Forensic Aspects of Trauma 2

Question 1

What are typical defensive type injuries?

Answer 1

Can be blunt or sharp force

Question 2

What can defensive type injuries be classed as?

Answer 2

• Passive
  
  • Victim raises arms and legs for protection
  • Sliced, shelved often with skin flaps over back of hands and forearms
• Active
  
  • Victim tries to grab weapon or attackers hand
  • Sliced shelved incised wounds on palmer aspects of hands and web spaces between fingers

Question 3

What are passive and active defensive type injuries?

Answer 3

• Passive
  
  • Victim raises arms and legs for protection
  • Sliced, shelved often with skin flaps over back of hands and forearms
• Active
  
  • Victim tries to grab weapon or attackers hand
  • Sliced shelved incised wounds on palmer aspects of hands and web spaces between fingers

Question 4

How can you identify self-inflicted injuries?

Answer 4

• Commonly sharp force
• Site of election
  
  • Often wrists, forearms, chest and abdomen
• Parallel, multiple and tentative incisions
• Positions of clothing

Question 5

What are common sites of injuries for self-inflicted injuries?

Answer 5

• Often wrists, forearms, chest and abdomen

Question 6

What do the consequences of an injury depend on?

Answer 6

• Type of mechanical insult
  
  • Blunt, sharp, homicidal, suicide, accident etc
• Nature of target tissue
  
  • Head, chest, abdomen, fat
• Forces involved
  
  • High speed RTC, fall from height, kicking, stamping, punch
• Number of impacts
  
  • Single vs multiple

Question 7

What are examples of head injuries?

Answer 7

• Standard skin injuries from before
• Skull fractures
  
  • Linear, depressed
• Bleeding over brain

Question 8

What are the different kinds of skull fracture?

Answer 8

• Linear, depressed

Question 9

What is bleeding over the brain associated with?

Answer 9

Fractures

Answer 10

• Subarachnoid
  
  • Often caused by aneurysm
  • But can also occur due to trauma, called traumatic subarachnoid haemorrhage
    
    • Usually due to punch at jaw, causing rapid rotational movement of head
    • Immediate unconsciousness and cardiac arrest, so suspected to be brainstem damage
• Subdural
  
  • Venous blood so accumulates slow
• Extradural
  
  • Arterial blood so accumulates quick

Question 11

What is subarachnoid haemorrhage often caused by?

Answer 11

• Often caused by aneurysm
• But can also occur due to trauma, called traumatic subarachnoid haemorrhage
  
  • Usually due to punch at jaw, causing rapid rotational movement of head
  • Immediate unconsciousness and cardiac arrest, so suspected to be brainstem damage

Question 12

What speed do the following present:

• subarachnoid haemorrhage
• subdural haemorrhage
• extradural haemorrhage

Answer 12

• Subarachnoid
  
  • Immediate unconsciousness and cardiac arrest, so suspected to be brainstem damage
• Subdural
  
  • Venous blood so accumulates slow
• Extradural
  
  • Arterial blood so accumulates quick

Question 13

Do the following involve arterial or venous blood:

• subdural haemorrhage
• extradural haemorrhage

Answer 13

• Subdural
  
  • Venous blood so accumulates slow
• Extradural
  
  • Arterial blood so accumulates quick

Question 14

How does the outcome of brain haemorrhage vary with volume of blood?

Answer 14

Question 15

What is a brain diffuse injury?

Answer 15

• Diffuse axonal injury (immediate and prolonged coma with no apparent mass lesion or metabolic abnormality) is the clinical term for traumatic axonal injury pathological term (damaged axons due to trauma)
• TAI can be focal or diffuse (grade 1-3 based on severity)

Question 16

What is diffuse axonal injury the clinical term for?

Answer 16

Traumatic axonal injury (pathological term)

Question 17

What does TAI stand for?

Answer 17

Traumatic axonal injury

Question 18

What are the different kinds of TAI?

Answer 18

• TAI can be focal or diffuse (grade 1-3 based on severity)

Question 19

What does internal damage often depend on?

Answer 19

Type of injuries

Question 20

What internal injuries are often seen in blunt force for the following areas:

• ribs
• lungs
• heart
• aorta
• abdomen

Answer 20

Question 21

What internal injuries are often seen in sharp force for the following areas:

• ribs
• lungs
• heart
• aorta
• abdomen

Answer 21

Question 22

Other than blunt force and sharp force, what are examples of other types of injuries?

Answer 22

• Burns
  
  • Full thickness or partial thickness
• Firearms injuries
• Explosions
• Resuscitation
  
  • Includes bruising to neck, finger marks, bruising/laceration of lips and gums, damage to teeth, sternal and rib fractures, pleural cavity haemorrhage, laceration of lung, heart rupture, venopuncture and cannulation
• Post mortem injuries
  
  • Clues are lack of vital reaction and parchmentation
  • Could be animal or insect predation

Question 23

What is typically seen due to resuscitation injuries?

Answer 23

• Includes bruising to neck, finger marks, bruising/laceration of lips and gums, damage to teeth, sternal and rib fractures, pleural cavity haemorrhage, laceration of lung, heart rupture, venopuncture and cannulation

Question 24

What are clues for post-mortem injuries?

Answer 24

• Clues are lack of vital reaction and parchmentation
• Could be animal or insect predation