Forensic Aspects of Trauma Flashcards

1
Q

Injury

A
  • Physical harm or damage to someone’s body caused by an accident or an attack
  • Damage to any part of the body due to the application of mechanical force
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2
Q

What forces does the intensity of injury obey?

A

Laws of physics

  • Force varies directly with mass of the ‘weapon’ and directly with square of velocity of impact
  • Kinetic energy = ½ mass x velocity^2
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3
Q

How does area over which force acts affect injury severity?

A

-Force (same mass and velocity) over a smaller area will deliver a greater impact to any given unit of tissue

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4
Q

How do seatbelts work?

A

Stretching of seatbelt fabric extends time of energy exchange and considerable area of seatbelt surface is preferable to alternative of transferring all kinetic energy via a few cm^2 of the forehead against the windscreen

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5
Q

What can excessive mechanical force cause?

A
  • Compression
  • Traction
  • Torsion
  • Tangential (shearing)
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6
Q

What does resultant damage depend on?

A

Type of mechanical insult and nature of the target tissue

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7
Q

How can injury be classified?

A

Appearance or method of causation:
-Abrasion, contusion, laceration, incised wounds, gunshot wounds, burns

Manner of causation:
-Suicidal, accidental, homicidal

Nature of injury:
-Blunt force, sharp force, explosive

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8
Q

How are blunt force injuries caused?

A

Caused by impact with blunt object (ground, fist, foot, weapon)

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9
Q

Give examples of blunt force injuries.

A

Contusions (bruises)
-Burst blood vessels in skin

Abrasions (graze, scratch)
-Scraping of skin surface

Lacerations (cut, tear)
-Tear/split of skin due to crushing

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10
Q

Give examples of patterned bruises.

A
  • Tramline bruises
  • Finger trip bruises
  • Patterns from objects
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11
Q

What factors affect prominence of bruising?

A
  • Skin pigmentation
  • Depth and location
  • Increased subcutaneous fat
  • Young and old
  • Resilient area such as buttocks and abdomen bruise less easily
  • Areas with underlying bone bruise more easily
  • Coagulative disorders (including alcoholics)
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12
Q

What is a sharp force injury?

A
  • Injury caused by any weapon with sharp cutting edge.

- Can be superficial or penetrating

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13
Q

Give examples of sharp force injuries.

A
  • Incised wounds

- Stab wounds

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14
Q

How do incised wounds occur?

A

Superficial sharp force injury caused by a slashing motion

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15
Q

How do incised appear?

A

Longer on the skin surface than it is deep

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16
Q

How do stab wounds occur?

A

Penetrating injury resulting from thrusting motion

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17
Q

How do stab wounds appear?

A

Wound depth greater than length on the surface

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18
Q

What types of defensive injuries do you get?

A

Blunt and sharp force

19
Q

How do passive defensive injuries occur?

A

Victim raises arms and legs for protection

20
Q

What types of passive defensive injuries can occur?

A

Sliced, shelved often with skin flaps over backs of hands and forearms

21
Q

How do active defensive injuries occur?

A

Victim tries to grab weapon or attacker hand

22
Q

What types of active defensive injuries can occur?

A

Sliced shelved incised wounds on palmer aspect of hands and web spaces between fingers – particularly between thumb and index finger

23
Q

What sites are usually used for self inflicted injuries?

A
  • Wrists/forearms

- Chest and abdomen

24
Q

How do self-inflicted injuries usually appear?

A
  • Commonly sharp force
  • Parallel, multiple and tentative injuries
  • Positioned under clothing
25
What does consequence of injury depend on?
Type of mechanical insult -Blunt, sharp, homicide, suicide, accident Nature of target tissue -Head, chest, abdomen, fat Forces involved -High speed RTC, fall from a height, kicking, stamping, punch Number of impacts -Single vs multiple
26
What can head injuries result in?
- Skull fractures (linear or depressed) | - Subarachnoid, subdural, extradural haemorrhage
27
When will patients start to show symptoms of brain haemorrhage?
35ml blood loss
28
How will a patient present with 40-50ml of brain haemorrhage?
- Clinical deterioration | - Life threatening
29
How will a patient present with 80-100ml of brain haemorrhage?
Commonly fatal due to increased ICP and herniation
30
How will a patient present with 150ml+ of brain haemorrhage?
Proves fatal
31
What is usually the cause of extradural haemorrhage?
Rupture of the middle meningeal artery
32
What is usually the cause of subdural haemorrhage?
Rupture of emissary
33
What is usually the cause of subarachnoid haemorrhage?
- Contusions of the brain | - Rupture of berry aneurysms
34
What is a common consequence of subarachnoid haemorrhage?
Traumatic brain injury
35
How do traumatic subarachnoid haemorrhages occur?
-Due to rapid rotational movement of head, usually as the result of a single punch to jaw/ upper part of neck or side of head -Sudden unexpected twisting movement Causes traumatic rupture of vessels at base of brain – most frequently distal portion of intracranial vertebral arteries at point where they cross the dura -
36
What does traumatic subarachnoid haemorrhage result in?
Immediate LOC and cardiac arrest
37
Diffuse axonal injury
- Clinical term | - Immediate and prolonged coma with no apparent mass lesion or metabolic abnormality
38
Traumatic axonal injury
- Pathological term - Damaged axons due to trauma - Focal or diffuse - Graded 1-3 dependent on severity
39
What internal damage can blunt force cause?
Falls, RTC, kicks, blows Ribs -Multiple fractures, flail chest Lungs -Contusions, lacerations including vessels Heart -Bruising, laceration, common carotids Aorta -Deceleration trauma, rupture Abdomen -Bowel tears, mesenteric haemorrhage and laceration, liver and spleen lacerations, haemorrhage
40
What internal damage can be caused by sharp force injuries?
Stabs Intercostal vessels, ribs, pneumothorax, haemothorax Lungs -Penetration haemorrhage, collapse, through and through Heart -Penetration, tamponade, haemothorax Aorta -Haemopericardium, haemothorax Abdomen -Penetration of bowel, liver, spleen etc. haemorrhage
41
What injuries can occur during resuscitation attempts?
- Bruising to neck and chest - Finger mark bruising - Bruising/laceration of lips and gums - Damage to teeth - Sternal and rib fractures - Pleural cavity haemorrhage - Laceration of lung - Heart rupture - Venepuncture and cannulation
42
Give examples of other types of injuries.
- Burns - Firearm injuries - Explosions
43
What post- mortem injuries can occur?
- Parchmentation - Animal predation - Insect predation