Head and Neck Injuries Injuries in the chest Abdominal Injuries Pelvic Injuries Extremities

Factors influencing the Degree and extent of the Head injuries: a. Nature of the wounding agent
b. Intensity of the force c. Point of Impact d. Mobility of the skull at the time of Force

Head Injuries are classified as to the Site of Application of Force:

Direct or coup injuries Indirect Injuries
Contre coup injury Remote injuries Locus minoris Resistencia

Coup-contre-coup injuries ( both )

A wound of the scalp although small & negligible is always potentially serious because:
It is difficult to prevent the spread of infection.

There is proximity of the scalp to the brain.

There is a free vascular connection between

the structures inside and outside the cranium. It is frequently difficult to determine the extent of damage of the skull.

Abrasion contusion commonly unnoticed Hematoma easily develops Lacerations most common Incised wounds generally involved the cranium

Fractures of the scalp

Fissure fractures Localized depressed fractures Penetrating injuries of the skull comminuted fractures pond or indented fractures gutter fractures bursting fractures

Intracranial hemorrhages

extradural/epidural hemorrhage is caused by a fracture

in the skull. Fracture will cause laceration of the blood vessels which are grooved at the inner table of the skull. subdural hemorrhage is essentially venous or capillary & the most common cause of cerebral compression. subarachnoidal hemorrhage may be due to trauma or to spontaneous rupture of blood vessel. cerebral hemorrhage may be traumatic or spontaneous in origin. Traumatic hemorrhage is usually due to laceration or contusion of the brain in contre-coup injuries.

Brain

lacerations of the brain: direct or coup laceration, Contre-

coup Lacertio edemas of the brain : Localized or Generalized Edema Concussion of the brain Compression of the brain

Is the origin of the intracranial hemorrhage due to trauma or disease? In cases of cerebral concussion, can the victim remember the incidents before, during or after the accidents? Can the victim of head injuries still retain voluntary movement & speech? Post-traumatic Automatism In gunshot wounds of the head, how can the point of entrance be determined? Post-traumatic Irritability

Wounds on the face heal relatively faster as compared with wounds on the other parts of the body on account of its great vascularity. Eye Hemorrhage observed on first blow May be lacerated by a blunt weapon or piece of stone Acute inflammatory changes occur with injury of the cornea, iris, and lens Nose Fist blows: fracture of nasal bone Ear Blow on ear may produce rupture of tympanic membrane (permanent/temporary deafness) Hemorrhage from ear is suggestive of fracture at the base of middle cranial fossa Could be lacerated or cut off Mouth Contusion, laceration & swelling on lips at first blow Fracture of lower jaw due to direct violence & always associated with laceration of gums

Abrasions present in manual strangulation Ligature marks present in death by hanging Suicidal cut throats are diagonal; homicidal wound usually horizontal Incised & stab wounds include trachea & big blood vessels (fatal).

Fracture of the vertebrae

cause: Direct and Indirect Violence

Concusion of the spine

Usual complaints: headache, restlessness,

pain & tenderness over the spine, loss of sexual power, irritability of the bladder, inability to walk, weakness of the limbs .
Motor vehicle collision and in a railway accident

Injuries to the chest wall

pleural viscera Fracture of the ribs

Stab wounds are quite common Bullet wounds may be superficial or may involve the

Injuries to the lungs

Hemorrhage in pleural cavity may cause compression

& collapse of lungs, patient may die of respiratory embarrassment or anemia. Contusion of the lungs may be caused by a blunt instrument with/without fracture of the ribs Injury of lungs may cause bloody froth coming out of the mouth Death may be due to severe shock & a rapid hemorrhage

Hemorrhage Compression of the lungs Severe pneumothorax Cerebral air embolism Hemoptysis Subcutaneous emphysema

 Wounds of the heart are produced by sharp

instrument, bullets of sharp-end of fractured ribs Contusion easily produced on slight trauma Tearing of the heart from its attachment may be due to violent compression of the chest with the pressure forcing the organ downward & away from the neck Crushing injuries are due to compression of chest in vehicular accidents or violent dynamic blast

 Any penetrating wound in diaphragm

may cause a potent rent for diaphragmatic herniation

Rupture of the diaphragm is due to a sudden increase of intrabdominal pressure crushing injuries caused by vehicular accidents or traumatic compression of the chest.

Abdominal wall

Area in the middle superior half of the

Stomach

abdomen forming a triangle is vulnerable to trauma applied from any direction.

Spontaneous rupture may be observed in

cases of gastric ulcer or new growth. Most common site of rupture: pyloric end & the greater curvature Penetrating stab wounds Tearing of stomach common when run over by a motor vehicle

Intestine

Traumatic rupture may be due to blow, kick,

Liver

fall or vehicular accident. Injuries caused by sharp instruments or by gunshots usually cause multiple lesions in the intestine & may involve other visceral organs.
One of the most vulnerable organs in the

abdominal cavity Injuries frequently met in cases of blow, kick, crush, or fall Stab wounds & gunshot involving the liver may cause severe hemorrhage & shock causing death

Spleen
Penetrating stab wounds in the spleen are

common.

Kidney
Traumatic injury may be due to blow at the

lumbar region. May be ruptured at the slightest violence when it is diseased as in cases of hydronephrosis, pyelonephritis, tuberculosis, abscess or tumor. Injury to kidney is accompanied by peri-renal hematoma consists of blood & urine.

Pancreas
May be injured by a violent blow at the

epigastric region. Death may be due to hemorrhage, shock or insulin insufficiency.

Urinary bladder Bladder my be involved in a blow, crush or kick at the hypogastrium especially when distended with urine. Among parturient women, the bladder may rapture in the course of delivery. It may be involved in fractures of the pubic bones. Symptoms of bladder rupture: pain, tenderness at the lower portion of the abdomen, bloody urine, difficulty in urination, & rigidity of the abdominal muscles.

Uterus Gravid uterus is likely to rupture in blow, kick or crush injuries. Partial separation of the placenta may be spontaneous or due to trauma Vagina Laceration of the vagina due to sexual act or a faulty instrumentation to induce a criminal abortion. Vaginal wall may be lacerated during parturition.

 Direct violence will result in a contusion and

when the force applied is severe it may cause interstitial muscular hemorrhage & fractures of the underlying bone. Indirect violence Crushing injuries of the limb can result in severe soft tissue trauma and are most commonly caused by vehicular accidents or fall of heavy materials.

Contusions & abrasions common injuries Fracture of the bones may be due to direct violence.