LEGAL

 MEDICINE   CAUSES  OF  INJURY  

DR.  LISING  
CAUSES  OF  INJURY    
• Mauling   Sport  injuries  
• Domestic  Injury   • Boxing  
• Industrial  Accident   • Wrestling  
• Vehicular  Accident   • Newer  sports  with  attendant  risks:  
• Sports  Injury   o Mixed  Martial  Arts  
• Stabbing  Injuries   o Extreme  Games  
• Gunshot  Injuries   o Sky  Diving  
   
Mauling   Injuries  common  in  combat  sports  
• Results   from   a   violent   altercation   between   2   persons   or   • Lacerations  to  the  eyebrow  &  malar  region  (cheek)  
groups  of  persons   • Hemorrhage   secondary   to   the   blood   vessel   rupture   or  
• Injury  may  be  sustained  by:   fracture  of  the  orbital  plate  of  the  frontal  bone  known  as  
o The  feuding  parties   Spectacle  Hematoma  
o Bystanders   • Hematoma   of   pinna   with   auricular   cartilage   necrosis  
  known  as  Cauliflower  ears  
Domestic  &  Industrial  accidents   • Cerebral  concussion  
• Usually   results   from   the   myriad   of   combinations   of  
accidents  at  home  or  at  work  
• A   physician   must   note   whether   there   is   presence   of  
alcohol  on  the  patient  
 
Vehicular  Accidents  
• Factors  responsible  in  VAs  
o Human  factor  
o Environmental  factor    
 
o Mechanical  factor  
• Subdural  hemorrhage  (most  common)  
o Social  factor  
o Pedestrian  
Human  factors  
• Mental  Attitude  
• Perception  Defects  
• Delayed  or  Sluggish  Reaction  Times  
• Disease  
• Chemical  Factors  
   
Factors  responsible  for  passenger  and  driver  injury    
• Impact  within  structures   • Pontine  hemorrhage  (known  as  boxer’s  hemorrhage)  
• Ejection  
• Direct  impact  with  other  vehicle  occupants  
• Acceleration-­‐deceleration  injury  (Whiplash)  
 
Pedestrian-­‐vehicle  collision  
• Primary  impact  
o Causes  injuries  such  as  bumper  fractures  as  well  
as  patterned  wounds  of  the  front  grills  
 
• Secondary  impact    
• Run  over  injuries   Stabbing  injuries  
o Usually   results   to   patterned   injuries   such   as   tire   • Anything   with   an   edge   could   be   used   for   injuries   of   this  
tread  contusion  as  well  as  abrasions   type  
• Hit  and  Run  injuries   o Knives  
  o Bolo/Machete  
Motorcycle  injuries   o Broekn  bottles  
• Is  the  leading  cause  of  vehicular  accidents   o Scalpels  
• Reason  for  increase:   o Sharpened  instruments  such  as  shanks  
o Relatively  number  of  motorcycles    
o Relatively  small  profile  of  motorcycles   Legal  Classification  
o Continued   failure   to   use   mandated   safety   • Mutilation  (Art  262  RPC)  
equipment   o Intentionally   depriving   a   person,   totally   or   partially  
o Very   little   material   in   a   motorcycle   to   cushion   the   of  some  of  the  essential  organs  of  reproduction  
impact  

      TRANSCOM  |  DRA.  JACKIE   1  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
o Intentionally   depriving   a   person,   totally   or   partially   o There  is  a  tumultuous  affray  
of  any  part  other  than  that  of  theessential  organs  of   o Participants  suffered  from  serious  physical  injuries  
reproduction   o Persons  who  inflicted  could  not  be  identified  
• Serious  Physical  Injuries  (Art  263  RPC)   o All   those   who   appear   to   have   used   violence   upon  
o Done  by:   the   offended   party   shall   be   penalized   by   arresto  
! Wounding   from  5  to  15  days  
! Beating    
! Assaulting   PD  169  
! Administering  injurious  substances  without  the   • A   physician   must   report   cases   of   serious   and   less   serious  
intent  to  kill   physical  injuries  
o Graduated    
! Prision  mayor   GUNSHOT  INJURY  
• Person   shall   become   insane,   imbecile,  
impotent  or  blind   FIREARM  
! Prision  correctonal  (medium  to  maximum)   • An  instrument  used  for  the  propulsion  of  a  projectile  using  
• Loss   of   the   use   of   speech,   power   to   expansive   force   of   gases   coming   from   the   burning   of  
hear/smell  loss  of  an  eye,  hand,  foot,  arm   gunpowder  
&  leg  
• Includes:  
• Loss  of  use  of  any  such  member  
o Rifles  
• Becomes   incapacitated   for   the   work   in  
which  he  was  habitually  engaged  
o Muskets  
! Prision  correcional  (minimum  to  medium)   o Shotguns  
• Person  shall  become  deformed   o Revolvers  
• Loss  of  any  other  member  of  his  body   o Pistols  
• Loss  the  use  thereof    
• Becomes   ill   or   incapacitated   for   the   Classification  of  Firearms  
performance   of   work   habitually   engaged   • As  to  wounding  power  
in  for  more  than  90  days   o Low  velocity  firearm  (<1,400  fps)  
! Arresto   Mayor   (maximum)   to   Prisioncorrecional  
o High   power   firearm   (>1,400   fps   but   usually  
(minimum)  
2,200-­‐2,500  fps)  
• Becomes   ill   or   incapacitated   for   the  
performance   of   work   habitually   engaged   • As  to  nature  of  the  bore  
in  for  more  than  30  days   o Smooth  bore  
  o Rifled  bore  
• Administering   Injurious   Substance   or   Beverages   (Art   264   • As  to  manner  of  firing  
RPC)   o Pistol  –  single  handed  weapon  
o Infliction  upon  another  of  any  serious  physical  injury   o Rifle  –  shoulder  fired  weapon  
o It  was  done  knowing  that  the  substance  is  injurious   • As  to  the  nature  of  the  magazine  
or   took   advantage   of   the   victims   weakness   or   o Cylindrical  revolving  magazine  
credulity   o Vertical  or  horizontal  magazine  
o No  intent  to  kill    
  Components  of  a  weapon  
• Less  Serious  Physical  Injuries  (Art  265  RPC)   • The  Cartridge  
o Incapacitate  the  offended  party  from  labor  for  more   • The  Firearm  
than  10  days    
o Requires  medical  attendance  for  more  than  10  days   The  Cartridge  
o Qualified  by:   • Cartridge  Case  or  Shell  
! Manifest   intent   to   insult   or   offend   the   injured   • Primer  
person   • Powder  or  propellant  
! Circumstance  adding  ignominy   • Bullet  or  projectile  
! Victim   is   the   offender’s   parents,   ascendants,    
guardian,  curators  or  teachers  
! Victim  is  a  person  of  rank  or  authority  
 
• Slight  Physical  Injuries  (Art  266  RPC)  
o Incapacitate  the  offended  party  from  labor  for  1  to  9  
days  (arrestomenor)  
o Causes   injury   which   do   no   prevent   the   offended  
party   from   working   nor   require   medical   attendance    
 
(arrestomenor,  censure)  
o Ill-­‐treatment  by  deed  
 
• Physical   Injuries   Inflicted   in   a   Tumultuous   Affray   (Art   252  
RPC)  

      TRANSCOM  |  DRA.  JACKIE   2  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
• Plastic  Bullet  
• Bullet  with  Plastic  Sabot  
• Bullet  with  Secondary  Explosion  
• Soft  Point  Bullets  
*  Depleting  uranium  tip  
*  Teflon  
 
FIREARMS  

 
  • Parts  of  the  firearm  of  medicolegalimportance:  
  o Trigger  with  firing  pin  
  Cartridge  Case  or  Shell   o Barrel  
• Cylindrical   structure   with   a   base   which   houses   the    
different  parts  of  the  ammunition   Trigger  
• May  be:   • Part  of  the  firearm  which  causes  the  firing  evolution  
o Cartridge  with  a  rim   • Classification:  
o Rimless  cartridge   o Relation  of  cocking  &  trigger  pressure  
o Semi-­‐rimless  cartridge   ! Single  action  
o Belted  cartridge   ! Double  action  
  o Number  of  shots  on  pressure  on  the  trigger  
Primer   ! Single  shot  firearm  
• Functions  to  transform  the  mechanical  energy  of  the   ! Automatic  firearm  
firing  pin  to  chemical  energy  by  its  rapid  combustion    
• Located   at   the   base   of   the   cartridge   and   covered   by   a   Barrel  
small   disc   of   soft   metal   known   as   percussion   cap   or   • Riflings  
primer  cap   o Series   of   parallel   spiral   grooves   on   the   whole  
• Center  fire  cartridge   length  
o Percussion  cap  located  at  the  center   • Land  
o Most  common   o Space  between  2  grooves  
• Rimfire  cartridge    
o Primer  is  placed  inside  the  rim  of  the  shell  
o Common  in  0.22  caliber  firearm  
• Firearm  with  a  pin  
 
Gunpowder/propellant  
• Primary  propulsive  force  in  the  cartridge  
• Types  of  Propellant  
o Black  powder  (80%KNO3,  15%S,  10%C)  
o Smokeless  powder    
 
! Single   base   (either   cellulose  
1)  Number  –  varies  from  2-­‐12  
nitrate  or  nitroglycerin)  
 
! Double  base  (contains  both)  
2)  Twist  Rate  –  expression  of  1  complete  twist  
o Semi-­‐smokeless   powder   (80%black   &  
 
20%smokeless)  
3)  Direction  –  clockwise  or  counterclockwise  
 
 
Bullet  
4)  Width  
• The   projectile   attached   to   the   free   end   of   the  
 
cartridge  case  
• Determination  of  caliber  
• Classification:  
o Distance  of  the  barrel  between  2  lands  
o Shape  of  the  tip  
 
! Conical  
Mechanism  of  Firearm  action  
! Hemispherical  
! Wad  cutter  (square  nose)  
! Hollow  point  
o Presence  or  absence  of  jacket  
! Naked  lead  bullet  
! Jacketed  bullet  (full  or  semi)  
 
Special  Bullets  
• Armour  piercing  bullets  
• Phosphorus  flare  or  tracer  bullet    

      TRANSCOM  |  DRA.  JACKIE   3  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
Thing  which  come  out  of  the  muzzle  after  firing   Destruction  Mechanism  of  Gunshots  
• Bullet   • Lacerations  &  permanent  cavity  of  the  bullet  trajectory  
• Flame   • Temporary  Cavity  
• Heated,  compressed  and  expanded  gas   o The  greater  the  velocity,  the  greater  the  cavity  
o Instantaneous   radial   displacement   of   the   soft   tissue  
• Residue  coming  from  bullet  (fragment  or  lubricant)   during  the  passage  of  the  bullet  
• Primer   o Secondary  to  the  liberation  of  kinetic  energy  
• Powder  particles   • Hydrostatic  force  
o Powder  grains   o The   bullets   kinetic   energy   is   imparted   upon   the   fluid   in  
o Soot   the  fluid  filled  cavities  creating  as  secondary  projectile  
o Graphite   • Shock  wave  
• Barrel   o Dissipation   of   kinetic   energy   in   a   radial   direction  
perpendicular  to  the  path  of  the  bullet  
o Lubricant  
• Fragmentation  of  the  bullet  
o Rust,  Dust   o Bullet  breaks  apart  into  multiple  projectiles  
o Scraping  form  previous  fire   • Fragmentation  of  hard  brittle  object  in  the  bullet  trajectory  
• Cartridge  Case   o Bone  fragmentation  
  • Muzzle  blast  
Bullet  Movement   o Occurs  in  contact  fire  
• Forward  movement   • Other  complication  
• Spinning  movement   o Hemorrhage  
o Infection  
• Tumbling  movement   o Paralysis  
• Wobbling  movement   o Loss  of  function  
• Gravitational  Pull    
  Characteristics  of  Point  of  Entry  
Factors  Responsible  for  Injurious  effect  of  the  bullet   • Caliber  of  the  wounding  weapon  
• Inherent  on  the  bullet   • Characteristics  inherent  to  entrance  wound  
o Speed  of  the  bullet   • Direction  of  fire  
o Size  and  shape     • Shape  &  composition  of  missile  
o Character  of  the  missile’s  momentum  in  flight   • Range  
• Nature  of  the  target   • Kind  of  weapon  
o Density  of  the  target    
o Length  of  tissue  involvement   Point  of  Entry  –  contact  fire  
o Nature  of  media  traversed   • Where  bone  is  superficial  
o Importance  of  the  organ  involved   o Wound  is  large  and  stellate  shaped  
 
o Edges  may  be  everted  
Flame  
o Burns,   tattooing,   smudging   &   singeing   of   hair   is  
• Brought  about  by  the  ignition  of  the  propellant   present  
• Doesn’t  not  usually  go  beyond  distance  of  6”  and  in  pistols   o Muzzle  imprint  on  the  skin  
is  often  less  than  3”   • Where  bone  is  deeply  located  
• Causes  burning  of  the  skin  in  contact  or  near  fire   o Wound   is   usually   large,   circular   &   without  
  radiating  laceration  
  o Edges   may   be   everted,   some   tissue   may   be  
Heated,  Compressed  &  Expanded  Gas   found  in  the  gun  barrel  
• Brought  about  by  the  limited  space  in  the  chamber  of  the   o Burns,   tattooing,   smudging   &   singeing   of   hair   is  
firearm   present  
• Responsible  for  the  Population  of  the  projectile   o Muzzle  imprint  on  the  skin  
• Responsible  for  the  muzzle  blast    
  Point  of  Entry  –  near  contact  fire  
Smoke   • Wound   is   usually   large   &   circular   depending   on   the   angle  
• Product   of   the   complete   combustion   of   the   gunpowder   of  fire  
and  the  propellant   • Contusion  collar  distinct  
• Light  almost  black&  only  covers  the  skin   • Burns,  tattooing,  smudging  &  singeing  of  hair  is  present  
• May  be  readily  wiped  off   • Muzzle  imprint  on  the  skin  present  
• May  be  seen  up  to  a  distance  of  12”   • Blackening  of  the  bullet  tract  
   
Powder  grains   Point  of  Entry  –  short  range  fire  1-­‐15cm  distance  
• Product  of  the  incomplete  combustion  of  the  gunpowder   • Edges  of  the  wound  inverted  
  • Contusion  collar  distinct  
Contusion  Collar   • Tattooing  &  smudging  is  present  
• Caused  by  the  pressure  of  the  bullet  on  the  skin   • If  within  3”,  burns  may  be  present  
   
 

      TRANSCOM  |  DRA.  JACKIE   4  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
Point  of  Entry  –  medium  range  fire  15-­‐60cm   3. Arborescent  or  Filigree  burns  (Lichtenberg  figures)  
• Edges  of  the  wound  inverted   • Radiating  burns  from  a  point  
• Contusion  collar  distinct    
• Tattooing  &  smudging  (if  less  than  30cm)  is  present  but  of   Effects  of  lightning  
lesser  density   • Primarily  affected  is  the  CNS  
• Burns  &  singeing  is  absent   • Causes  spasmodic  contraction  of  the  cerebral  vessels  
  causing  hypoxia  
Point  of  Entry  –  greater  than  60cm  distance    
• Edges  of  the  wound  inverted   Post  mortem  findings  
• Contusion  collar  distinct   1. Externa  
• Tattooing,  smudging,  burns  &  singeing  is  absent   • Marked  tearing  of  the  clothing  
  • Burns  of  different  degree  
Point  of  Exit  (outshoot)   • Different  wound  patterns  
• No  characteristic  shape   • Magnetization  of  metals  in  the  clothing  
• Edges  are  usually  everted   • Fusion  of  metals  &  glass  
  • Singeing  of  the  hair  
Special  Consideration  on  Bullets   2. Internal  
• Souvenir  bullet   • Fracture  of  the  bones  
• Bullet  migration   • Internal  hemorrhage  due  to  rupture  of  organs  
• Tandem  Bullet   • Petechial   hemorrhage   of   the   lung,   pericardium   &  
  brain  
  ELECTRICAL  CURRENT  
Shotgun  Wounds   • Main  cause  of  death  is  SHOCK  
• Classes  of  shot  in  a  shotgun  shell   • Principal   factor   is   the   intensity   of   the   currentor   the  
1. Birdshot   –   small   &   measuring   200-­‐400   shots   in   the   amperage  
shell    
2. Buckshot   –   shot   ranges   from   .24   to   .33   inch   in   Factors  affecting  Electrical  shock  
diameter.  Std  12  gauge  =  9  shots   • Personal  idiosyncracy  
3. Single  Projectile  or  Rifled  slug   • Disease  
  o Heart  Disease,  presence  of  pacemakers  
Types  of  Shotgun   • Sleep  
• As  to  number  of  barrels   o Increases  resistance  to  electrical  current  
o Single  barrel   • Amperage  
o Double  barrel   o 70-­‐80  in  AC  
• As  to  the  manner  of  firing  &  reloading   o 250  in  DC  
o Bolt  action   • Resistance  of  the  body  
o Lever  action   o Lesser  resistance  =  greater  injury  
o Pump  action   • Nature  of  the  current  
o Autoloading   o AC  vs  DC  
  • Grounding  
  • Duration  of  contact  
LIGHTNING   • Kind  of  conductor  
LIGHTNING   • Point  of  entry  
• Electrical  charge  in  the  atmosphere    
• May  reach  1  Gigavolts  &  10,000  to  200,000  amperes   Mechanism  of  death  
• The  distribution  is  variable  &  unpredictable   • Ventricular  fibrillation  
  o Low  of  cardiac  output  
Elements  which  produce  injury   o Low  voltage  
• Direct  effect  of  current  on  the  body   • Respiratory  Failure  
• Surface  “flash”  burns  from  the  discharge   o Bulbar  paralysis  
• Mechanical  effect  of  air  expansion   o High  voltage  
• Compression  effect  of  superheated  air   • Mechanical  asphyxia  
o Causes  sledgehammer-­‐like  blow  on  the  body   o Prolonged  convulsions  
 
Classes  of  Burn  in  Lightning  Injury  
1. Surface  Burns  
• Superficial,  usually  under  metallic  objects  
2. Linear  Burns  
• Found  in  areas  of  least  resistance  
• May  vary  from  1  to  12  inches    

      TRANSCOM  |  DRA.  JACKIE   5  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
Electrical  Burns   Types  of  Chemical  Explosion  
• Other  names  include:   • Diffused  Reactant  Explosion  
o Electrical  necrosis   o Caused   by   mixture   of   gas   &   air   and   initiated   by   a  
o Electric  marks   flame  
o Current  markings   o Examples  include:  
• These  may  be  seen  at  the  point  of  entry  &  point  of  exit   ! Internal  combustion  engine  
• Skin   is   puckered   with   gray   color   &   traversed   by   deep   ! Fuel  Air  Bomb  
impressions  at  right  angles    
• Marks  are  painless   • Condensed  Reactant  Explosion  
• Show  no  signs  of  inflammation   o Caused   by   a   large   quantity   of   heat   &   gas  
  produced   as   a   consequence   of   a   rapid   chemical  
Metallization   reaction  in  a  liquid  or  solid  
• A  specific  feature  of  electrical  injury   o Radiating   in   an   outward   direction   thus   maximal  
• Metal   of   the   conductor   is   volatilized   &   the   particles   are   damage  is  sustained  nearest  the  point  of  origin  
driven  into  the  epidermis   o Subclassified  as:  
• Color  depends  of  the  conductor   ! Low   order   explosive   (Deflagrating  
o Iron  =  yellow  brown   explosive)  
o Copper  =  bluish   ! High  order  explosive  
o    
   
Post  mortem  findings   Low  order  explosive  
• Non  specific   • Relies   on   burning   &   confinement   ot   produce  
  explosions  
INFECTION   • Gunpowder   is   the   best   known   low   order  
explosive  
• Caused  by  a  pathogen   High  order  explosive  
• May  be:   • Type  of  explosive  which  detonates  
o Viral   • Detonation  is  a  chemical  process  which  results  in  
o Bacterial   the   extremely   rapid   decomposition   of  
o Parasitic   nitrogenous   compoung   releasing   heat   &   gas   as  
o Prions   its  by-­‐product  
• Discusses  further  in  IM-­‐Infectious   • Damage  is  caused  by  the  shock  wave  
• Of  medicolegal  importance:   o results   from   the   sudden   release   of  
o Weaponized  strains  pathogens   heat  &  gas  
  • Types:  
Historical  Implications   o Stable  
• Used  since  time  of  antiquity   o Unstable  
o Assyrians  –  used  fungus  of  poison  enemy  wells    
o Hannibal  –  used  snakes  on  enemy  ships   Stable  
o Mongols   –   animal   carcasses   to   poison   enemy   • Stable   until   detonated   by   another  
walls   explosive  such  as  a  blasting  cap  
• Advent  of  germ  theory   • E.g:  dynamite  &  plastique  such  as  C4  or  
o Weaponization  of  botulism  &  brucellosis   Semtex  
  Unstable  
Weaponization   • Easily   detonates   from   heat,   flame,  
• Incrasing  resistance  to  environmental  factors   spark  or  percussion  
• Means:   • E.g:  Picric  Acid  &  Nitroglycerin  
o Adding   cancer   genes   to   increase   the   robustness    
of  the  pathogen   Other  types  of  explosive  
• Usually  studied  pathogens   • Mechanical  or  Hydraulix  
o Small  pox   o Pressure   inside   a   container   exceeds   its   structural  
o Ebola   strength  
o Lassa   • Electrical  
o Anthrax   o Resutls  from  electrical  arc  
  • Nuclear  
CHEMICAL  ENERGY    
  Injury  is  due  to:  
• Primary  effects  of  detonation  
• Causes  injury  when  there  is  a  sudden  release  of  potential  
o Occurs  when  the  body  is  in  contact  with  the  explosive  
energy   into   kinetic   or   thermal   energy   causing   a   sudden   o Causes   complete   disruption   or   fragmentation   of   the  
increase  in  pressure   victim’s  body  
• Results  in  an  explosion  

      TRANSCOM  |  DRA.  JACKIE   6  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
o Compression-­‐decompression   effect   brough   about   by   o Barotrauma  
sudden  rise  &  fall  of  atmospheric  pressure   o Thermal  
  o Chemical  
• Secondary  to  the  blast  wave  
o Infection  
o Body  may  be  thrown  some  distance  and  dismembered  
o Hollow  organs  are  most  heavily  dmage  
 
o Triad  of  blast  wave  injury  is  present   • Manner  of  Infliction  
1. Punctuate  bruises   o Hit  
2. Abrasions   o Thrust/Stab  
3. Lacerations   o Gunpowder  explosion  
  o Sliding  or  Rubbing  
• Peppering  of  shrapnel    
o Secondary   to   the   effect   of   blast   wave   to   small  
• Depth  of  the  Wound  
fragments  
o May  be  metallic  or  not   o Superficial  
  o Deep  
• Other  blast  wave  effects   ! Perforating  (solid  organ)  
o May  cause  fall  related  injuries   ! Perforating   (communication   between  
o Damage  to  the  respiratory  organs   inner   &   outer   portion   of   the   hollow  
o Damage  to  theear  &  the  tympanic  membrane   organs)  
   
• Burns  from  the  flame  or  heated  gas  
• Relation  of  the  Site  of  Application  of  Force  &  the  Location  
• Asphyxia  due  to  lack  of  oxygen  
of  Injury  
 
• Smoke  inhaltion  &  poisoning   o Coup  injury  
o Carbon  monoxide  poisoning   o Contre-­‐Coup  injury  
o Nitrous  or  Nitric  gases   o Coup-­‐Contre  injury  
o Hydrogen  sulfide,  sulfur  dioxide,  HCN  gas   o Locus  Minoris  Resistencia  
  o Extensive  
• Direct  injury  from  flying  debris    
 
Contusion   Hematoma  
• Injuries  from  falling  debris  
  • Diffused   blood   • Diffused   blood  
PHYSICAL  VIOLENCE   is   in   the   in   newly  
interstitial   formed  cavity  
• Wound  is  a  natural  disruption  of  the  anatomic  integrity  of   tissue   • Always  
a  tissue  of  the  living  body.   • No  elevation  of   elevated  
• Used  synonymously  with  physical  injury  however,  physical   the  skin    
injury  does  not  always  result  in  a  wound   • Puncture   &   • Puncture   &  
  aspiration   of   aspiration  
Physics  of  wound  production   the   wound   yields   blood   &  
• Wound     yields  no  blood   subsequent  
=  kinetic  energy  x  Time  x  Area  x  Other  factors   depression   of  
2
• Kinetic  energy  =  ½  mv   the  lesion  
Where     M  =  mass    
V   =   velocity   (very   important   because   this   is   the   value   which   changes  
most.  That  is,  High  powered  rifle  bullet  vs  Pistol  bullet)  
 
Vital  reaction  
• Old  term  for  inflammation  
o Rubor  or  redness  or  congestion  
o Calor  or  sensation  of  heat  
o Dolor  or  pain  
o Loss  of  function    
  • Special  types  of  Wounds  
Classification  of  Wounds   o Defensive  wounds  
• Kind  of  Instrument  used   o Patterned  wounds  
o Blunt   o Self  inflicted  wounds  
o Sharp   o Extensive  
! Sharp  edged    
! Sharp  pointed   Types  of  Wounds  
! Edged  &  Sharp   • Closed  wounds  
o Tearing  force   o No  breach  in  the  continuity  of  the  skin  
  o May  be  superficial  or  deep  
• Kind  of  Instrument  used   • Open  wounds  

      TRANSCOM  |  DRA.  JACKIE   7  

 
 LEGAL  MEDICINE   CAUSES  OF  INJURY  
DR.  LISING  
  Open  Wounds  
Petechiae   1. Abrasion  
• Circumscribed   extravasation   of   blood   into   the   subcutaneous   2. Incised  wound  
tissues  or  beneath  the  mucou  membrane   3. Stab  wound  
• Usually  from  the  capillary  systems   4. Punctured  wound  
• Causes:   5. Lacerated  wound  
o Asphyxia  
 
o Trauma  
o Coronary  occlusion  
Abrasion  
o Clotting  disorders   • An  injury  characterized  by  the  removal  of  the  superficial  epithelial  
layer  secondary  to  friction  against  a  hard  rough  surface  
 
• Usually  develops  at  the  precise  point  of  impact  
Contusion  
• May  exhibit  the  pattern  of  the  wounding  material  
• Effusion  of  blood  into  the  surrounding  tissues  
 
• Results  from  blunt  force  trauma  
• Does  not  immediately  develop  after  the  trauma  
Incised  wound  
• Medicolegal  significance:   • Wound  produced  by  a  sharp  edged  instrument  
o May  correspond  to  the  shape  of  the  object  causing  it   • May  be:  impact  cut  or  slice  cut  
o Extent  may  suggest  the  degree  of  force  applied    
o Distribution  may  indicate  character  &  manner  of  injury   Incised  wound   Lacerated  wound  
• Age  can  be  estimated  by  color  
• Edges  are  clean   • Edges  are  
o Red  to  purple  =  recent  
o Green  =  4-­‐5  days   cut,  regular  &   roughly  cut,  
o Yellow  =  7-­‐10  days   well-­‐defined   irregular  &  ill-­‐
o Gradual  resumption  of  skin  tone  =  14-­‐15  days   • No  surrounding   defined  
  hematoma  or   • There  is  
Hematoma   contusion   swelling  &  
• Extravasation   or   effusion   of   blood   in   a   newly   formed   cavity   • Extremities  of   contusion  
underneath  the  skin   the  wound  are   around  the  
• Usually   formed   if   force   is   applied   where   the   bone   is   superficailly   sharp,  rounded   wound  
located   or  contused   • Extremities  of  
  • Caused  by  a   the  wound  are  
  sharp  edged   ill-­‐defined  &  
Deep  Closed  Wounds   instrument   irregular  
1. Musculoskeletal  injuries   • Caused  by  blunt  
2. Internal  Hemorrhage   instrument  
3. Cerebral  Concussion  
 
 
Stab  wound  
Musculoskeletal  injuries  
• Wound  produced  by  the  penetration  of  a  sharp  pointed  &  
• Sprain  
sharp  edged  instrument  
o Partial   or   complete   distruption   in   the   continuity  
 
of  amuscular  or  ligamentous  support  of  a  joint  
Punctured  wound  
o Caused  by  a  blow,  kick  or  torsion  force  
• Injury  resulting  from  the  use  of  a  sharp  pointed  instrument  
• Dislocation  
such  as  an  icepick  
o Displacement   of   the   articular   surface   of   bones  
 
entering  into  a  joint  
Lacerated  wound  
• Fracture  
• Tear   of   the   skin   &   underlying   tissues   due   to   forcible  
o Fragmentation   of   bone   resulting   loss   of  
contact  with  a  blunt  instrument  
continuity  
 
• Strain  
 
o Over-­‐stretching  of  a  muscle  or  ligament  
• Subluxation  
o Implies   the   presence   of   complete   or   partial  
dislocation  
 
Internal  hemorrhage  
• Rupture  of  blood  vessel  which  may  result  in  hemorrhage  
 
Cerebral  Concussion  
• Concussion   is   a   trauma-­‐induced   change   in   mental   status,   with  
confusion   &   amnesia,   and   with   or   without   a   brief   loss   of  
consciousness  
• Most  commonly  caused  by  vehicular  accident  &  Sports  injuries  
 
 

      TRANSCOM  |  DRA.  JACKIE   8