LEGAL MED TRANS p. 312-320 b. Nose- suicide: muzzle of gun may be placed in the nostril and there would be no visible wound of entrance -injuries are dangerous due to infection to the brain c. Ear- rupture of the tympanic membrane -hemorrhage suggests fracture of the base of the middle cranial fossa d. Mouth- fracture of lower jaw is due to direct violence and is the most common in the insertion of the canine and region of the condyle -spread of infection is to the respiratory system Injuries to the Lungs -hemorrhage cause compression and collapse of the lungs -contusion may be caused by blunt instrument or compression of the chest -death is due to shock and hemorrhage Complications of Lung Injuries a. Hemorrhage- 1500cc may be recovered sa pleura b. Compression of lungs –death by asphyxia c. Severe pneumothorax- laceration of bronchi d. cerebral air embolism- laceration of pulmo veins e. Hemoptysis – f. Subcutaneous emphysema- laceration of parietal pleura and lung Neck-ligature marks: death by hanging or strangulation -cut throat wounds: diagonal -homicidal wounds: horizontal -asphyxia, pneumonia, hemorrhage, shock: cause of death -wounds of the esophagus are not common -reflex by the vagus nerve can cause loss of consciousness or even death Injuries to the Heart (aawwwww....) -sharp instruments, bullets, sharp fractured ribs -contusion is easily produced in slight trauma -wounds in the ventricle less dangerous because of thick muscle layer -right vent: most common wounds with external violence -rupture of aorta: may be due to aneurysm -cause of death: hemorrhage or cardiac tamponade Vertebral Column and Spinal Cord: a. Fracture of the Vertebrae- Fracture of C1-4 can cause paralysis of the phrenic nerve *causes of the fracture of the spine: (1) direct violence –blow from back, fall, collision (2) Indirect violence – fall on feet, buttocks, forcible bending of the body, twist of the body b. Concussion of the spine -occur even without external injuries -Sx: headache, restlessness, pain in spine, loss of sexual power, irritability of the bladder Injuries of Diaphragm -penetrating wounds cause herniation of organs 2. Injuries in the Chest Injuries to the chest wall -easily contused because ribs are superficial -stab wounds are common -rib fracture: pain in respiration Causes of rib fracture: a. direct violence – blow, stab, bullet b. indirect violence- fracture is not at the site of application of force -crush injuries, pressure on the chest -usually mid-axillary -usual site of fracture of sternum is the junction of the manubrium and gladiolus, usually transverse -sternum fracture is associated with laceration of the pericardium and heart injury 3. Abdominal Injuries Abdominal Wall -most vulnerable: point of attachment of organs, source of blood supply, point where vessels change direction -triangle in the middle superior half of the abdomen: bounded by the ribs on both sides and horizontal line through the umbilicus is prone to trauma Stomach-gastric ulcer or new growth causes rupture -rupture most frequent in pyloric end and greater curvature Intestine-cause of death: peritonitis and hemorrhage Liver –one of the most vulnerable -right lobe more frequently involved -rupture is usually transversely or AP Spleen –superficial and fragile so involved in trauma -laceration is common in the hilus Kidney –right is more vulnerable -“crush syndrome”:secondary kidney changes in crush injuries; edema and anuria after crush Pancreas-fat necrosis after trauma if not death 4. Pelvic injuries -fracture of pubis is the most common -urinary bladder may be injured Urinary Bladder- Sx of rupture include pain in lower abdomen, bloody urine, muscle rigidity Uterus-gravid uterus is likely to rupture in trauma Vagina-laceration is due to sexual act or faulty instrumentation in criminal abortion