Wounds

Question 1

What is trauma?

Answer 1

An injury to the body as a result of violence or force applied to the body.

Question 2

What is a wound?

Answer 2

Damage to any part of the body by application of a violent mechanical force resulting in disruption of continuity of tissues.

Question 3

What is an injury?

Answer 3

Damage to body by violent forces including mechanical & non-mechanical forces

Question 4

What is a lesion?

Answer 4

Any area of the body that suffered an injury, developed a disease or suffered local degeneration

Question 5

Name 6 physical factors that cause injuries & wounds

Answer 5

• Barotrauma (diving)
Ionising radiation
Thermal injuries
Electrical injuries
Mechanical injuries
Medical operations
BITE MM

Question 6

Name other chemical causes of injuries & wounds

Answer 6

Exposure chemical materials
• Inhalation
• Intramuscular, intradermsl, subcutaneous, IV,
• Ingestion
• External contact
• Rectal administration

• also Environmental exposure
  Triple I ER

Question 7

Classify wounds & injuries

Answer 7

Kinetic injuries:
BLUNT FORCE GLACS
- Gunshot
- Laceration
- Abrasion
- Contusion/bruise
- Swelling

SHARP FORCE CIS
- Chopping
- Incision
- Stab

Question 8

What is the pathogenesis of wounding?

Answer 8

A wound occurs when the intensity of the force applied exceeds the capability of the body to resist, absorb or adapt

Question 9

Which factors do the effective wounding force depend on?

Answer 9

BADS BP
Behaviour of object when it hits the body
Bio mechanical features of the tissues
Amount of energy transferred to the tissue
Duration of the application force
Surface of the application force
Protective material on the body or object

Question 10

What are 10 ways you can use to describe a wound?

Answer 10

A Soldier In South Africa Tries 3 Tricks With Arabs

Amount of force applied
Site/position of wound
Individual extend of bleeding of the wound
Shape
Any foreign material in/around wound
Trace evidence in/around wound
3D size, L w d
Track of wound
Weapon that could have caused wound
Associated changes

Question 11

Differentiate ante-mortem and post-mortem bruises

Answer 11

Antemortem bruises:
Caused before death, size is proportional to applied force, vital reaction: interstitial haemorrhage, inflammation & healing. Histology will show vital Reaction. Haemorrhage can’t be washed off affected area

Postmortem: after death, size of bruise can’t be accurate correlated with force that caused it. No vital reaction. Histology will demonstrate no vital reaction

Question 12

Define Bruises and give examples of the patterns of injuries

Answer 12

An injury that results in interstitial haemorrhage without break in the continuity of the surface tissue involved.
Examples: Patterned - tram track bruises, fingertips, bite marks, impressions caused by tyres. Non-P: - blue eyes, Bruises caused by MVAs, kicks or falls, bleeding tendencies

Question 13

Aetiology, Epidemiology, Pathogenesis and Pathology of Bruises

Answer 13

A: caused by blunt force
E: degree & site of trauma, age & gender of individual, co-morbidities, medications, pigmentation, character of underlying tissue
P/g: applied force causes crashing of the soft tissues against a hard object eg, bone, resulting in tearing of blood vessels with bleeding to surrounding interstitium
P: redness, swelling, hot in alive person, colour changes due to Hb breakdown depending on age of injury. In corpse blood in interstitium upon incision. Histologically interstitial haemorrhage & parenchymal injury.

Question 14

6 complications of Bruises

Answer 14

Hypovolemia & hypovolemic shock
Renal failure
Acute neurogenic cardiac arrest
Bruising of vital tissue
Fat embolism syndrome
Secondary infections

HRABFS

Question 15

5 Medico-legal significance of Bruises

Answer 15

What instrument was used to cause the bruise?
Is it ante-mortem or postmortem bruise?
Age
Underlying factors that may worsen bruise
Could the bruise have caused death?

Question 16

Abrasions: Def, Aetiology, Epidemiology, Classification, Pathogenesis , Pathology, DDx of Bruises

Answer 16

D: Traumatic injury of skin where tissue disruption is limited to the epidermis & upper part of the dermis
A: Blunt trauma
Classification: Scratch, scrape/graze, friction, Imprint
E: no med conditions, not significantly influenced by any comorbidities
P: superficial wound with redness, swelling sometimes oozing of serum
DDx: Ante- Slight, present Dark brown color. Post- no bleeding, no infiltration, parchment like yellow/orange color
Complications: nome but sepsis maybe

Question 17

Medico-legal significance of Abrasions

Answer 17

Ante or post?
Age? How old
Secondary infection?
What instrument caused the injuries
Is there trace evidence around wound?

Question 18

Lacerations: Def,Classification, Aetiology, Epidemiology, Pathogenesis, Class, Pathology, Ddx

Answer 18

D: wound that is formed when blunt forces tears, splits or crushes tissues resulting in a wound that extends beyond subcutaneous tissues in the skin.
C: superficial, split, degloving, decollement, penetrating, puncture wound, perforating, shattering
A: blunt objects. Blunt margins
E: skin has high elasticity than subcutaneous tissue & muscle thus needs significant force to lacerate. Age & female gender & underlying disease may negatively influence outcome
P/g: when blunt force is applied, body will absorb force by deformation
P: classical signs: bridging strands of tissue, limited bleeding compared to incision, irregular margin, ass with contusions & abrasions, foreign material, redness or swelling

Question 19

What are complications of lacerations

Answer 19

Haemorrhage
Laceration of vital organs may cause death
Infections as lacerations are dirty
Extensive scarring > malfunction or organ failure

Question 20

Incised wounds: Def, Aetiology, Epidemiology, Pathogenesis, Class, Pathology, Ddx

Answer 20

D: Injury that is formed when a sharp hard object strikes a body part with some degree of force
A: sharp hard objects
C: Depth of wound, size of surface compared to depth, source of wound, surface shape of wound
Epid: soft tissue but may penetrate to bone
P/g: sharp hard objects cause injury by cutting tissues on their sharp ends. Split tissues, clean cut wound
P: bleed profusely, clean cut edges, no bridging tissues, no marginal abrasions, clean wound
Ddx:

Question 21

What are the complications of incisions & medico-legal significance

Answer 21

Bleed a lot> hypovolemic haemorrhagic shock
Infections, death by penetrating or perforating vital organs, air embolism, haemo/pnemothorax, peritonitis

• determine shape of wound & wound track to help determine weapon used
• differentiate incision from laceration
• any complications
• ante or postwound
  Site & appearance will help with determining if it’s a defence/tentative/accidental/homicidal wound

Question 22

Chopping wounds: Def, Aetiology, Epidemiology, Pathogenesis, Classification, Ddx & Pathology

Answer 22

D: heavy object with an element of sharpness on the cutting edge
C: according to dominant feature; lacerated chopping or incised
A: sane as definition
Epid: Homicidal, mob justice
P/g: formed when relatively sharp, hard object hits body with cutting, crushing & deforming forces because if it’s weight & sharp edge.
P: features of lacerations & incision
Ddx: differentiate between chopping, incised & lacerated wounds

Question 23

Complications & Medico-legal significance of chopping wounds

Answer 23

Immediate death from trauma which crushes body oart
Serious internal injuries
Serious bleeding

Mrdico
- Diff between chopping, laceration & incision. Can help police determine weapon