Mechanical Injuries - III

Mechanical Injuries-III
Dr.Romana
Dr:filza Ali
Forensic Medicine & Toxicology
Motto of RMU
Vision of Rawalpindi Medical University
The Dream/ Tomorrow
• To impart evidence based research oriented medical education

• To provide best possible patient care
• To inculcate the values of mutual respect and ethical practice of medicine
Prof Umar’s LGIS Model
Describe the different types of punctured wound with
calculation of age of a punctured wound.
Briefly describe the features of Stab wound
State the medico-legal importance of Punctured and Stab
wound.
LEARNING OBJECTIVES:
STAB WOUNDS:
“Injury caused by pointed object when it is
driven in through skin
and its depth is the greatest
dimension”
weapons used; knife, dagger, needle, spear,

arrow, scissors, ice pick
Types:
1. Penetrating stab wound:
i) when weapon enters a body
cavity such as
thorax or abdomen
ii) only entry wound present
STAB WOUNDS:
2. Perforating stab wound:
i) when a weapon after penetrating the
tissues,comes out from the other side making an
exit wound
ii) both entry and exit wound is present
2. Punctured stab wound:
i) made by pins,needles
ii) M/L importance in Infanticide
iii) fontanelle,nape of neck,axilla.
Characteristics:
a) Wound of Entry:
i) Bigger than exit wound
ii) Shape corresponds to the weapon used
• Knife ( single edge) ‫ ……………… وقاچ‬Wedge shape
• Dagger( double edge) ‫رجنخ‬..................elliptical shaped
iii) Size of wound
• Smaller than breadth of weapon.
• In drawing out, due to Rocking movement than it becomes larger
iv) Margins clear cut and inverted.
In rusty weapon ..………… edges everted & bruised
b) Wound of EXIT:
i) SMALLER than entry wound
ii) Margins everted
c) Depth
is greater than its length and breadth
MEDICOLEGAL ASPECTS OF STAB WOUND:
❑ Nature & dimensions of the weapon used.
❑ Position of victim and assailant from direction of wound.
❑ Nature of injury and intention

i.e Homicide,
Accident
Suicide
❑ Stab wound is converging wound whereas firearm

is diverging wound.
DEFENCE WOUNDS:
“Injuries sustained by a person as a result of his spontaneous
reaction
to protect himself when attacked”
Common site:
i) grasping surface of hands
ii) ulnar borders of forearms
iii) dorsum of hand
iv) lower limbs in sexual assault
v) Back
Characteristics:
May be superficial or deep
Corresponds to the weapon used
Tells about victim’s awareness , consciousness & ability to resist
e.g. not seen if hands are tied
SELF-INFLICTED WOUNDS:
Injuries produced by a person on his body himself (self inflicted) or
caused by other acting in agreement with him ( friendly hand
injury).”
Also known as FABRICATED, FACTITIOUS,FORGED or
INVENTED INJURIES
Common sites: easily accessible parts of body e.g top of head,
forehead,front and outer side of thighs
Characteristics:
i) parallel,multiple & superficial
ii) non-involvement of clothes & vital organs
iii) hestation marks may be present
Objects:
a) To support a false charge
b) To avert suspicion
CAUSE OF DEATH FROM WOUNDS:
PRIMARY OR IMMEDIATE CAUSES
i) excessive bleeding
ii) injury to vital organs
iii) neurogenic shock
iv) Embolism
v) Crush syndrome
2) SECONDARY OR INDIRECT CAUSES
i) infection
ii) thrombosis
iii) sepsis
iv) supervening of new disease
v) exacerbation of pre-existing disease
vi) neglect of patient
3) EWING POSTULATE
FEATURES LACERATION INCISED WOUND STAB WOUND
Type of weapon Blunt weapon Sharp weapon Pointed weapon
Shape Irregular Linear/Spindle Depends on type of

weapon
Site Usually over bony Anywhere Usually on chest and
prominences abdomen
Surrounding Burised Normal Abraded/Bruised
Margins Irregular Clean cut and everted Entry wound inverted
Dimensions Variable Length > Depth Length < Depth
Hair & Blood Vessels Crushed Clean cut Variable
Hemorrhage Less Profuse Variable
Foreign body + _ +/-

❑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720275/
❑ https://www.ncbi.nlm.nih.gov/books/NBK554465/
❑ https://my.clevelandclinic.org/health/diseases/25079-abrasion
RESEARCH
The 4 basic ethical principles of
✓Beneficence
✓Non-Maleficence
✓Respect for autonomy
✓Justice
BIOMEDICAL ETHICS
❖ Patients attending an emergency department (ED) are entitled to
assume that they will be treated in accordance with the best
available evidence. The emergency physician (EP) has a
responsibility to expand the fund of knowledge that underpins
best evidence by means of clinical studies of new technologies
and interventions:
❖ NSAIDs , such as ibuprofen, help decrease swelling, pain, and
fever. This medicine is available with or without a doctor's order.
NSAIDs can cause stomach bleeding or kidney problems in
certain people. If you take blood thinner medicine, always ask if
NSAIDs are safe for you.
FAMILY MEDICINE
THANK YOU

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Mechanical Injuries-III

• To impart evidence based research oriented medical education

weapons used; knife, dagger, needle, spear,

❑ Position of victim and assailant from direction of wound.

❑ Nature of injury and intention

❑ Stab wound is converging wound whereas firearm

Type of weapon Blunt weapon Sharp weapon Pointed weapon

Shape Irregular Linear/Spindle Depends on type of

Margins Irregular Clean cut and everted Entry wound inverted

Dimensions Variable Length > Depth Length < Depth

Hair & Blood Vessels Crushed Clean cut Variable

Hemorrhage Less Profuse Variable

Foreign body + _ +/-

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