Module 9 Physical Injuries

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  MODULE 7: PHYSICAL INJURIES By the end of the module, the student should be able to: 1. Identify the types of wound based on skin continuity and injuring agents 2. Distinguish the different types of gunshot wounds (GSW) 3. Identify defense wound, suicide injuries, self-injuries, mutilation, torture injuries 4. Identify fatal wounds 5. Relate the type of wounds as applied to actual cases: People v. Mayingque et al.,G.R.No.179709,July 6,2010; People v. Reforma,G.R. No. 133440, June 7, 2004; People v. Noel Lee, G.R. No. 139070. May 29, 2002. ——— 1. Classification of wounds based on skin continuity ABRASION Removal of the superficial epithelial layer of the skin, usually the epidermis, by friction against rough surface. a.   Scratch: caused by a sharp or pointed object passing across the skin b.   Graze abrasion: caused by horizontal or tangential friction between the skin and the hard rough surface c.   Pressure abrasion: caused by direct impact or linear pressure of a rough object over the skin d.   Imprint abrasion: caused when the force is applied perpendicular to the skin BRUISE/CONTUSION Extravasation of blood in the subcutaneous/subepithelial tissues due to rupture of blood vessels; usually no loss of continuity of the overlying skin LACERATED WOUND Tearing or splitting of the skin, mucous membranes, muscles or internal organs caused by either a shearing or a crushing force and produced by application of a blunt force to a broad area of the body a.   Split laceration: occur when soft tissues are sandwiched between a hard unyielding deeper structure and the agent applying the force b.   Stretch lacerations: result from a heavy forceful frictional impact of blunt forces exercising localized pressure with pull c.   Avulsion: produced by force delivered at an oblique or tangential angle to detach a portion of traumatized skin surface or viscus d.   Tears: tearing of skin and subcutaneous tissue can occur from localized impact by or against some hard, irregular object e.   Cut laceration: heavy sharp-edged weapon causes a deep and wide cut over the body tissues INCISED WOUND Clean cut wound through the tissues, caused by a sharp-edged instrument, which is more long than deep. CHOP WOUND Deep gaping wounds caused by a blow with the moderately sharp cutting edge of a heavy weapon, applied with a significant degree of force. STAB WOUND Wound produced from penetration with long narrow instruments having pointed ends into the depths of the body; usually deeper than its length and width. a.   Penetrating wound: weapon enters into the body cavity producing only one wound b.   Perforating wound: weapon after entering into one side of the body will come out through the other side, producing two wounds FIREARM WOUND FRACTURE/DISLOCATION OF BONE, TOOTH OR JOINT 2. Classification of words based on injuring agents a. Sharp instruments: incisions, cuts, slash, amputations !    sharp instruments !    smooth edges !    generally, length is greater than width !    generally, not life threatening !    tends to gape !    examples of sharp-edged objects are a knife, razor, or glass splinter. !    incisions – a clean cut in the skin, one caused by a cutting instrument !    amputations - removal of a body extremity by trauma, prolonged constriction, or surgery b. Blunt instruments: lacerations, contusion (bruise), hematoma, macerations, fractures !    length (depth) usually greater than width (diameter) !    generally more fatal due to involvement of internal organs !    extent of injury not easily observable on ocular inspection !    infection may go deeper !    lacerations – tear like wound !    contusions - swollen bruises due to accumulation of blood and dead cells under skin !    hematoma - a mass of usually clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessels !    fractures - break in the continuity of the bone !    macerations - a situation in which the surrounding skin of a wound retains too much moisture and thus causing it to turn white and soften c. Pointed instruments: stabs, prick, puncture, spike !    depth greater than width !    more fatal  !    deeper infection !    not too bloody but internal haemorrhage could be extensive !    wounding instrument may be deduced from shape of point of entry !    stab - specific form of penetrating trauma to the skin that results from a knife or a similar pointed object that is deeper than it is wide !    prick – a puncture made to the skin that is caused by an instrument with a pointed end d. Rough surface: abrasion, scrape, scratch, excoriate !    abrasion - made when the skin is rubbed or scraped off; rope burns, floorburns, and skinned knees or elbows are common examples of abrasions !    this kind of wound can become infected quite easily because dirt and germs are usually embedded in the tissues e. Electricity: electrical burns !    severity determined by voltage, current and resistance !    a burn that results from electricity passing through the body causing rapid injury. !    differs from thermal or chemical burns in that they cause much more subdermal damage can exclusively cause surface damage, but more often tissues deeper underneath the skin have been severely damaged; !    electrical burns are difficult to accurately diagnose, and many people underestimate the severity of their burn; in extreme cases, electricity can cause shock to the brain, strain to the heart, and injury to other organs. f. Chemicals: chemical burn, poison injury !    chemical burn are burns to internal or external organs of the body caused by contact, ingestion, inhalation of noxious fumes of acids, alkalis or organic materials.); all chemical burns are classified as major burn injuries g. Explosives: blast injury, burns, avulsions, fractures !    a complex type of physical trauma resulting from direct or indirect exposure to an explosion !    blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives and these injuries are compounded when the explosion occurs in a confined space !    avulsion - an injury in which a body structure is forcibly detached from its normal point of insertion by either trauma or surgery; the term most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures (i.e., subcutaneous tissue, muscle, tendons, or bone); similar to an abrasion but more severe, as body parts such as an eyelid or an ear can be partially or fully detached from the body. h. Gravitational force: contusions, hematoma, fractures, macerations i. Stretching: avulsions  j. Poisons, chemicals: Chemical burns k. Electricity: electrical burns l. Cold: Hypothermia !    Hypothermia - medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature; a potentially fatal condition, occurs when body temperature falls below 95°F (35°C) m. Hot: Hyperthermia !    defined as a temperature greater than 37.5–38.3 °C (99.5–100.9 °F), depending on the reference used, that occurs without a change in the body's temperature set point !    elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. !    extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death !    most common causes of Hyperthermia include heat stroke and adverse reactions to drugs n. Radiation: Radiation burns !    damage to the skin or other biological tissue caused by exposure to radiation !    radiation types of greatest concern are thermal radiation, radio frequency energy, ultraviolet light and ionizing radiation. !    most common type of radiation burn is a sunburn caused by UV radiation !    high exposure to X-rays during diagnostic medical imaging or radiotherapy can also result in radiation burns !    radiation burns are often associated with radiation-induced cancer due to the ability of ionizing radiation to interact with and damage DNA, occasionally inducing a cell to become cancerous o.   Microwaves/radiowaves: microwave/radiowave injuries !    microwave burns are burn injuries caused by thermal effects of microwave radiation absorbed in a living organism !    in comparison with radiation burns caused by ionizing radiation, where the dominant mechanism of tissue damage is internal cell damage caused by free radicals, the primary damage mechanism of microwave radiation is thermal, by dielectric heating !    microwave damage can manifest with a delay; pain and/or signs of skin damage can show some time after microwave exposure p.   Bacteria/viruses: Infections  3. Gunshot wounds (GSW) 3.1.1. Medium/high velocity Penetrating mechanisms of injury can be described as low, medium or high velocity. Damage from low-velocity mechanisms, such as stabbings, is often limited to the structures directly contacted. Medium-velocity mechanisms, like bullets from most types of handguns, produce less tissue destruction than high-velocity forces. High-velocity mechanisms include shots from rifles and larger military weapons.  3.1.2. Entrance/exit wound Gunshots may create both entrance and exit wounds. Entrance wounds tend to have a round shape with a surrounding margin of abrasion. It has three categories- contact wounds, close- or intermediate-range wounds, and distant-range wounds. Contact wounds occur when a firearm is held directly against the body, and can include a muzzle imprint and soot on the skin. Close- or intermediate-range wounds may have a wider zone of powder stippling. Distant-range wounds tend to lack powder stippling and may have holes roughly equal to the caliber of the projectile fired. Exit wounds can have a variety of appearances, including round, oval, slitlike, stellate or crescent. They may be larger than entrance wounds if the bullet expanded or tumbled on its axis, but most likely won't have gunshot residue. If an exit wound was abutted by firm support, such as clothing or furniture, it may have a circular defect and abraded margin resembling an entrance wound. 3.1.3. Abrasion rim/collar Term which identifies a type of wound that occurs when someone is shot from more than two feet away. It usually looks like a bruise in the shape of a halo circling the bullet’s point of entry.  3.1.4. Stippling o   Entry wound o   Due to unburned gunpowder grains exiting from the gun – these cause PINPOINT ABRATIONS on the skin.   !   NOT burns   o   Presence of stippling defines the INTERMEDIATE RANGE   !   Distance: from a few centimeters up to several feet 3.1.5. Shoring o   A shored exit wound is one in which the skin is in contact with another object when the bullet exits. o   Produced when the outstretched skin is impaled, sandwiched, and crushed between the outoin bullet and the unyielding object over the exit site – leaving an abrasion collar on the wound margin. 3.1.6. Stellate wound o   Entry wound o   Due to tearing of skin from expanding gas dissecting between the scalp and skull. o   Associated with the CONTACT RANGE (where the muzzle is pressed against the skin when fired). 3.1.7. Buckshots A large size of lead shot used in shotgun shells for hunting game, as pheasants or ducks. Buckshot wound 3.1.8. Shotgun wounds/satellite injuries o   Shotgun bullets contain numerous pellets o   At contact range up to a few feet, the entrance wound is a single round defect o   At a range of 3-4 feet, the pellets begin to spread out before reaching the body, producing one large entry  wound surrounded by scalloping or several smaller defects due to penetration by individual pellets o   As the range increases, the central defect becomes smaller and the number of surrounding pellet holes increases 3.1.9. Snowstorm pattern Centerfire rifle wounds: o   In contact wounds of the head with centerfire rifles, there is massive tissue destruction of the skin, skull, and brain o   Full metal jacketed bullets produce less tissue damage and tend to travel through the body undeformed o   Semi-jacketed ammunition creates the classic “lead snowstorm” appearance on x-ray due to peeling back of the jacket as it travels through the body, releasing numerous small lead fragments 3.1.10. Keyhole o   Tangential entrance wounds into bone may produce keyhole defects with entrance and exit side-by-side, so that the arrangement of bevelling can be used to determine the direction of fire. o   The mechanism of injury used to explain keyhole lesions is that as the bullet enters the skull tangentially, the bullet is split, one portion entering the cranial cavity while the other is expelled producing the exit defect. o   However, this is not always the case, the keyhole defect may be produced by a bullet that remains virtually intact. o   Keyhole defects, although, are not exclusive to entrance sites and have also been observed in exit sites.
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