OLFU COLLEGE OF MEDICINE CLASS 2017
Legal Med Physical Injury: Part 1
PHYSICAL INJURY
 Effect of some form of stimulus on the body
 Becomes apparent only if stimulus applied is
SUFFICIENT!
 May be acute or delayed depending on the
type of applied stimulus
CAUSES OF PHYSICAL INJURIES
 Barometric trauma or Dysbarism
 Radiation from radioactive substances
 Heat or Cold (thermal injury)
 Electrical energy (lightning or socket)
 Chemical energy → injury that cause changes
from one chemical state to the next
(explosion)
 Infection
 Physical violence
BAROMETRIC TRAUMA
 Hyperbarism
 Hypobarism
HYPERBARISM
 Increase in atmospheric pressure
 Condition commonly seen in scuba divers, oil
rig divers, salvage divers and caisson miners
HENRY’S LAW
 At a constant temperature
 Increase in pressure = increase in dissolved
gases in the blood
Trans by: URACIL MD
3rd year
Dr. Lising
NITROGEN NARCOSIS
 Caused by excessive amounts of dissolved
nitrogen in the blood
 Preceded by a feeling of euphoria and later on
a feeling of drunkenness
 Dangerous when at depth because it may
cause the diver to do foolish things or to fall
asleep
 Nitrogen – most common gas in the
atmosphere (75%)
 Causes euphoria just like when you are
drunk
 Conscious and rational decisions are
impaired
OTHER HYPERBARIC CONDITIONS
 Pulmonary edema
- occurs w/in 6 hours of diving
- Exact cause is unknown
- Theoretically occurs due to the difference in
pressure brought about by diving in the
pulmonary capillaries
 Tympanic membrane damage
- Results from the difference in pressure in
the middle ear and the external auditory
meatus → Rupture tympanic membrane
- Valsalva maneuver – is used to equalize
pressure in the said chambers
EFFECT OF ASCENT FROM DEPTH
 Gradual ascent
- Untoward effects may not be observed
 Rapid ascent
- Gases which was previously dissolved would
be released causing pneumothorax and air
embolism
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 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 1 Dr. Lising

POST MORTEM FINDINGS HYPOBARISM

 Immediate Death  Caused by a decrease in atmospheric pressure
- Subcutaneous emphysema resulting in liberation of dissolved gases to
- Generalized visceral congestion the tissues
- Presence of air bubbles  May be observed by:
 Death occurred after several days - Going up to a higher altitude
- Degeneration and softening of the white - Ascending from depths while diving
matter of the spinal cord
- Fat necrosis of the liver SIGNS OF HYPOBARISM
- Osteonecrosis  Bends
- Decompression sickness
COMMON SIGNS OF DIVING BEND - Pain in the joints and muscles due to gas
 Head deposition in the said areas
- Vertigo - Causes a patient to bend to minimize the
- Poor balance pressure of the muscle or joint
- Confusion  Chokes
- Nausea - Results from bubble formation in the
- Fatigue pulmonary capillaries resulting to coughing
- Unconsciousness and distress
 Chest and body - Distress caused by impairment in air
- Skin rash exchange
 Spine  Substernal emphysema
- Abdominal pain - Gas accumulates under the skin
- Loss of bladder function - On examination: manifests as crepitus
- Paralysis
 Fingers and feet TRAPPED GAS
- Tingling, pins and needles  Trapped gas expands with decreasing
 Knees, elbow, shoulders pressure
- Joint pain  Boyle's law P1V1=P2V2
 At 18,000 ft. – hollow viscus size doubles
 At 33,000 ft. – hollow viscus size quadruples

Trans by: URACIL MD 2

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 1 Dr. Lising

ANOXIA
 Seen in alpine climbing and aircraft related
decompression injuries
 Oxygen content decreases as altitude
increases
 Hypoxia – 8,000 to 15,000 ft. above sea level
 34, 000 ft. above sea level – requires oxygen
supplementation

RADIATION RELATED INJURIES

 Caused by ionizing radiation that is released
either by fission or fusion of atomic nuclei
 Became apparent after the detonation of the
atomic bombs in Hiroshima and Nagasaki
 100 lbs. of uranium = 1 million tons of TNT

ATOMIC BOMB EXPLOSION

 Produces millions of pounds of pressure per
square inch (psi)
 Fireball has a diameter of 7,200 ft. in 10
seconds
 4 ½ miles in diameter in 1 minute

TYPE OF EXPLOSIVE
 Fission type
- Core is Uranium
- 4.5 blast range
 Fusion type
- Core is Hydrogen (Deuterium) INJURY DEPENDS ON PLACE OF DETONATION
- 9 blast range  Aerial detonation or airburst
- Thermonuclear bomb  Ground detonation or groundburst
 Specialized type of explosive  Submarine detonation
- Neutron bomb  Subterranean detonation
 Produces neutron radiation  Aerial and Ground
 Destroys any living things
- can kill people
- Salted bomb
 Submarine and Subterranean
 Deny the area
- used for testing
- Suitcase bomb
 Mk 54 SADM (Special Atomic Demolition
Munition) TYPES OF EMITTED RADIATION PARTICLES
 Man portable H192  Alpha radiation
- Dirty bomb
 Beta particle
 Conventional bomb that has radioactive
 Gamma rays
material
 Neutron
 X-rays

Trans by: URACIL MD 3

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 1 Dr. Lising

 ɑ  Nausea and Vomiting

- low energy - caused by sloughing off of epithelium
 β of abdomen/gastric area
- more powerful  Lymphoid tissue
- allow damage up to SQ layer - replicates fast
- Thyroid Ca - replication is stopped due to DNA
 Ƴ damage causing ulceration
- high energy particle
- DNA damage
FACTORS AFFECTING SUSCEPTIBILITY
- goes thru body
 Age
 Neutron
 Dosage
- kills human due to cellular dysfunction
 Type of radiation particle exposed to
 X-rays fractional doses → Radiotherapy
- high energy particles  Sensitivity (genetic)
- has therapeutic value
- stops by bones, metals OTHER SOURCES OF RADIATION
 Natural Sources
- Sun
EFFECTS OF IONIZING RADIATION
- Naturally occurring Uranium
 Inversely proportional to the distance
 Man-made Sources
 1 megaton can cause fire up to 10 miles in
- X-ray
diameter
- CT scan
 The damage is primarily attributed to the
 Clinical Nuclear Medicine
thermal and pressure injuries
- Radiotherapy
 Ionizing radiation causes damage to DNA by
- Industrial sources (Nuclear Powerplant)
formation of cross linkages and other cellular
structures by formation of highly reactive free
THERMAL INJURIES
radicals
 Caused by appreciable deviation from normal
 General Effects
temperature
- Massive doses
 Either a decrease or an increase
 Generalized erythema
- Cold – frostbite
 Disorientation
- Heat – burns or scalds
 Coma
 Death
DEATH OR INJURY FROM COLD
- Lesser doses (doses gotten at a greater
 Unusual in tropical countries
distance)
 Cause of death
 Nausea
- Decreased dissociation of oxygen from
 Vomiting
hemoglobin in the RBC
 Leukemia
- Diminished ability of the tissue to utilize
 Delayed Effects
oxygen
- Ulceration of lymphoid tissue
- Vascular effects of cold causes hemostasis
- Easy fatigability
and later cell death, necrosis and infection
- Oro-pharyngeal ulceration
- Leukopenia
- Carcinomas especially thyroid carcinoma

Trans by: URACIL MD 4

 OLFU COLLEGE OF MEDICINE CLASS 2017
Legal Med Physical Injury: Part 1
MECHANISM OF DEATH FROM FREEZING
Trans by: URACIL MD
3rd year
Dr. Lising
DEATH OR INJURY FROM HEAT
 General or systemic
- Heat cramps
- Heat exhaustion
 Moist & clammy skin
 Pupils dilated
 Normal or subnormal temp
- Heat stroke
 Dry hot skin
 Pupils constricted
 Very high body temp
 Local
- Scalds
- Burns
HEAT CRAMPS
 Involuntary spasmodic contraction of muscles
 Due to dehydration and excessive loss of
electrolytes
 Deceased potassium
 Treatment is IV fluid
HEAT EXHAUSTION
 Precipitated by muscular exertion and warm
clothing
 The hypothalamic center fails to continue
with thermoregulation
 Due to loss of fluid which prevents sweating
 At 42° → dead
HEAT STROKE
 Usually occurs among those working in ill
ventilated places with dry and high temp or
direct exposure to sunlight.
 Defined as body temp > 40.6°C
 Occurs due to the failure of the body's
thermoregulatory control
 May lead to cardiac arrest
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 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 1 Dr. Lising

LOCAL EFFECTS PURPOSES OF INTENTIONAL FIRE

 To conceal identity and true cause of death
 To commit homicide
 To commit insurance fraud
 To commit suicide → common in India
 To perpetuate a cause

PROOF OF BURNING ANTEMORTEM

 Presence of smoke in the air passage
- Grayish-black amorphous material in the
mucosa of the larynx, trachea or bronchi
 Inflammation of the lung and airway

BURN CLASSIFICATION

 First degree
 Second degree
 Third degree

 Increased carboxy-hemoglobin blood levels

 Dermal erythema, edema and vesicle
formation (signs of inflammation)
 Subendocardial left ventricular damage

Trans by: URACIL MD 6

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 1 Dr. Lising

HEAT RUPTURE ◦○ END ○◦

 Splitting of the soft tissues of the body d/t Sources:
exposure to considerable heat - Dr. Lising Lecture 2015
 May be post or ante-mortem - Solis Legal Med
 Need to be differentiated from: - 01/25/14 Legal Med Trans
- Incised wound
- Lacerated wound

HEAT STIFFENING
 Exposure to temp > 75°C
 Caused by coagulation of CHON resulting to
shortening of muscle
 Assumes the pugilistic attitude – lower and
upper extremities are flexed and hands are
clenched

CHEMICAL BURNS
 Results from the action of strong acids and
alkalis and other irritant chemicals
 May cause extensive tissue destruction
 Characteristics:
- Absence of vesication
- Staining of the skin with the chemical
- Presence of the chemical
- Ulcerative patches of the skin
- Inflammatory erythema of the skin
- Delayed healing of the skin damage

Trans by: URACIL MD 7