medico legal; physical injuries

7/29/2019 medico legal; physical injuries

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Head and Neck Injuries

Injuries in the chest

Abdominal Injuries Pelvic Injuries

Extremities


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Factors influencing the Degree andextent of the Head injuries:

a. Nature of the wounding agentb. Intensity of the force

c. Point of Impact

d. Mobility of the skull at the time of Force


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Head Injuries are classified as tothe Site of Application of Force:

Direct or coup injuries

Indirect Injuries

Contre coup injury

Remote injuries

Locus minoris Resistencia Coup-contre-coup injuries ( both )


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A wound of the scalp although small &negligible is always potentially seriousbecause:

It is difficult to prevent the spread of infection.

There is proximity of the scalp to the brain.

There is a free vascular connection between

the structures inside and outside the cranium. It is frequently difficult to determine the extent

of damage of the skull.


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Abrasion contusion commonly unnoticed

Hematoma easily develops

Lacerations most common Incised wounds generally involved the

cranium

Fractures of the scalp Fissure fractures Localized depressed fractures Penetrating injuries of the skull comminuted fractures pond or indented fractures gutter fractures bursting fractures


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extradural/epidural hemorrhage is caused by a fracturein the skull. Fracture will cause laceration of the bloodvessels which are grooved at the inner table of the skull.

subdural hemorrhage is essentially venous or capillary &the most common cause of cerebral compression.

subarachnoidal hemorrhage may be due to trauma or tospontaneous rupture of blood vessel.

cerebral hemorrhage may be traumatic or spontaneous

in origin. Traumatic hemorrhage is usually due to lacerationor contusion of the brain in contre-coup injuries.

lacerations of the brain: direct or coup laceration, Contre-

coup Lacertio edemas of the brain : Localized or Generalized Edema

Concussion of the brain

Compression of the brain


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Is the origin of the intracranial hemorrhage dueto trauma or disease?

In cases of cerebral concussion, can the victimremember the incidents before, during or afterthe accidents?

Can the victim of head injuries still retainvoluntary movement & speech?

Post-traumatic Automatism

In gunshot wounds of the head, how can thepoint of entrance be determined?

Post-traumatic Irritability


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Wounds on the face heal relatively faster as compared with woundson the other parts of the body on account of its great vascularity.

Eye

Hemorrhage observed on first blow May be lacerated by a blunt weapon or piece of stone

Acute inflammatory changes occur with injury of the cornea,iris, and lens

Nose

Fist blows: fracture of nasal bone Ear

Blow on ear may produce rupture of tympanic membrane(permanent/temporary deafness)

Hemorrhage from ear is suggestive of fracture at the base of

middle cranial fossa Could be lacerated or cut off

Mouth

Contusion, laceration & swelling on lips at first blow

Fracture of lower jaw due to direct violence & alwaysassociated with laceration of gums


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Abrasions present in manual strangulation

Ligature marks present in death by

hanging

Suicidal cut throats are diagonal;homicidal wound usually horizontal

Incised & stab wounds include trachea &big blood vessels (fatal).


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Fracture of the vertebrae

cause: Direct and Indirect Violence

Concusion of the spine Usual complaints: headache, restlessness,

pain & tenderness over the spine, loss ofsexual power, irritability of the bladder,inability to walk, weakness of the limbs .

Motor vehicle collision and in a railwayaccident


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Injuries to the chest wall Stab wounds are quite common

Bullet wounds may be superficial or may involve thepleural viscera

Fracture of the ribs

Injuries to the lungs Hemorrhage in pleural cavity may cause compression

& collapse of lungs, patient may die of respiratoryembarrassment or anemia.

Contusion of the lungs may be caused by a blunt

instrument with/without fracture of the ribs Injury of lungs may cause bloody froth coming out of

the mouth

Death may be due to severe shock & a rapidhemorrhage


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Hemorrhage

Compression of the lungs

Severe pneumothorax

Cerebral air embolism

Hemoptysis

Subcutaneous emphysema


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Wounds of the heart are produced by sharpinstrument, bullets of sharp-end of fractured ribs

Contusion easily produced on slight trauma

Tearing of the heart from its attachment may bedue to violent compression of the chest with thepressure forcing the organ downward & awayfrom the neck

Crushing injuries are due to compression of chestin vehicular accidents or violent dynamic blast


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Any penetrating wound in diaphragm

may cause a potent rent for

diaphragmatic herniation

Rupture of the diaphragm is due to a

sudden increase of intrabdominal pressure

crushing injuries caused by vehicularaccidents or traumatic compression of the

chest.


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Abdominal wall Area in the middle superior half of the

abdomen forming a triangle is vulnerable totrauma applied from any direction.

Stomach Spontaneous rupture may be observed in

cases of gastric ulcer or new growth. Most common site of rupture: pyloric end &

the greater curvature Penetrating stab wounds Tearing of stomach common when run over

by a motor vehicle


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Intestine Traumatic rupture may be due to blow, kick,

fall or vehicular accident. Injuries caused by sharp instruments or by

gunshots usually cause multiple lesions in theintestine & may involve other visceralorgans.

Liver One of the most vulnerable organs in the

abdominal cavity Injuries frequently met in cases of blow, kick,

crush, or fall Stab wounds & gunshot involving the liver

may cause severe hemorrhage & shockcausing death


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Spleen Penetrating stab wounds in the spleen are

common.

Kidney Traumatic injury may be due to blow at the

lumbar region.

May be ruptured at the slightest violence when it

is diseased as in cases of hydronephrosis,pyelonephritis, tuberculosis, abscess or tumor.

Injury to kidney is accompanied by peri-renalhematoma consists of blood & urine.

Pancreas May be injured by a violent blow at the

epigastric region.

Death may be due to hemorrhage, shock orinsulin insufficiency.


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Urinary bladder Bladder my be involved in a blow, crush or

kick at the hypogastrium especially whendistended with urine.

Among parturient women, the bladder mayrapture in the course of delivery.

It may be involved in fractures of the pubicbones.

Symptoms of bladder rupture: pain,tenderness at the lower portion of theabdomen, bloody urine, difficulty in urination,& rigidity of the abdominal muscles.


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Uterus

Gravid uterus is likely to rupture in blow,

kick or crush injuries. Partial separation of the placenta may be

spontaneous or due to trauma

Vagina

Laceration of the vagina due to sexual

act or a faulty instrumentation to induce a

criminal abortion.

Vaginal wall may be lacerated duringparturition.


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Direct violence

will result in a contusion andwhen the force applied is severe it maycause interstitial muscular hemorrhage &fractures of the underlying bone.

Indirect violence - Crushing injuries of the limb can result in

severe soft tissue trauma and are mostcommonly caused by vehicular accidents orfall of heavy materials.

Contusions & abrasions common injuries

Fracture of the bones may be due todirect violence.


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medico legal; physical injuries