Regional Injuries

مدبولى/ جودة المنعم عبد مدبولى/ د جودة المنعم عبد ددكتوراة الطب الشرعي و السموم اإلكلينيكية,

, اإلكلينيكية السموم و الشرعي الطب مدرسالجامعي بنها بمستشفى التسمم عالج استشاري

الجودة بوحدة المقررات و البرامج مراجعة لجنة عضو

الرحيم الرحمن الله بسم

Incised wound in neck “ Cut throat ”:

They are seen in suicide & homicide and rarely accidental.

Accidental cut throat may be caused by glass injury that can produce an incised wound. It can be identified by the presence of fragments of glass in the wound, by small side cuts in its margin and by the circumstances.

Suicidal cut throatSuicidal cut throatHomicidal cut throat1-Circumstances-----------

2- Scene of the crime

1-History of troubles.2- +/- suicide notes. ----------------------------------1- Door is looked from inside2- No disturbance of furniture3- No physical evidence e.g. bl. Stains , finger prints of another persons

4- Weapon is usually present , the fingerprints & bl-stains on it related to the victim

1-History of threatening.2- +/- threading notes.---------------------------------1- Door isn’t looked from inside2- Disturbance of furniture3- Presence of physical evidence belonging to another persons4- Weapon is usually not presented . Fingerprints related to the assailant.

3-Exam. of the victim: 1-Sex

2-Position

3-Site of blood

4-Cadaveric spasm

5-Signs of struggle

6-Other injuries

1-Usually male2-Usually in front front of a mirror of a mirror 3- Directed in the front of the bodyfront of the body4- On the knife the victim firmly catch weapon on his hand

5- Not present

6- As cut wrist , superficial cuts in left index & thumb fingers

1-Any sex2-Any whereAny where

3- Blood is directed in the directed in the backback4- On assailant e.g. hair or piece of clothes

5- Defense abrasions or tears in the clothes

6- As multiple stabs in chest & abdomen

4-Exam of wound1-Site

2-Direction

3-Depth

4-Character

1- High up in the neck.

2- Oblique.

3- Usually starts deep & high up on the lt. side below the angle of the jaw “ Rt. handed “

4- Slanting : cuts skin at a higher level than S.C. tissues & muscles of the neck “ trachea or larynx “

1- Low down .

2- Transverse.

3- Deep all through cutting all vital structures .

4-Not slanting “ cuts skin & muscles at same level “

5-Hesitation marks

6-Edge

7-Cut vessels

8-Number

5- Present == superficial , slight, superficial , slight, repetitive incised wounds at repetitive incised wounds at beginning of wound beginning of wound

6- Linear- clean cut which since the skin is under tension when the victim throws back his head to clear a path for the weapon

7- Not divide jugular V. or carotid a. as protected by the extended sternomastoid muscle

8-usually one

5- Not present but have multiple irregular cuts

6- Toothed “ dental “ even e’ sharp weapon because the skin isn’t under tension “ thrown into folds”

7- Divide jugular V. or carotid a.

8-may be multiple

5-Examination of the assailant

6- Examination of the weapon

-No assailant

--------------------------- Cadaveric spasm

1. Signs of struggle , abrasion & bruises.

2. Clothes : tears or lost buttons.

3. Fingerprints & blood group compared with those found at scene of crime .

--------------------------

- Fingerprints & blood group

Homicidal Cut Throat Suicidal cut throatSuicidal cut throat

Mechanism of death in cut throat :Mechanism of death in cut throat :1-Neurogenic shock: from vagal cardiac inhibition .

2-Hemorrhage: from injured carotid & jugular vessels.

3-Venous air embolism: through the opened big veins in the neck.

4- Mechanical Asphyxia (Chocking): if the trachea is opened ,blood may be inhaled & chocking occurs. Or the soft parts of the neck fall in & closure of the airway results in mechanical asphyxia.

6-Delayed causes: due to edema of the glottis or sepsis of the wounds & aspiration pneumonia === 2ry bronchopneumonia.

هاااام سؤاااالWhen cut simulate lacerated wound?1- Homicidal cut throat2- Cut with serrated sharp object3- Corrugated skin (axilla & scrotum)

When lacerated simulate cut wound?•Only in scalp laceration

هاااام هاااام سؤاااال سؤاااال

Traumatic asphyxia:-• The thoracic cage is squeezed for a

considerable time, with sufficient force to impair respiratory movements.

Fractures of the ribs & sternum:-

FrFractures of the ribs are dangerous actures of the ribs are dangerous if :- if :- هام هام سؤال سؤال

1.1.MultipleMultiple; prevent expansion of the chest causing fatal respiratory embarrassment.

2.Fractured ends which penetrate pleura penetrate pleura &lungs &lungs causing he & pneumothorax.

3.3.Pleural & muscular pain Pleural & muscular pain that limit respiratory effort.

Fractures of the ribs are dangerous if Fractures of the ribs are dangerous if هام -: -: هام سؤال سؤال

Flail ChestFlail Chest1.Multiple rib fracture >3 consecutive ribs>3 consecutive ribs.

2.Commonly occurs in frontal violence frontal violence e.g. stamping assaults or motor car accidents.

3.3.Loss of rigidity of the chest cageLoss of rigidity of the chest cage, attempts at expanding chest volume during inspiration are impaired & the loose section is sucked inwards during inspiration “paradoxical respiration”.“paradoxical respiration”.

-C/P. : dyspnea , cyanosis ,hypoxia in extreme degree of flail chest.

-NB. Injury to liver (ribs 7-10), spleen (9-10) & kidney (11-12)

Flail ChestFlail Chest

Paravertebral fractures & child abuse:Paravertebral fractures & child abuse:• The ribs of infants and children are very

pliable and accidental fractures are uncommon except in gross injury.

• However, lateral compression of lateral compression of the infant chest the infant chest by adult hands in the battered child syndrome can cause

multiple paravertebral multiple paravertebral fracturesfractures. مهمممممممم.........

Stab wounds of chest:Most common homicidal stabbing [heart, lungs, & great

vessels; pulmonary a. , aorta}

Stab w. in the atria, Rt. V. , or great vessels are often more rapidly fatal than Lt. V. ? سؤااال........

Contraction of the thick muscles of the Lt.V. can partially close the stab w. “valve mechanism”.

Rt. V. is more often injured ? as it forms a great part of the anterior surface of the heart. ....سؤااال

Rupture aorta due to acc /dec →rapid death

Stab w. in the atria, Rt. V. , or great vessels are often more rapidly fatal than Lt. V. ?

................سؤااالسؤااال

Rt.Rt. V. is more often injured ? as it forms a great V. is more often injured ? as it forms a great part of the anterior surface of the heartpart of the anterior surface of the heart..

........سؤااالسؤااال

Mechanism of death due to Stab wounds of chest:

• Internal hemorrhage into the pleural cavity, the mediastinum, or the pericardial sac

(cardiac tamponade). 200 ml .....................................مهممممم.....

• However there may be little external bleeding.

Abdominal InjuriesBlunt inj. of the abdomen: Kicking or impact against the steering wheel in MVA. To the ant. Abdominal wall causing compression of the

viscera ,with lacerations & contusions.Stomach, intestine & mesentery: In adults, can tear the mesentery or intestine , leading to hge

& peritonitis. In infants ,compression of the intestine & mesentery against

the rigid lumbar spine the rigid lumbar spine can tear them.

D.D. Bet. traumatic & pathological rupture: سؤاالسؤاال ..... 1st one shows irregular edges surrounded by bruises with

bulging of m.m.to the outside & normal other parts of G.I.T. 2nd one shows regular edges surrounded by fibrosis with

evidence of disease as typhoid or peptic ulcer.

D.D. Bet. traumatic & pathological rupture: سؤاالسؤاال

Urinary BladderUrinary Bladder:: More common in males than in females ?

.........سؤاااال