GENERAL ASPECTS OF TRAUMAGENERAL ASPECTS OF TRAUMA

Danuta DeboaDanuta Deboa

Classification of TraumaClassification of Trauma

Anatomic Location of Injury Anatomic Location of Injury Manner of Production Manner of Production Method of ProductionMethod of Production

Causes and Types of TraumaCauses and Types of Trauma

MECHANICAL PHYSICAL Asphyxia Barotrauma Blunt Chemical

Heat and electrical: Penetrating Radiation Sonic Thermal

MECHANICAL PHYSICAL Asphyxia Barotrauma Blunt Chemical

Heat and electrical: Penetrating Radiation Sonic Thermal

Varying Factors in Trauma ProductionVarying Factors in Trauma Production

Type of Force AppliedType of Force Applied Duration of ApplicationDuration of Application Vulnerability of SiteVulnerability of Site

Objectives of Trauma InvestigationObjectives of Trauma Investigation

Determine :Determine : Activity With Lethal Injury Activity With Lethal Injury Cause of Death Cause of Death Cause and Effect Manner of Death Cause and Effect Manner of Death Survival Time Survival Time Time of DeathTime of Death

General Aspects of TraumaGeneral Aspects of Trauma

Trauma is classified according to method of production, Trauma is classified according to method of production, to anatomic location of the injury, or to the manner in to anatomic location of the injury, or to the manner in which the trauma was produced. The major causes of which the trauma was produced. The major causes of trauma are from mechanical injury which result from trauma are from mechanical injury which result from force or chemical injury in which there is a direct or force or chemical injury in which there is a direct or indirect effect on the body resulting in an injury.indirect effect on the body resulting in an injury.

Severity of TraumaSeverity of Trauma

The factors which effect the development and severity of trauma The factors which effect the development and severity of trauma include the type of force which is applied, the time of exposure include the type of force which is applied, the time of exposure of that force and the vulnerability of the anatomic structures to of that force and the vulnerability of the anatomic structures to the subsequent trauma. If, for instance, a very heavy weight the subsequent trauma. If, for instance, a very heavy weight struck an individual a glancing blow to the head, the resulting struck an individual a glancing blow to the head, the resulting effect would not be expected to be as severe as when the effect would not be expected to be as severe as when the individual sustained a blow to the head with the heavy weight individual sustained a blow to the head with the heavy weight which, in turn, impacted his head against another object or which, in turn, impacted his head against another object or actually crushed his head against the wall. The same swinging actually crushed his head against the wall. The same swinging weight may produce severe injuries to the abdomen with weight may produce severe injuries to the abdomen with resulting rupture of the organs, but if this weight did strike a part resulting rupture of the organs, but if this weight did strike a part of the body which was protected by a skeletal structure, then of the body which was protected by a skeletal structure, then the effect would be lessened.the effect would be lessened.

Objectives in Investigation TraumaObjectives in Investigation Trauma

The three basic objectives in investigation of trauma are:The three basic objectives in investigation of trauma are:1.1. To determine the cause of trauma.To determine the cause of trauma.2.2. To study the effect of this trauma.To study the effect of this trauma.3.3. To document the cause and effect.To document the cause and effect.

Investigation of the medico-legal aspect of the case, should Investigation of the medico-legal aspect of the case, should include:include:

The manner of death, time of death, the importance of the The manner of death, time of death, the importance of the consideration of natural disease processes, the presence of consideration of natural disease processes, the presence of intoxicants, and finally the determination of survivability of the intoxicants, and finally the determination of survivability of the individual with lethal injury.individual with lethal injury.

GENERAL ASPECTS OF TRAUMA INVESTIGATIONGENERAL ASPECTS OF TRAUMA INVESTIGATION

1.1. Determination of the causative factorsDetermination of the causative factors2.2. Determine the effect on the victimDetermine the effect on the victim3.3. Determine the circumstances of the accidentDetermine the circumstances of the accident4.4. Document the injuries and the patternDocument the injuries and the pattern5.5. Provide information to help injury preventionProvide information to help injury prevention

DETERMINATION OF CAUSATIVE FACTORSDETERMINATION OF CAUSATIVE FACTORS

1.1. Consider site of injury Consider site of injury2.2. Consider type of injury Consider type of injury3.3. Consider intensity of injury Consider intensity of injury4.4. Consider mechanism of injury Consider mechanism of injury5.5. Evaluate import of Natural DiseaseEvaluate import of Natural Disease6.6. Evaluate aspect of intoxicantsEvaluate aspect of intoxicants7.7. Document the injury and correlate with known Document the injury and correlate with known

causes.causes.

DETERMINATION OF EFFECT ON VICTIMDETERMINATION OF EFFECT ON VICTIM

1.1. Study clinical aspect from injury to medical careStudy clinical aspect from injury to medical care2.2. Study complicating factors related to the injuryStudy complicating factors related to the injury3.3. Study complicating factors related to medical Study complicating factors related to medical

managementmanagement4.4. Study complicating factors related to natural Study complicating factors related to natural

disease or intoxicants takendisease or intoxicants taken5.5. Document complicating factors in the case. Document complicating factors in the case.

Correlation of InjuriesCorrelation of Injuries

General Considerations General Considerations One of the main objectives of the investigation of One of the main objectives of the investigation of

injured-victims is to accumulate information about the injured-victims is to accumulate information about the injuries and correlate them with the method of injuries and correlate them with the method of production of the injuries. This serves several purposes production of the injuries. This serves several purposes including the possibility of reconstructing the including the possibility of reconstructing the mechanism by which injuries were produced, mechanism by which injuries were produced, correlation of specific injuries with the type of trauma. correlation of specific injuries with the type of trauma.

Reconstructing Injury ProductionReconstructing Injury Production

This can be accomplished by careful examination of the body This can be accomplished by careful examination of the body and clothing for obvious damage. The study of the injuries will and clothing for obvious damage. The study of the injuries will reveal the relationship and orientation of the victim in terms of reveal the relationship and orientation of the victim in terms of the direction of the trauma. The detailed examination of each the direction of the trauma. The detailed examination of each wound helps to establish the type of wound and injury wound helps to establish the type of wound and injury sustained. There may be several types of trauma to which the sustained. There may be several types of trauma to which the victim has been exposed. This may be antemortem and or victim has been exposed. This may be antemortem and or postmortem in origin. postmortem in origin.

The angle at which a bullet or knife blade enters the body is The angle at which a bullet or knife blade enters the body is important to determine the direction of the attack on the victim. important to determine the direction of the attack on the victim. It is also a factor in determining the position of the victim at the It is also a factor in determining the position of the victim at the time of his wounding.time of his wounding.

Pattern of InjuryPattern of Injury

There may be patterns which are characteristic as related to a There may be patterns which are characteristic as related to a tool or instrument such as a hammer, or cutting surface such tool or instrument such as a hammer, or cutting surface such as an axe, screw driver, scissor or a knife. The use of a ruler is as an axe, screw driver, scissor or a knife. The use of a ruler is essential as comparison of the size of a wound may be related essential as comparison of the size of a wound may be related to the specific instrument surface or car part in a hit and run to the specific instrument surface or car part in a hit and run accident. accident.

TYPES OFTYPES OF TRAUMA - CLASSIFICATIONTRAUMA - CLASSIFICATION

ETIOLOGICALETIOLOGICAL BLUNT FORCE : BLUNT FORCE : -- Impact from an objectImpact from an object-- Impact against a fixed objectImpact against a fixed object-- Impact with impalementImpact with impalement CRUSH FORCE - Movement and Pressure, Bite, Trapped in machine or by weight CRUSH FORCE - Movement and Pressure, Bite, Trapped in machine or by weight

(Asphyxial), Environmental Pressure (Barotrauma)(Asphyxial), Environmental Pressure (Barotrauma) PENETRATING FORCE - Missile penetrationPENETRATING FORCE - Missile penetration

Sharp object penetration or impalement Sharp object penetration or impalement Explosive penetration Explosive penetration

PHYSICAL FORCE - Electrical, Laser rays ,, Solar Energy Radiation, Wind PHYSICAL FORCE - Electrical, Laser rays ,, Solar Energy Radiation, Wind pressure.pressure.

THERMAL - Heat, Lightning, HypothermiaTHERMAL - Heat, Lightning, Hypothermia TOXICOLOGICAL- External exposure, Internal ExposureTOXICOLOGICAL- External exposure, Internal Exposure

BLUNT TRAUMA, ImpactBLUNT TRAUMA, Impact (foil 2)(foil 2)

Blunt trauma is that form of trauma which is a non-penetrating Blunt trauma is that form of trauma which is a non-penetrating type which may or may not result in splitting or crushing of the type which may or may not result in splitting or crushing of the skin. This occurs if the skin is compressed between the impact skin. This occurs if the skin is compressed between the impact forces and a fixed structure as the skull, face or other places forces and a fixed structure as the skull, face or other places where there is a close contact of the skin with bone as in the where there is a close contact of the skin with bone as in the hands.hands.

The mechanisms by which blunt trauma is produced include The mechanisms by which blunt trauma is produced include those in which the body is impacted by a moving object such as those in which the body is impacted by a moving object such as a falling object or when the body is in motion and it strikes a a falling object or when the body is in motion and it strikes a fixed object such as an upright post or the pavement. fixed object such as an upright post or the pavement.

Impact with body fixedImpact with body fixed

A blow from a falling object such as a stone, potted plant, hurled A blow from a falling object such as a stone, potted plant, hurled weapon, wrench or metal pipe. A wall collapsing as in a fire or exploding weapon, wrench or metal pipe. A wall collapsing as in a fire or exploding building, mine or cave ceiling or walls, at an excavation site collapse, building, mine or cave ceiling or walls, at an excavation site collapse, struck by a falling body, explosion debris, tornadic or hurricane force wind struck by a falling body, explosion debris, tornadic or hurricane force wind strewn debris. strewn debris.

Clubbed by a pipe, flashlight, or a wrench, tool, tire, iron. Transport Clubbed by a pipe, flashlight, or a wrench, tool, tire, iron. Transport accidents may produce forces of impact with greater intensity because of accidents may produce forces of impact with greater intensity because of the greater mass of the moving object which strikes the body. The degree the greater mass of the moving object which strikes the body. The degree of injury is greater also because of the larger body area being impacted of injury is greater also because of the larger body area being impacted and the greater forces to which the body is exposed. There may be and the greater forces to which the body is exposed. There may be secondary injury production as a result of a body being propelled after secondary injury production as a result of a body being propelled after impact to land against a fixed object of surface. The body may also be run impact to land against a fixed object of surface. The body may also be run over or impaled in these cases. over or impaled in these cases.

Impact by moving-bodyImpact by moving-body

A body may fall or be propelled from a moving vehicle A body may fall or be propelled from a moving vehicle and serious injuries may result which are proportionate and serious injuries may result which are proportionate to the height or velocity of the moving vehicle from to the height or velocity of the moving vehicle from which it is ejected. The injury results from the impact which it is ejected. The injury results from the impact with the surface and can vary according to the nature with the surface and can vary according to the nature of the surface.of the surface.

A flat surface which is soft such as snow or soft ground A flat surface which is soft such as snow or soft ground or muddy areas may allow the impact to be absorbed or muddy areas may allow the impact to be absorbed and cause a miracle survival after a fall from a great and cause a miracle survival after a fall from a great height. height.

Blunt Trauma - Crush Blunt Trauma - Crush (MV 3/89,)(MV 3/89,)

Crushing trauma is a form of blunt trauma where the Crushing trauma is a form of blunt trauma where the injury is related to the impact and the weight of the injury is related to the impact and the weight of the structure to which the body has been exposed. The structure to which the body has been exposed. The factors which determine the intensity of injury are how factors which determine the intensity of injury are how long the body or a part of the body is exposed to the long the body or a part of the body is exposed to the trauma, the size or magnitude of the crushing forces, if trauma, the size or magnitude of the crushing forces, if there is any impact force associated with the case, if there is any impact force associated with the case, if there is any motion involved in the trauma and what there is any motion involved in the trauma and what body areas are involved. body areas are involved.

Blunt Trauma – CrushBlunt Trauma – Crush ((1st foil)1st foil)

The analysis of crushing trauma must take into The analysis of crushing trauma must take into consideration the period to which the individual or a consideration the period to which the individual or a body part is exposed to the trauma, as follows:body part is exposed to the trauma, as follows:1.1. Short term exposure- This may occur when a Short term exposure- This may occur when a

pedestrian is run over by a car, a horseback rider is pedestrian is run over by a car, a horseback rider is rolled over by the horse. rolled over by the horse.

2.2. Long term exposure- This occurs when the victim is Long term exposure- This occurs when the victim is trapped by collapsing walls, coal mine tunnels. trapped by collapsing walls, coal mine tunnels.

Blunt Trauma - CrushBlunt Trauma - Crush

The injuries sustained by crushing trauma may vary from minimal The injuries sustained by crushing trauma may vary from minimal injury of a simple pinching nature to those which require amputation. injury of a simple pinching nature to those which require amputation. Muscle damage may also be severe and cause permanent disability Muscle damage may also be severe and cause permanent disability in the injured victims. Severe fractures may result in severe bleeding, in the injured victims. Severe fractures may result in severe bleeding, infection, possible fat embolism syndrome.infection, possible fat embolism syndrome.

The prolonged crushing by any cause may have localised and or The prolonged crushing by any cause may have localised and or serious generalised effects on a victim. Compression so that the serious generalised effects on a victim. Compression so that the airway is obstructed and resultant asphyxia kills the victim may occur airway is obstructed and resultant asphyxia kills the victim may occur without nassive crushing as opposed to traumatic asphyxia which without nassive crushing as opposed to traumatic asphyxia which consists of severe limitation of respiratory movement by a large consists of severe limitation of respiratory movement by a large object. object.

Blunt TraumaBlunt Trauma -- BitesBites

HUMANHUMAN Suck mark ("hickey")Suck mark ("hickey") Bite mark location - ear, lip, nose, breast, Bite mark location - ear, lip, nose, breast,

finger, buttocks, finger, buttocks, Magnitude - superficial, deep, disfiguringMagnitude - superficial, deep, disfiguring

Blunt TraumaBlunt Trauma -- BitesBites

ANIMALANIMAL Marine - shark, snakes, turtles, piranha, barracuda teeth Marine - shark, snakes, turtles, piranha, barracuda teeth

marks, testis, extremity Postmortem - crabs, shrimpmarks, testis, extremity Postmortem - crabs, shrimp Land - Insects - mosquito, scorpion, spider, flies, roaches Land - Insects - mosquito, scorpion, spider, flies, roaches

Exposed surfaces - hand, face, buttocks, legs, arms, feet, Exposed surfaces - hand, face, buttocks, legs, arms, feet, neckneck

Animals - Domestic - cats, dogs, birds, pigs, horses, donkeysAnimals - Domestic - cats, dogs, birds, pigs, horses, donkeys Wild - wolves, reptiles, bears, birds Wild - wolves, reptiles, bears, birds Character - multiple, deep Character - multiple, deep Location - face, head, hands, feet, legs, eyes Location - face, head, hands, feet, legs, eyes

Explosives - Explosions and Pressure TraumaExplosives - Explosions and Pressure Trauma

General General Various types of injuries are associated with an Various types of injuries are associated with an

explosive or high pressure trauma. Various types of explosive or high pressure trauma. Various types of injuries can be produced by the effect of the blast with injuries can be produced by the effect of the blast with or without penetration of the body. Such effects or blast or without penetration of the body. Such effects or blast effects can be seen where there is severe heat injury effects can be seen where there is severe heat injury and/or air blast effects. Such explosions can be and/or air blast effects. Such explosions can be experienced under water. experienced under water.

Explosives Explosives

Investigation of any explosions may be fraught with difficulty Investigation of any explosions may be fraught with difficulty because of the condition of the body as presented to the because of the condition of the body as presented to the medicolegal investigator. It may be fragmentary, or it may be medicolegal investigator. It may be fragmentary, or it may be intack or in large chunks. intack or in large chunks.

Penetrating injuries are often seen in individual who have been Penetrating injuries are often seen in individual who have been killed in addition to the fragmentation changes of the injuries killed in addition to the fragmentation changes of the injuries that is severe amputating injuries of extremities. Foreign that is severe amputating injuries of extremities. Foreign objects such as doorknobs, nails ,locks, wire and batteries may objects such as doorknobs, nails ,locks, wire and batteries may be blown into the body from the exploded building or the device be blown into the body from the exploded building or the device itself. In gas explosions there may be a severe burning related itself. In gas explosions there may be a severe burning related to propane or methane in buildings or mines. to propane or methane in buildings or mines.

Explosives Explosives

Asphyxia due to the elimination of oxygen supply is Asphyxia due to the elimination of oxygen supply is also an important factor in mine and sever explosions also an important factor in mine and sever explosions in some cases. Traumatic injury can include in some cases. Traumatic injury can include concussion as well as unsuspected rupture of viscera concussion as well as unsuspected rupture of viscera in the chest or abdomen. in the chest or abdomen.

Penetrating Trauma - Sharp InstrumentsPenetrating Trauma - Sharp Instruments

Trauma related to sharp instruments can be divided Trauma related to sharp instruments can be divided into that produced by stabbing, slashing, hacking, and into that produced by stabbing, slashing, hacking, and cutting where the instrument is placed against the flat cutting where the instrument is placed against the flat surface and a major laceration is produced. surface and a major laceration is produced. Instruments used such as knives, scissors, machetes Instruments used such as knives, scissors, machetes or glass, metal, wood splinters, or any flying object.or glass, metal, wood splinters, or any flying object.

Penetrating Trauma - Sharp InstrumentsPenetrating Trauma - Sharp Instruments

In the investigation, one has to consider whether the instrument In the investigation, one has to consider whether the instrument was moving or it was fixed. If it is fixed, the individual sustains was moving or it was fixed. If it is fixed, the individual sustains injury by falling onto a fixed object such as a fence picket, and injury by falling onto a fixed object such as a fence picket, and is impaled. This may be the result of a fall from a height or is impaled. This may be the result of a fall from a height or after the body is ejected from a moving vehicle. Any part of the after the body is ejected from a moving vehicle. Any part of the body may be impaled on a protruding fixed object. Deaths from body may be impaled on a protruding fixed object. Deaths from exsanguination result if an individual falls onto the handle of a exsanguination result if an individual falls onto the handle of a refrigerator and tears a major vessel in the neck. A fall from a refrigerator and tears a major vessel in the neck. A fall from a standing position onto a root of a tree may also prove fatal.standing position onto a root of a tree may also prove fatal.

In instances where the sharp objects are moving, we have the In instances where the sharp objects are moving, we have the possibility of cutting, stabbing, slashing, and hacking type possibility of cutting, stabbing, slashing, and hacking type wounds.wounds.

The cutting woundThe cutting wound

Injuries may be due to the defense of a victim and are seen on his hands, Injuries may be due to the defense of a victim and are seen on his hands, arms, or legs. They are severely cut when the hand catches hold of a knife arms, or legs. They are severely cut when the hand catches hold of a knife blade and when the assailant pulls it out, the injuries may occur on several blade and when the assailant pulls it out, the injuries may occur on several parts of the hand.parts of the hand.

A victim may not be able to get out of the way of glass, metal, or wood A victim may not be able to get out of the way of glass, metal, or wood splinters after an explosion, and thus is punctured by these flying objects. splinters after an explosion, and thus is punctured by these flying objects. With attempted suicide, there may be slashes made increasingly deeper With attempted suicide, there may be slashes made increasingly deeper after initial hesitation set on the wrists or on the throat. The major after initial hesitation set on the wrists or on the throat. The major complication is massive bleeding from cutting a major vessel. complication is massive bleeding from cutting a major vessel.

Homicidal injuries are cutting in the region of the throat when both the Homicidal injuries are cutting in the region of the throat when both the jugular vein and carotid artery are severed. (photos cs 15, 16)jugular vein and carotid artery are severed. (photos cs 15, 16)

CASESCASES

StabbingStabbing

These injuries are produced by knives, tools such as a screw These injuries are produced by knives, tools such as a screw driver, scissors, arrows, a bayonet. It can be accidental, driver, scissors, arrows, a bayonet. It can be accidental, homicidal or suicidal. In the Japanese culture, there is a homicidal or suicidal. In the Japanese culture, there is a ceremonial suicide (Kara Kari). During tornados and wind ceremonial suicide (Kara Kari). During tornados and wind storms, wood splinters may actually be blown with penetrating storms, wood splinters may actually be blown with penetrating force through the body.force through the body.

Slashing and HackingSlashing and Hacking

These are seen with heavy instruments such as These are seen with heavy instruments such as machetes, bayonets, and causes amputation of machetes, bayonets, and causes amputation of limbs, the head, the breasts. It may be the limbs, the head, the breasts. It may be the result of a homicidal attack. result of a homicidal attack.

InvestigationInvestigation (cs 3/52)(cs 3/52)

Basic objectives in cases involving sharp instruments include the Basic objectives in cases involving sharp instruments include the measurement of the width, thickness, and length of the knife blade, the measurement of the width, thickness, and length of the knife blade, the angle of the knife, entry, and its through the body passage. The structures angle of the knife, entry, and its through the body passage. The structures injured and part of the knife, such as the hilt or the handle. X-rays should injured and part of the knife, such as the hilt or the handle. X-rays should be done to determine if there is still part of the knife present. The depth of be done to determine if there is still part of the knife present. The depth of penetration into the body should be measured to determine the potential penetration into the body should be measured to determine the potential length of the knife, remembering that a knife thrust may be longer than the length of the knife, remembering that a knife thrust may be longer than the length of the knife if there is a forceful thrust into the abdomen or neck. The length of the knife if there is a forceful thrust into the abdomen or neck. The knife handle if removed may show the presence of blood still there after knife handle if removed may show the presence of blood still there after washing.washing.

Penetrating sharp instrumentPenetrating sharp instrument

Fall from height Impalement on inanimate object Impact and additional impact

Body as projectile Propelled from moving vehicle Fall against object Tree root,

Postmortem-mutilation-sexual, breast Defensive- hands, arms, legs

FIXED

Cutting Offensive - cut-throating Flying objects - glass, metal, wood Suicidal - wrists, throat, legs Masochistic - sexual mutilation

Penetrating sharp instrumentPenetrating sharp instrument

Warfare - crossbow bolts, arrows, Suicide – Hara-kiri, sword, sharp tool Homicide - knife, bayonet, icepick, scissor, Accident - saws, tools, machines

MOVING Stabbing

Storms – tornado-splinters

KNIFE WOUND EXAMINATIONKNIFE WOUND EXAMINATION

1.1. Measure wound. Measure wound. 2.2. Determine depth of penetration.Determine depth of penetration.3.3. Determine injury and bleedingDetermine injury and bleeding4.4. X-ray for metal fragments.X-ray for metal fragments.

KNIFE EXAMINATIONKNIFE EXAMINATION

1.1. Measure blade length, width, thickness.Measure blade length, width, thickness.2.2. Remove handle, look for blood & fibers.Remove handle, look for blood & fibers.3.3. Look for damage to knife or marks made by Look for damage to knife or marks made by

edge serrations or hilt on skin.edge serrations or hilt on skin.

Penetrating InjuryPenetrating Injury -- gun traumagun trauma

The basic objectives of the investigation of gun wounds are:The basic objectives of the investigation of gun wounds are:a.a. To carefully document the appearance of the wound To carefully document the appearance of the wound

entrance and exit.entrance and exit.b.b. To determine the proximity of the gun to the skin at firing by To determine the proximity of the gun to the skin at firing by

looking for tattooing of the surrounding skin by unburnt looking for tattooing of the surrounding skin by unburnt powder, soilage of smoke, splitting of skin or reddish color of powder, soilage of smoke, splitting of skin or reddish color of gases in subcutaneous tissue, beveling in of bone inner gases in subcutaneous tissue, beveling in of bone inner table in skull, powder on hand.table in skull, powder on hand.

c.c. The zone of injury to determine the relation that the bullet The zone of injury to determine the relation that the bullet had to the skin which may indicate the line of fire of the had to the skin which may indicate the line of fire of the weapon.weapon.

Penetrating InjuryPenetrating Injury -- gun traumagun trauma

d.d. The x-ray of the body area effected to determine the location The x-ray of the body area effected to determine the location

of the bullet and in the head x-ray the path of the bullet by a of the bullet and in the head x-ray the path of the bullet by a lateral and posterior-anterior film to following bits of metal lateral and posterior-anterior film to following bits of metal from entrance to exit or entrance to the bullet.from entrance to exit or entrance to the bullet.

e.e. To determine the path of the bullet through the body if it has To determine the path of the bullet through the body if it has not struck a bone or been deflected by any structure.not struck a bone or been deflected by any structure.

Penetrating InjuryPenetrating Injury -- gun traumagun trauma

f.f. To determine the damage produced and the degree of To determine the damage produced and the degree of bleeding as may indicate the period that circulation may bleeding as may indicate the period that circulation may have continued and possibly how long the victim may have have continued and possibly how long the victim may have survived and been capable of movement. survived and been capable of movement. The amount of blood on the clothes and the scene may also The amount of blood on the clothes and the scene may also be helpful.be helpful.

g.g. The bullet holes should be numbered in relation to the feet. The bullet holes should be numbered in relation to the feet. h.h. The bullet or fragments found including a jacket or large The bullet or fragments found including a jacket or large

portion of the slug is marked and handed at the table to the portion of the slug is marked and handed at the table to the law enforcement officer present at the autopsy. This may be law enforcement officer present at the autopsy. This may be reidentified in court.reidentified in court.

PENETRATING TRAUMAPENETRATING TRAUMA - GUN- GUN

OBJECTIVES OF WOUND EXAMINATIONOBJECTIVES OF WOUND EXAMINATION1.1. Determine entrance and exit holesDetermine entrance and exit holes2.2. Determine angle of bullet entranceDetermine angle of bullet entrance3.3. Determine proximity of gun to skinDetermine proximity of gun to skin4.4. Determine bullet location -X-rayDetermine bullet location -X-ray5.5. Determine bullet path § injuriesDetermine bullet path § injuries6.6. Assess damage to bulletAssess damage to bullet7.7. Bullet - remove, mark and record locationBullet - remove, mark and record location

a

b

b

c d

Barotrauma Barotrauma

Injuries related to barotrauma may result from exposure to Injuries related to barotrauma may result from exposure to massive pressure under water or in tunnels deep under the massive pressure under water or in tunnels deep under the ground. This is the consequence of the failure to maintain ground. This is the consequence of the failure to maintain equality of pressure between the body and the surroundings. equality of pressure between the body and the surroundings.

It may be due to the weakness of the individual himself or to the It may be due to the weakness of the individual himself or to the inadequacy of protection available to him, his equipment or to inadequacy of protection available to him, his equipment or to the handling of the equipment by other people. The actual the handling of the equipment by other people. The actual injuries include pneumothorax, interstitual emphysema and air injuries include pneumothorax, interstitual emphysema and air embolism. The latter may result in brain damage as evidenced embolism. The latter may result in brain damage as evidenced by convulsions, flaccid paralysis or spastic paralysis, visual by convulsions, flaccid paralysis or spastic paralysis, visual changes, vertigo and tingling in the limbs. Hemoptysis and changes, vertigo and tingling in the limbs. Hemoptysis and nosebleeds occur. nosebleeds occur.

Barotrauma Barotrauma

The ear is effected by pressure increases in the middle The ear is effected by pressure increases in the middle ear with severe pain resulting. Ruptured eardrums may ear with severe pain resulting. Ruptured eardrums may occur. Gas collections in the roots of teeth may result in occur. Gas collections in the roots of teeth may result in pain as would pressure in the sinuses if inflammation is pain as would pressure in the sinuses if inflammation is present. Intestinal gas accumulation may be seen and present. Intestinal gas accumulation may be seen and is associated with abdominal distension and pain.is associated with abdominal distension and pain.

Barotrauma Barotrauma

The investigation of deaths in divers must include an The investigation of deaths in divers must include an investigation in the location of the death and a check of investigation in the location of the death and a check of his equipment. The examination of the scuba tank for his equipment. The examination of the scuba tank for carbon monoxide or other noxious gases and for rust is carbon monoxide or other noxious gases and for rust is to be done by certified investigators. The body must be to be done by certified investigators. The body must be checked for air embolisation and evidence of lung, ear checked for air embolisation and evidence of lung, ear or sinus trauma and gastrointestinal injury. In a hard or sinus trauma and gastrointestinal injury. In a hard hat diver electrical injury must be ruled out. The hat diver electrical injury must be ruled out. The presence of alcohol and drugs must be checked in the presence of alcohol and drugs must be checked in the victims body fluids. Natural disease must also be victims body fluids. Natural disease must also be looked for in the victim as it may be a crucial factor. looked for in the victim as it may be a crucial factor.

Cold traumaCold trauma

Effects of Cold:Effects of Cold: Local effects include poor circulation in exposed areas Local effects include poor circulation in exposed areas

such as the nose, fingers, toes, ears, lips , eyelids and such as the nose, fingers, toes, ears, lips , eyelids and neck. This injury may be seen as pain and after neck. This injury may be seen as pain and after exposure for a longer period obvious mortification. exposure for a longer period obvious mortification. There may also be further problems if the individual is There may also be further problems if the individual is exposed to wetness as well. exposed to wetness as well.

In some of these cases the victims may lose their In some of these cases the victims may lose their extremities. extremities.

Clinical and Autopsy findingsClinical and Autopsy findings

Systemic hypothermia is cooling below 35°C. Death is due to Systemic hypothermia is cooling below 35°C. Death is due to cessation of circulation usually preceded by ventricular cessation of circulation usually preceded by ventricular fibrillation. The body temperature range at which this occurs is fibrillation. The body temperature range at which this occurs is 21-26°C. Body cooling in this range may be seen in Barbiturate 21-26°C. Body cooling in this range may be seen in Barbiturate intoxication. Clinically this condition is manifested as redness intoxication. Clinically this condition is manifested as redness in the skin , shivering, vasoconstriction, a disappearance of in the skin , shivering, vasoconstriction, a disappearance of body movements, muscle stiffness and unconsciousness.body movements, muscle stiffness and unconsciousness.

The autopsy reveals red livor almost like Carbon Monoxide livor. The autopsy reveals red livor almost like Carbon Monoxide livor. Edema may be seen in the dermis, right side heart dilatation, Edema may be seen in the dermis, right side heart dilatation, respiratory tract edema, Gastric erosions may be seen (in respiratory tract edema, Gastric erosions may be seen (in Poland these erosions are called “Wiszniewski’s erosions”). Poland these erosions are called “Wiszniewski’s erosions”). Pancreatic changes of inflammation are reported. Fat emboli Pancreatic changes of inflammation are reported. Fat emboli have been described.have been described.

COLD TRAUMACOLD TRAUMA

SYSTEMIC HYPOTHERMIASYSTEMIC HYPOTHERMIA ENVIRONMENTAL - Climatic Exposure TypesENVIRONMENTAL - Climatic Exposure Types

1.1. Dry Cold typeDry Cold type2.2. Immersion or wet cold TypeImmersion or wet cold Type3.3. With alcohol and drug useWith alcohol and drug use4.4. With physical exertion (sports) With physical exertion (sports) 5.5. With poor physical condition With poor physical condition

COLD TRAUMACOLD TRAUMA

THERAPEUTIC - Cryotherapy and CryosurgeryTHERAPEUTIC - Cryotherapy and Cryosurgery1.1. Skin wart removalSkin wart removal2.2. Eye surgery- retinal detachmentEye surgery- retinal detachment3.3. Gastric ulcer bleeding controlGastric ulcer bleeding control4.4. Prostate freezingProstate freezing

SummarySummary

The investigation of injury and deaths due to The investigation of injury and deaths due to hypothermia must be accompanied by an hypothermia must be accompanied by an understanding of the history in the case, the condition understanding of the history in the case, the condition of the health and state of intoxication of the individual. of the health and state of intoxication of the individual. The findings of cold injury should be determined as well The findings of cold injury should be determined as well as the temperature of the environment as well as the as the temperature of the environment as well as the body. body.

Chemical TraumaChemical Trauma

General Aspects - Chemical trauma may be seen externally General Aspects - Chemical trauma may be seen externally and determined as present in internal organs occasionally by and determined as present in internal organs occasionally by gross appearence or by histologic examination. The injury may gross appearence or by histologic examination. The injury may be immediate or delayed. The exposure to chemical injury may be immediate or delayed. The exposure to chemical injury may be through the skin, the gastrointestinal tract, the lungs or be through the skin, the gastrointestinal tract, the lungs or through mucous membranes or by injection into blood vessels through mucous membranes or by injection into blood vessels or subcutaneous tissues. The noxious or toxic substances may or subcutaneous tissues. The noxious or toxic substances may be in the form of gases, liquids, solids or vapors. be in the form of gases, liquids, solids or vapors.

These substances may act as corrosives, irritants, protoplasmic These substances may act as corrosives, irritants, protoplasmic poisons or toxic substances producing hemorrhagic or chemical poisons or toxic substances producing hemorrhagic or chemical changes in the blood and tissues.changes in the blood and tissues.

EXTERNALEXTERNAL

Skin - burns, tanning, skin slippage - gasoline, charring Mucous Skin - burns, tanning, skin slippage - gasoline, charring Mucous membranes - reddening, ulcerations, bleeding Esophagus - membranes - reddening, ulcerations, bleeding Esophagus - erosions, ulceration, charring, constriction-late Eyes - reddened, erosions, ulceration, charring, constriction-late Eyes - reddened, corneal damage, scarring, blindness Anus and rectal area - corneal damage, scarring, blindness Anus and rectal area - erosions, bleeding, scarring Fingers and hand - infant erosions, bleeding, scarring Fingers and hand - infant contractures due to scarringcontractures due to scarring

INTERNALINTERNAL

General - acidosis or alkalosisGeneral - acidosis or alkalosis GI tract - ulcers, perforation, obstruction, contractures, GI tract - ulcers, perforation, obstruction, contractures,

adhesionsadhesions Kidney - swelling, renal failure, hemorrhageKidney - swelling, renal failure, hemorrhage Bladder - cystitisBladder - cystitis Lungs - pneumonia, bronchial erosions, bleeding, respiratory Lungs - pneumonia, bronchial erosions, bleeding, respiratory

failurefailure Brain - anoxia, depression, brain death - barbituratesBrain - anoxia, depression, brain death - barbiturates Heart - cardiac muscle toxicityHeart - cardiac muscle toxicity

Heat TraumaHeat Trauma

Heat trauma may occur without direct contact with fire Heat trauma may occur without direct contact with fire by exposure to high degrees of heat. This occurs if a by exposure to high degrees of heat. This occurs if a victim is exposed to high temperatures as from the victim is exposed to high temperatures as from the climate or in a closed space exposed to high levels of climate or in a closed space exposed to high levels of heat as occurred during fire raids in victims in shelters. heat as occurred during fire raids in victims in shelters. The body is left in a baked condition in this case. The The body is left in a baked condition in this case. The victim may suffer mild heat exhaustion, serious shock victim may suffer mild heat exhaustion, serious shock and cerebral injury or stroke. The latter is characterized and cerebral injury or stroke. The latter is characterized by rapid increase in body temperature with dry, hot by rapid increase in body temperature with dry, hot skin.skin.

The investigation of a potential heat related death The investigation of a potential heat related death should include information about the environmental should include information about the environmental conditions at the time of exposure. This may be conditions at the time of exposure. This may be obtained from the weather bureau who will relate obtained from the weather bureau who will relate temperature variation, humidity, wind velocity and cloud temperature variation, humidity, wind velocity and cloud cover information. The circumstances of exposure and cover information. The circumstances of exposure and temperature of the environment are also important. temperature of the environment are also important. The findings at autopsy may merely be congestion of The findings at autopsy may merely be congestion of viscera. Petechiae may be seen on the surfaces of the viscera. Petechiae may be seen on the surfaces of the pleura and on the abdominal organ surfaces. pleura and on the abdominal organ surfaces.

Heat TraumaHeat Trauma

Electrical traumaElectrical trauma

May or may not be obvious. Thus a death produced by electric current may May or may not be obvious. Thus a death produced by electric current may be missed unless there is a degree of suspicion or obvious injury. The be missed unless there is a degree of suspicion or obvious injury. The examination of a potential electrocution victim must include careful search examination of a potential electrocution victim must include careful search for contact injury. for contact injury.

The investigation of an electrocution must include study of the source of The investigation of an electrocution must include study of the source of electricity. The defect in the grounding of the electrical source must be electricity. The defect in the grounding of the electrical source must be determined. The amount of current is also important to know. A low determined. The amount of current is also important to know. A low intensity current or 25-74 milliamperes may produce cardiac arrest during intensity current or 25-74 milliamperes may produce cardiac arrest during diastole or if for more than 30 seconds will produce fibrillation. Low voltage diastole or if for more than 30 seconds will produce fibrillation. Low voltage kills immediately or not at all. Currents from 75 milliamperes to 3-4 kills immediately or not at all. Currents from 75 milliamperes to 3-4 milliamperes may give rise to cardiac fibrillation and currents of higher milliamperes may give rise to cardiac fibrillation and currents of higher intensity to cardiac standstill or arrhythmias. The manner of death may be intensity to cardiac standstill or arrhythmias. The manner of death may be accidental, suicidal or homicide.accidental, suicidal or homicide.

Electrical traumaElectrical trauma - - SOURCES AND TYPESSOURCES AND TYPES

Natural - Lightning stroke Static ElectricityNatural - Lightning stroke Static Electricity Accidental Electromagnetic Waves Accidental Electromagnetic Waves

Physiotherapy, Radar, Microwaves Home, Physiotherapy, Radar, Microwaves Home, Industrial, Hospital sourcesIndustrial, Hospital sources

Homicidal & Suicidal Homicidal & Suicidal