A model wound certificate

wound (page 255)

Wound certificate

What should be the contents of an

wound certificate ?
We should pay attention to these points .
1. General appearance
2. If the injured complains of any pain, or if there is
tenderness, difficulty in respiration, swallowing or
speech, urination or defecation
3. Posture and Gait
4. Any sign of intoxication
5. Dress – blood stain or any other stain, recent tear or
cutmarks
6. Any blood or other stain on any part of the body
More attention 5 and 6
Particulars of injuries present –

Serial Type of Size Site Simple/grievous Weapon used or Remarks

No. injury or dangerous manner of production
1.
2.

In the “type of injury” column it should be

mentioned, whether it is abrasion, bruise or incised
wound etc.
 To describe the size of the injury, bruises and
abrasions should be described in two dimensions
(i.e. Length × breadth) and all others should be
described in three dimensions (i.e. Length×
breadth× depth).
The site or location of the injury should be
described in relation to two external anatomical
landmarks of the body. For example, the site of an
injury on the anterior wall of the abdomen may be
described as “3 cm.left of midline and 5 cm. below
the level of the umbilicus”.
 To opine whether an wound is simple or
grievous, 1)the list of grievous wounds under. sec.
320 I.P.C.should be remembered (page 206). 2)
X’ray examination must be advised in doubtful
cases of which affect the vital functions of the body
or cause excessive loss of blood or multiple simple
injuries involving wide areas of the body, by their
collective action may pose danger to the life of the
injured.
 3) About the weapon of infliction, it should be mentioned
whether the weapon could be a blunt, hard and blunt, sharp-
cutting, pointed, heavy, moderately heavy or light one. 4) About
the manner of infliction, whether the injury has been caused by
striking with the weapon or by drawing the weapon or saw like
movement of the weapon on the body, should be noted.5)If the
injury is due to the result of fall on the ground or some material,
that also should be noted.
In the column ‘remarks’, the colour of the injury, bleeding and
other features of the injury along with the time of infliction,
whether self inflicted or inflicted by others or otherwise, the
treatment given, further recommendation about the treatment and
investigation and any other point of medical and medicolegal
interest shoud be mentioned.
 While issuing an injury certificate, two points
must be remembered. 1. Deep extravasations may
appear late as delayed bruise. 2. Deep dangerous
wounds inside the chest, abdominal or cranial cavity
may occur without any superficial or surface injury.
Another important precaution, the doctors must
take is that, in case of punctured wound, he must not
use a probe to know the depth of the wound.
Probing may increase the depth of the wound, may
injure a vital organ and may cause fresh bleeding. If
depth of the wound cannot be visualised and if the
patient is to be operated upon then the depth can be
measured during the operation.
 CAUSES OF DEATH DUE TO INJURY
1. Immediate Cause
a) Haemorrhage
i) External haemorrhage – Loss of more than
1/3rd of the total volume of body blood at a time
may cause death due to circulatory failure.
External haemorrhage is more and rapid in case of
incised wounds of arteries. ii) Internal
haemorrhage – Depending on the site of internal
haemorrhage, the quantity which may cause death
varies. Example: Haemorrhge of 1 litre may not
cause death. When it is in the pericardial sac 100
ml bleeding may also be compatible with life.
 But when it is in the pons or base of brain,
bleeding of only a few drops may cause quick death.
b)Injury to vital organs like brain, heart, lungs, liver or
kidneys may cause immediate or rapid death.
c) Vagal shock from injury may cause rapid death.
d) Primary or neurogenic shock - Excessive and
extensive pain as in cases of burns, may cause death
within a few minutes to a few hours, due to
neurogenic shock.
e) Secondary or hypovolumic shock – This
may occur due to loss of blood in case of
mechanical injuries and due to loss of fluid
in case of burning and scalding (through
blister formation). Death may occur within
about 48 hrs.
f) Embolism –
i) Air embolism – when some big veins or
subcutaneous veins are injured, air may be
sucked in them. Ordinarily, about 100ml. of
air, when enters the circulation, may cause
death.
 ii) Fat embolism – due to, injury to
subcutaneous fatty tissue with rupture of
veins there; fracture of femur causing fat
containing bone marrow emboli.
iii) Thrombus formed inside an injured vessel
may act as an embolus and may be taken to
distant places due to atrio-ventricular septal
defect or may be obstructed by lung. Death
may occur in either case.
 g) Asphyxia – May occur as in case of
choking due to inhalation of blood in cut
throat injury.
II. Delayed Causes :
a) Infection
b) Complications of injuries
c) Mismatched due to spinal injury
III). Immediate or delayed – Due to wrong
treatment or neglect in the treatment.