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Physical Injuries

Atty. Malaya Capulong, M.D.

I-3

CLASSIFICATION OF PHYSICAL INJURIES

  • A. Depth

 

1.

Superficial

2.

Deep

 

a.

Penetrating used for body cavities (ex. A penetrating wound to the abdomen)

b.

Perforating used for hollow organs (ex. A stab perforating the stomach)

  • B. Severity

1.

Deadly/Morbid

2.

Non-deadly/Non-morbid

  • C. Instruments used/Cause

1.

Sharp instruments (ex. Knife blade)

2.

Blunt instruments (ex. Baseball bat)

3.

Tearing force

4.

Change in atmospheric pressure (ex. Bends)

5.

Heat or cold (ex. Burns and frostbite)

6.

Explosion (ex. Putok. CHOT. Grenade explosion)

  • D. Consequential injury

1.

Coup

2.

Contre Coup

3.

Coup Contre Coup

4.

Locus Minoris Resistencia (Place of least resistance)

5.

Extensive Injury

  • E. Integrity of skin

 
  • F. Legal (Revised Penal Code)

SPECIAL TYPES OF WOUNDS

  • A. Defense Wounds

  • B. Patterned Wounds give a picture of the nature and the shape of the instrument/s used to inflict the injury

  • C. Self-inflicted wounds

MEDICAL CLASSIFICATION OF WOUNDS

  • A. Closed Wounds/Injury Contusion (a.k.a PASA) Extravasation of blood into the tissues underneath the skin because of rupture of the blood vessels Initially red or purple 4-5 days turns green 7-10 days turns yellow 14 th -15 th day disappears

Note: colors may

all be present

at

one time

in

a single

contusion due to the different rates of healing of the affected tissue

Trippings ni Perry! Gamitin ang salitang “CONTUSION” sa pang-araw-araw na buhay: “OUCH!!! Tumama ako sa kanto
Trippings ni Perry!
Gamitin ang salitang “CONTUSION” sa pang-araw-araw na
buhay:
“OUCH!!! Tumama ako sa kanto ng mesa!
MagkakaCONTUSION nanaman akooo!”

Hematoma (Bumubukol na pasa) The collection of blood in a newly formed cavity under the skin

Musculo-Skeletal Injuries o Sprain disruption in the continuity of muscular or ligamentous support of a joint o Dislocaton displacement of the articular surface of bones entering into the formation of a joint (Most common: shoulder dislocation) o Fracture

  • closed/simple

  • open/compound

  • comminuted

  • linear

  • spiral common fracture in the humerus

  • greenstick sa bahagi ng fracture, may part na bali at may part na buo pero nakabend na.

Sabi ni Perry! This is what a greenstick fracture looks like:
Sabi ni Perry!
This is what a greenstick fracture looks like:
  • B. Open Wounds Abrasion (a.k.a. GASGAS) Caused by friction against a hard or rough surface Usually involves the superficial layers of the skin Consists of parallel linear injuries

 

Incised Wound Produced by a sharp-edged instrument Knife, razor, bolo, edge of metal sheet, glass

 

Stab Wounds Produced by the penetration of a sharp-pointed instrument Knife, dagger, saber, scissors

 

Lacerated Wound

 

Usually caused by instrument

forcible contact

of

the skin

with

a

blunt

Incised Wound vs Lacerated Wound

 
 

INCISED WOUND

 

LACERATED WOUND

 
 

Edges clean-cut, regular, well- defined

 

Edges roughly cut, irregular, ill- defined

 
 

No swelling or contusion

 

With swelling or contusion

 

Extremities of wound sharp or round

Extremities ill-defined and irregular

 
 

Hair bulbs are cut

 

Hair bulbs intact

 
 

Scar is linear or spindle-shaped

   

Scar is irregular

 
 

Healing is faster

 

Healing is delayed

 
 

Sharp-edged instrument

   

Blunt instrument

 
 
   

Based on the Revised Penal Code

 

PHYSICAL INJURIES Art. 263. Serious physical injuries Any person who shall wound, beat, or assault another:

o

 
  • 1. The penalty of prision mayor, if in consequence of the physical injuries inflicted, the injured person shall become insane, imbecile, impotent or blind;

  • 2. The penalty of prision correccional in its medium and maximum periods,

    • Lost the use of speech

    • The power to hear or smell

    • Lost an eye, a hand, a foot, an arm or a leg or lost the use of said member

    • Incapacitated for the work in which he was habitually engaged

  • 3. The penalty of medium periods,

  • prision correccional in its minimum and

    • The person injured becomes deformed

    • Lose any other part of his body or lose the use thereof

    • Become ill or incapacitated for the performance of the work in which he as habitually engaged >90 days

    • 4. The penalty of arresto mayor in its maximum period to prision correccional in its minimum period, if the physical injuries inflicted shall have caused the illness or incapacity for labor of the injured person for >30days

    o

    Art. 265. Less serious physical injuries Any person who shall incapacitate the offended party for labor for 10 days or more

    o

    (max 30 days), or shall require medical assistance for the same period, Art. 266. Slight physical injuries and maltreatment The crime of slight physical injuries shall be punished:

    • 1. By arresto menor when the offender has inflicted physical injuries which shall incapacitate the offended party for labor from 1 to 9 days, or shall require medical attendance during the same period

    • 2. By arresto menor or a fine and censure when the offender has caused physical injuries which do not prevent the offended party from engaging in habitual work nor require medical assistance.

    • 3. By arresto menor in itsminimum period or a fine when the offender shall ill-treat another by deed without causing any injury.

    DESTRUCTION OF LIFE

    Revised Penal Code Title 8, Chapter 1 Destruction of Life

    o

    Art. 246.

    Parricide Any

    person who shall

    kill

    his father,

    mother, or child, whether legitimate or illegitimate, or any of his ascendants, or descendants, or his spouse, shall be guilty of parricide and shall be punished by the penalty of reculsion perpetua to death.

    o

    Art. 248. Murder – Any person who …shall kill another, …if committed with any of the following attendant circumstances:

    • 1. With treachery, taking advantage of superior strength, with the aid of armed men, or employing means to weaken the defense or of means or persons to insure or afford impunity.

    • 2. In consideration of a price, reward or promise.

    • 3. By means of inundation, fire, poison, explosion, shipwreck, stranding of a vessel, derailment or assault upon a street car or locomotive, fall of an airship, by means of motor vehicles, or with the use of any other means involving great waste and ruin.

    • 4. On occasion of any of the calamities enumerated in the preceding paragraph, or of an earthquake, eruption of a volcano, destructive cyclone, epidemic or other public calamity.

    • 5. With evident premeditation.

    • 6. With cruelty, by deliberately and inhumanly augmenting the suffering of the victim, or outraging or scoffing at his person or corpse.

    Challenge ni Perry! If you are Phil Younghusband, which specific article in the RPC can you
    Challenge ni Perry!
    If you are Phil Younghusband, which specific article in the RPC
    can you use to file a case against an angered woman who ran
    you over with her car, leaving your right leg and foot badly
    damaged and in a cast? What penalty will she get?
     

    GUNSHOT WOUNDS

     

    Blackening of bullet tract

     

    Carboxyhemoglobin present

    Firearms

     

    Hand weapons, handguns or rifles, used for the propulsion of a

     
    • C. Short Range Fire (1-15cm) Gunshot Wound

    projectile

     
     

     

    Includes rifles, muskets, shotguns, revolvers, pistols, etc., from which a bullet, ball, shot, shell, or other missile may be

     

    Entrance wound inverted There may be area of burning (3-6inches) Smudging is present

    Powder tattooing present

    discharged by means of gunpowder

    Types of firearms:

     

    Abrasion ring present

     

     
    • Handguns

    o

    Revolver

    • D. Medium Range Fire (15-60cm) Gunshot Wound

    o

    Semi-automatic pistol

    Entrance wound inverted

    • Rifles o o

     

    Smudging may be present (<30cm)

    o With long barrels, spirally grooved

    Powder tattooing present of lesser density

    May be single shot

    Burning effect absent

    Military rifles semi-automatic or automatic

    Contact ring present

    • Shotgun o Usually sporting guns with long smooth bore barrels o o

    • E. Long Range Fire (>60cm) Gunshot Wound

    Effective within a range of 30 to 50 meters

    Fires large numbers of small spherical lead shot

    Entrance wound circular or oval No burning, smudging or tattooing

     

    Contact ring present

    Identification of Firearms

    • 1. Serial Number

    • F. Exit Wound ― ― ―

    • 2. Manufacturer

    Slit-like

    • 3. Caliber (diameter of the barrel between two lands, in inches)

    • 4. Fingerprints

    • 5. Fouling of the Barrel (creates the “thumbmark” of the gun)

     

    No powder or soot

    Could be mistaken for a stab wound

     
       

    ELECTRICAL INJURIES

    Cartridge complete unfired unit, consisting of the bullet, primer,

     

    cartridge case and gunpowder

     

    Lightning Injuries One of the most frequent injuries caused by natural phenomenon

    Ballistics science dealing with the trajectories of projectiles, firing

    characteristics of firearms, bullets, and cartridges, usually

    for

    Mortality 20-30%

     

    identification.

       

    THERMAL INJURIES

    Forensic Ballistics science of firearm identification

    • A. Injury Due to Cold Degree of damage depends upon

    Medical Ballistics studies the penetration/effects of the missile or

     
    • Severity

    • Duration of exposure

    bullet to the human body, with emphasis on the appearance and

    • Area of body involved

    severity of wounds.

    • Sex

    Gunshot Wounds

     
    • Humidity

     

    Death may result

    • A. Firm Contact Fire Gunshot Wound Entrance wound large, star-shaped when bone is superficially

     
     
    • B. Injury Due to Heat Effects may be local or systemic

     

    located (as in contact fire to the forehead)

     
    • Local scalds and burns

     

    Edges are everted Smudging, burning and tattoing prominent

     
    • Systemic heat cramps, heat exhaustion, heat stroke

     

       

    Burns

     

    Muzzle imprint present

     
    • Thermal

     

    Singeing of hair Blood and tissue are pink due to carbon monoxide

     
     

    o

    Due to dry heat

    • B. Close Contact/Near Fire Gunshot Wound Illustrating a patterned abrasion around the wound in the shape of

    o

    May be due to fire, radiant heat, friction, solid substances and electricity

     

    o

    Usually accidental

       

    o

    Singeing of hair present

     

    the gun muzzle

       
    • Chemical

     

    Entrance wound round or oval

       

    o

    May be due to strong acids or alkali

     

    Abrasion collar distinct Smudging, burning, and tattooing prominent

     

    o

    Blisters are not present

    Muzzle imprint may be present

     
    o o o Staining of skin and clothing Borders are distinct Usually accidental  Mechanical asphyxia,
    o
    o
    o
    Staining of skin and clothing
    Borders are distinct
    Usually accidental
    Mechanical asphyxia, including strangulation, can be marked by the
    appearance of petechial hemorrhages on the conjunctiva
    Radiation
    4.
    o
    o
    o
    May be due to x-ray, ultraviolet light, or radioactive
    substances
    Injury ranges from reddening of the skin to blister
    formation to atrophy of superficial tissue
    Ultraviolet light causes persistent and severe dermatitis
    Drowning or submersion – nostrils and mouth are submerged in
    any wayter, viscid fluid, preventing the free entrance of air into the
    air passage and lungs
    5.
    Electrical and lightning/Electrocution
    Pressure on the chest – free exchange of air in the lungs is
    prevented by the immobility of the chest and abdomen due to
    external pressure or crush injury
    o
    Factors affecting injury and outcome
    a.
    Amperage
    6.
    Irrespirable gases – carbon monoxide poisoning
    b.
    Voltage
    c.
    Type of current (AC vs DC)
    d.
    Duration of contact
    S
    e.
    Tissue resistance
    f.
    Pathway of current
    ♫♪
    Music Corner ni Perry!♪♫
    ASPHYXIA
    HIDE
    (by Joy Williams; from the Album “Genesis”)
    General term applied to all forms of violent death resulting from
    interference with respiration
    Classification of Asphyxia
    To anyone who hides behind a smile
    To anyone who holds their pain inside
    To anyone who thinks they’re not good enough
    1.
    Hanging – brought about by the suspension of the body by a
    ligature which encircles the neck and the constricting force is the
    weight of the body
    To anyone who feels unworthy of love
    To anyone who ever closed the door,
    Closed their eyes and locked themselves away
    2.
    Strangulation – compression of the neck by means of a ligature
    which is tightened by a force other than the weight of the body
    Patterns of Injury
    HANGING
    STRANGULATION BY LIGATURE
    You don’t have to hide
    You don’t have to hide anymore
    You don’t have to face this on your own
    You don’t have to hide anymore
    Hyoid bone injured Hyoid bone spared
    Ligature mark inverted V-shape
    Ligature at level of hyoid
    Ligature groove deepest opposite
    site of the knot
    Vertebral injury frequent
    Ligature mark is horizontal
    Ligature below the pharynx
    Ligature groove is uniform in depth
    So come out, come out, come out wherever you are
    Anyone who’s trying to cover up their scars
    To anyone who’s ever made a big mistake
    We all been there so don’t be ashamed
    Vertebral injury not observed
    Come out, come out and join the rest of us
    You’ve been alone for way too long
    Cause of Death
    HANGING
    Simple asphyxia
    STRANGULATION BY LIGATURE
    Asphyxia
    due
    to
    compression
    of
    larynx
    Congestion of venous blood vessels
    in the brain
    Coma
    due
    to
    arrest
    of
    cerebral
    You don’t have to hide
    You don’t have to hide anymore
    You don’t have to face this on your own
    You don’t have to hide anymore
    circulation
    Lack of arterial blood in the brain Shock or syncope
    Syncope due to pressure on the
    vagus and carotid sinus – paralysis
    of the medullary autonomic sensors
    Injury of the spinal cord
    Inhibition of the respiratory center
    due to pressure on the vagus and
    sympathetic nerves
    Vertebral injury not observed
    And if you feel like no one understands
    Come to the One with scars on His hands
    ‘Cause He knows where you are and where you’ve been
    His scars will heal you if you let Him
    3.
    Suffocation – exclusion of air from the lungs by closure of air
    openings or obstruction of the air passageway from the external
    openings to the air sacs
    You don’t have to hide
    You don’t have to hide anymore
    You don’t have to face this on your own
    You don’t have to hide anymore
    a.
    Smothering – caused by closing of the external respiratory
    orifices
    b.
    Choking – caused by the impaction of foreign body in the
    respiratory passages
    ― Vomitus, bolus of food, false teeth, blood
    ♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥♫♪♥

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