Nem’s Notes…
Phase 2 Year 2
INFECTION, IMMUNITY & CELLULAR PATHOLOGY 8 (page 1 of 2)
Forensic Medicine
Wound
Damage to any part of the body by the application of violence. Clinically wounds are a
composite of the following basic injuries.
Abrasion
(a) ‘Graze’ or ‘scratch’.
(b) Superficial injury to the skin usually resulting from a tangentially applied force.
(c) May bleed if papillary vessels are breached.
(d) May show direction of application of force.
(e) In crush or patterned abrasions the force is applied vertically leaving an imprint of
the object applying the force.
Laceration
(a) Full thickness of skin is penetrated due to blunt tear or crush.
(b) Often associated with abrasion and bruising.
(c) Narrow margin of bruising and crushing.
(d) Bridging by tissue strands or hairs.
(e) The nature of the underlying tissue is important (eg scalp laceration may look
clean like an incised wound).
Incised Wound (a) Caused by a sharp object.
(b) Skin and underlying tissue are clean cut and have minimal adjacent injury.
(c) Stab wounds are special cases where the depth is greater than width.
(d) Nature of external wound and depth of internal wound may indicate weapon.
(e) Caution is required innocent-looking wounds may conceal bad trauma.
Gun-Shot
Wound
(a) Caused by either shotgun (scattered shot which causes multiple lacerations) or
(b) Rifle or handgun (single circular incised wound with concentric contusion).
(c) There may be an entrance and exit wound indicating internal bullet path.
(d) Strictly this is a composite of an incised wound and contusion.
Contusion
(Bruise)
(a) Extravascular collection of blood resulting from mechanical blood vessel damage.
(b) Externally visible bruising mainly involves subcutaneous fat.
(c) Deeper bruising may involve muscle or parenchyma of organs.
(d) Patterned objects may leave mark intradermally (eg shoe-tread)
(e) Tramline bruising occurs from rectangular or cylindrical objects.
If the bruise appears fresh without colour changes then it is unlikely to be more than 2
days old. Bruises that are turning bluish brown or greenish brown are likely to be
older. Yellow bruises are likely to be more than 18 hours old. Several bruises of the
same size and roughly in the same area of different colours strongly suggests that
they were sustained at different times.
Attempted
Strangulation
(a) Bruising to the neck.
(b) Petechial haemorrhages in the face, conjunctivae and ears.
(c) Mucosal haemorrhage.
(d) May be injury to larynx.
Degree of
Force
The degree of force must take into account the nature of the object. For instance the
same degree of force can be exerted by a fast moving light object and a slow moving
heavy object.
more online at http://homepage.virgin.net/nemonique.sam/noteindx.htm page 1 of 2
Nem’s Notes…
Phase 2 Year 2
INFECTION, IMMUNITY & CELLULAR PATHOLOGY 8 (page 2 of 2)
Forensic Medicine
Child Abuse
Features to be aware of:
(a) Delayed presentation
(b) Repeated presentation for no obvious reason
(c) Explanations inconsistent with findings
(d) Poisoning (including salt and other household substances)
(e) Burns (including cigarette burns)
(f) Bites
(g) Finger type bruises, gripping of limbs
(h) Frenular tears
(i) Genital injuries
(j) Skeletal injuries
Characteristic radiological features
Metaphyseal and epiphyseal injuries
Sub-periostal haemorrhage
Any fracture before the child is mobile is suspicious
(k) Signs of shaking
Subdural haemorrhage
Retinal haemorrhage
(l) Respiratory problems due to partial suffocation
(m) Visceral injuries
Statement
Writing
(a) Preamable. (Who you are. Your capacity. Relevant specialist skills.)
(b) Time, date, place.
(c) Factual systematic account of injuries sustained.
(d) Formulation and opinion (eg the injuries were consistent with having been...)
But do not go beyond your level of expertise.
(e) Opinion on causes, timing and mechanism.
(f) Body diagrams are a good method for recording injuries.
more online at http://homepage.virgin.net/nemonique.sam/noteindx.htm page 2 of 2