

Answer 10

muscle and internal organs.

Question 11

Factors modifying the shape and degree of bruising

Answer 11

Severity of the blow
Onset of death
Natural diseases: As haemophilia or purpura , vitamin deficiency and liver disease.
Type of tissue
– Vascular and lax areas (eye lids and labia major) :
Tough areas (palm and sole): minimal bruises.
– Underlying tissues:
Muscles (abdominal wall): minimal bruises.
Bone (shin of tibia): severe bruises.
Age:
Sex: female more.
Gravity:

Question 12

_______take the shape of the causal object

▶️▶️▶️Blow by a stick leads to two elongated parallel lines bruises

Answer 12

Bruises

Human bite gives two curved rows of bruises that may be accompanied by abrasions.
– Animal bite gives two parallel rows of bruises that may be accompanied by abrasions.
– Whip mark gives curved bruise around the body.

Question 13

Site of bruises : bruise usually occurs at the same site of force application, but sometimes it may shift under the influence of gravity

Answer 13

e.g. blow to the forehead may appear as a black eye owing to gravitation of effused blood from tough scalp to loose tissue of the lids. A blow to the temple may find its way to the cheeks. Also a blow to the calf may find its way around the ankle

Question 14

Age of the bruise: this can be estimated from the______________ that occur from the periphery to the center of the bruise.

Answer 14

color changes

Question 15

When first formed the bruise is bright red in color (oxyhemoglobin)
Gradually, it becomes more or less blue
(reduced hemoglobin).
Then, to a green color (biliverdin), and finally it
becomes yellowish (bilirubin),
_________(an iron containing pigment) is released as well giving a brown tinge to the bruise
Then, it completely fades away (engulfment by phagocytes).
Each change takes____ days until color fades in 1-3 weeks.

Answer 15

🔴▶️🔵▶️🟢▶️🟡▶️🟤

Hemosidrin

2-3

Question 16

_________ occur P.M, on dependent areas, blanching.

_________occurs A.M, anywhere of the body, non-blanching.

Answer 16

Hypostasis

Bruices.

Question 17

CUT WOUNDS

Answer 17

drawing the edge of a sharp object on the skin e.g. knife razor or broken glass.

Question 18

جدول سلايد ٣٠ ،٣١، ٣٢مهم

Answer 18

🔴🔴🔴

Question 19

Varieties of incised wounds
They are usually________, but :
Multiple small parallel cut wounds at the beginning of ▶️incision indicate hesitation in suicidal wounds (___________).
▶️Incised wounds in the palm or forearms indicate_____ wounds.
▶️________ incisions.
– Shelving occurs when the blade is at an angle to the surface.

Answer 19

‏homicidal،

hesitation marks

defense

Surgical

Question 20

Age of incised wounds

Answer 20

Age of incised wounds may be compared with the date of a certain crime.
First 12 hours: The edges are red and swollen.
36 hours: New vessels start to grow towards
the skin surface.
After 5 days : New vessels start obliteration.
After 10 days : primary intention.
After 3 weeks : The scar is red.
After 3 month : The scar is coppery brown.
After 6 month : The scar is white and may be invisible.

Question 21

Subtypes of Contused Wounds

Answer 21

-Crushed wound: where the tissue of limb is crushed or amputated e.g. run over car accidents.
-Torn wounds: in this types a ragged irregular flap of the skin separated in most of its contour e.g. by a revolving belt of a machine. In such case, the underlying muscles are crushed.
-Rupture of internal organ:
-Avulsion by grinding compression separating
the skin from underlying tissue.
-Split (Cut-lacerated) by heavy edged instrument against bone.

Question 22

Fabricated / Self-Inflicted wounds

Answer 22

are simple wounds which are self inflicted (or fabricated) by the person on his body.

Question 23

Characters of Fabricated Wound

Answer 23

-Superficial
– In an area readily accessible to the victim – inflicted on bare skin
– not usually correlate with the date

Question 24

Defense Injuries

Answer 24

These are injuries sustained by the victim to defend himself.

Question 25

In case of punching, kicking
– abrasion or bruises on the outer side of the forearm, back of hands and fingers may be broken in an attempt by the victim to shield himself.

Answer 25

In kicking, defend bruises may occur on the outer side of the thigh as the victim tries to protect his genital region.

Question 26

In attacks by knife,

Answer 26

its blade may be gripped by the victim, so that cut wounds may occur across the flexors of the fingers and in the palm.

Question 27

5- Stab Wounds

Answer 27

These are clean edged wounds caused by forcing a sharp pointed object into the body e.g. knife and dagger

Question 28

Cut wound▶️ two acute angles

Sharp object▶️ blunt angle and acute angle

Answer 28

Dd

Question 29

Types of stab wounds

Answer 29

1. Transfixing wounds: When the weapon passes from one side of a limb to the other, or if connects 2 organs.
2. Punctured wounds: These are due to pointed blunt edged objects e.g. poker, closed scissors or a nail. The wound takes the shape of the cross section of the weapon e.g. rounded, square of triangular.

Question 30

Causes of Death in wounds

Answer 30

A) Early:
– Hemorrhage.
– Traumatic shock (primary & secondary).
– Embolism (Air embolism: Venous and arterial. Fat embolism and bone marrow embolism and Thromboembolic)
B) Late :
– Sepsis.
– Surgical interference.
– Suprarenal hemorrhage.
– Disseminated intra-vascular coagulation (DIC).
– Adult respiratory distress syndrome.
– Acute renal failure

Question 31

Hemorrhage

Answer 31

Amount to cause death from hemorrhage. Clinical picture.

Postmortem

Question 32

Grades of hemorrhage

Answer 32

1- 750 ml and tachycardia
2-1500ml and orthostatic hypotension
3- 1500-200 and hypotension
4- more than 2000 ml

Question 33

Hemorrhage :
Amount causing death :
– External hge : 1.5-2 liters (1/3 blood volume).
– Internal hge : According to its site : 10-20 ccs in the brain.
100 ccs in the pleural cavity.
200 ccs in pericardial sac →cardiac tamponade.
Rate of bleeding is important: If he is gradual, it may be compensated (e.g.: piles), but if the loss is rapid, it will be fatal.

Answer 33

Clinical picture :
– Pulse : Weak and rapid.
– B.P : Low.
– Resp : Rapid and shallow.
– Skin : Cold and clammy→ coma and death.

Question 34

P.M.P. Of hemorrhage

Answer 34

External :
– Blood on the ground and clothes. – Pale body.
– Pale (ill defined) hypostasis.
Internal :
– Pale organs.
– Contracted empty heart with subendocardial hemorrhage as the heart squeezes itself to supply the last drop of blood to the brain thus injuring itself. These petechiae may also be found in death due to burn, arsenic, phosphorous and benzol poisoning.
– Contracted spleen: as a source of auto transfusion (Corrugated splenic capsule).

Question 35

Traumatic shock :

Answer 35

1-Primary (neurogenic shock):
a) Parasympathetic inhibition of circulation (reflex vagal inhibition: R.V.I.):
b) Sympathetico-adrenal stimulation:
2- Secondary (hematogenic or surgical) shock:
جدول سلايدة ٥٨

Question 36

2- Secondary (hematogenic or surgical) shock:

Answer 36

This occurs due to absorption of histamine-like substances from the site of trauma which cause :
– vasodilatation → ↓V.R, C.O and B.P.
This reaction takes few hours to develop.
Clinical picture :
– Pulse : Rapid and weak. – B.P. : Low.
– Resp : rapid and shallow. – Temp : subnormal.
– Finallycomadeath(fromtissueanoxia)
P.M.P. :
– Petechial hemorrhages in tissues. – Effusion in serous cavities.

Question 37

III- Embolism

A. Air embolism
i-Venous : (Pulmonary)
Causes: a) Cut throat b) I.V. infusions.
c) Tubal insufflation. d) Criminal abortion.
Air fills the right side of the heart and pulmonary arteriesacute heart failure. 100-200 ccs are fatal.
Diagnosis at P.M. :
– *X-ray: Air fills the right side of heart and pulmonary
arteries.
– *Filling the pericardial sac with water then puncturing the right ventricle with a needle  air bubbles come out.

Answer 37

ii-Arterial :
Causes :
During artificial pneumothorax : if the needle is passed
in plum. veins.
Stab (transfixing) connecting a bronchus with a plumonary vein.
Barotraumas: by rapid ascent of divers and release of nitrogen gas emboli.
Few ccs are fatal due to occlusion of coronary and cerebral arteries.
Death is prevented by lowering the patient’s head.
Diagnosis at P.M. :
* Coronary and cerebral arteries are beaded.
* Ophthalmoscope : Air bubbles in retinal arteries.

Question 38

B- Fat embolism and bone marrow embolism

Answer 38

Causes:
a) Fracture of a long bone with a torn vein.
b) Burns in a fatty area with a torn vein.
c) Trauma to a fatty area.
The fats will reach the right side of the heart and pulmonary arteryacute heart failure. Fatal systemic emboli may reach the brain, heart and kidneys.
Diagnosis at P.M. :
– Sections of the lungs stained with fat stains (osmic acid and sudan III) will show fat cells.

Question 39

C- Thromboembolism:

Answer 39

Causes in trauma:

• Immobilization→ stasis of blood in veins → thrombus formation.
• Shock, sepsis and hypoxia→ tissue devitalization → thrombus formation

Question 40

B) Late causes

Answer 40

IV- Sepsis )septicaemia, peritonitis, pericarditis…(
may cause delayed death.
Localized infection may be transmitted to vital organs as the lungs and meninges resulting in fatal pneumonia or meningities.
Tetanus( caused by Cl. Tetanii in non immunized, feeble patient wounded in the street contaminated with the spore forming organism). Gas gangrene is another serious infection caused by Cl. Welchii.
V- Surgical interference:
Done to save the victim’s life.
The assailant is responsible for the result of the operation so long as it was indicated and skillfully done.

Question 41

VI- Disseminated intravascular coagulation (DIC)
Trauma →
– thromboplastin-initiated coagulation.
– endothelial damage and stasis of blood flow →
precipitate intravascular coagulation→ infarctions.
– Bleeding diathesis also occur due to consumption of platelets and fibrin in thrombi.

Answer 41

VII- Supra-renal hemorrhage :

Usually after impaction of loins in traffic accidents. It occurs few days after the trauma (2-20 days)

Question 42

VIII- Adult respiratory distress syndrome
aspiration of gastric contents, heavy impacts on the thorax,
inhalation of irritant gases, pulmonary infections and systemic shock.

Answer 42

Clinically,
lungs become increasingly stiff and hard to ventilate.
Cardiovascular and
renal failure may follow and death occurs within few days in 50% of cases (40-80%).

Question 43

IX- Acute renal failure
Causes:
– Shock and decrease renal blood flow.
– DIC leading to deposition of fibrin in glomeruli.
– Crush injuries : circulating myoglobin obstructs renal tubules.
– Iatrogenic : e.g.
Use of vasopressor agent, e.g. epinephrine.
Nephrotoxic antibiotics e.g. amino glycosides and polymyxin B.

Answer 43

…

Question 44

اللهم افتح لي أبواب حكمتك، وانشر عليّ رحمتك، وامنن عليّ بالحفظ والفهم، سبحانك لا علم لنا إلا ما علمتنا، إنّك أنت العليم الحكيم.

Answer 44

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