Physical Injuries

Atty. Malaya Capulong, M.D.

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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) Severity 1. Deadly/Morbid 2. Non-deadly/Non-morbid 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) Consequential injury 1. Coup 2. Contre Coup 3. Coup Contre Coup 4. Locus Minoris Resistencia (Place of least resistance) 5. Extensive Injury Integrity of skin Legal (Revised Penal Code) SPECIAL TYPES OF WOUNDS A. B. C. Defense Wounds Patterned Wounds give a picture of the nature and the shape of the instrument/s used to inflict the injury 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 14th-15th 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 ng mesa! MagkakaCONTUSION nanaman akooo!

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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.

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Sabi ni Perry! This is what a greenstick fracture looks like:

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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 forcible contact of the skin with a blunt instrument

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

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Incised Wound vs Lacerated Wound INCISED WOUND LACERATED WOUND Edges clean-cut, regular, wellEdges roughly cut, irregular, illdefined 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 LEGAL CLASSIFICATION OF PHYSICAL INJURIES Based on the Revised Penal Code PHYSICAL INJURIES o Art. 263. Serious physical injuries Any person who shall wound, beat, or assault another: 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 prision correccional in its minimum and medium periods, 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

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. 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 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?

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GUNSHOT WOUNDS Firearms Hand weapons, handguns or rifles, used for the propulsion of a projectile Includes rifles, muskets, shotguns, revolvers, pistols, etc., from which a bullet, ball, shot, shell, or other missile may be discharged by means of gunpowder Types of firearms: Handguns o Revolver o Semi-automatic pistol Rifles o With long barrels, spirally grooved o May be single shot o Military rifles semi-automatic or automatic Shotgun o Usually sporting guns with long smooth bore barrels o Effective within a range of 30 to 50 meters o Fires large numbers of small spherical lead shot Identification of Firearms 1. Serial Number 2. Manufacturer 3. Caliber (diameter of the barrel between two lands, in inches) 4. Fingerprints 5. Fouling of the Barrel (creates the thumbmark of the gun) Cartridge complete unfired unit, consisting of the bullet, primer, cartridge case and gunpowder Ballistics science dealing with the trajectories of projectiles, firing characteristics of firearms, bullets, and cartridges, usually for identification. Forensic Ballistics science of firearm identification Medical Ballistics studies the penetration/effects of the missile or bullet to the human body, with emphasis on the appearance and severity of wounds. A.

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Blackening of bullet tract Carboxyhemoglobin present

Short Range Fire (1-15cm) Gunshot Wound Entrance wound inverted There may be area of burning (3-6inches) Smudging is present Powder tattooing present Abrasion ring present Medium Range Fire (15-60cm) Gunshot Wound Entrance wound inverted Smudging may be present (<30cm) Powder tattooing present of lesser density Burning effect absent Contact ring present Long Range Fire (>60cm) Gunshot Wound Entrance wound circular or oval No burning, smudging or tattooing Contact ring present Exit Wound Slit-like No powder or soot Could be mistaken for a stab wound ELECTRICAL INJURIES

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Lightning Injuries One of the most frequent injuries caused by natural phenomenon Mortality 20-30% THERMAL INJURIES Injury Due to Cold Degree of damage depends upon Severity Duration of exposure Area of body involved Sex Humidity Death may result Injury Due to Heat Effects may be local or systemic Local scalds and burns Systemic heat cramps, heat exhaustion, heat stroke Burns Thermal o Due to dry heat o May be due to fire, radiant heat, friction, solid substances and electricity o Usually accidental o Singeing of hair present Chemical o May be due to strong acids or alkali o Blisters are not present

Gunshot Wounds A. Firm Contact Fire Gunshot Wound Entrance wound large, star-shaped when bone is superficially located (as in contact fire to the forehead) Edges are everted Smudging, burning and tattoing prominent Muzzle imprint present Singeing of hair Blood and tissue are pink due to carbon monoxide B. Close Contact/Near Fire Gunshot Wound Illustrating a patterned abrasion around the wound in the shape of the gun muzzle Entrance wound round or oval Abrasion collar distinct Smudging, burning, and tattooing prominent Muzzle imprint may be present

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o Staining of skin and clothing o Borders are distinct o Usually accidental Radiation o May be due to x-ray, ultraviolet light, or radioactive substances o Injury ranges from reddening of the skin to blister formation to atrophy of superficial tissue o Ultraviolet light causes persistent and severe dermatitis Electrical and lightning/Electrocution o Factors affecting injury and outcome a. Amperage b. Voltage c. Type of current (AC vs DC) d. Duration of contact e. Tissue resistance f. Pathway of current ASPHYXIA General term applied to all forms of violent death resulting from interference with respiration Classification of Asphyxia 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 2. Strangulation compression of the neck by means of a ligature which is tightened by a force other than the weight of the body

Mechanical asphyxia, including strangulation, can be marked by the appearance of petechial hemorrhages on the conjunctiva 4. 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 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 Irrespirable gases carbon monoxide poisoning

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S Music Corner ni Perry!

HIDE (by Joy Williams; from the Album Genesis) To anyone who hides behind a smile To anyone who holds their pain inside To anyone who thinks theyre not good enough To anyone who feels unworthy of love To anyone who ever closed the door, Closed their eyes and locked themselves away You dont have to hide You dont have to hide anymore You dont have to face this on your own You dont have to hide anymore So come out, come out, come out wherever you are Anyone whos trying to cover up their scars To anyone whos ever made a big mistake We all been there so dont be ashamed Come out, come out and join the rest of us Youve been alone for way too long You dont have to hide You dont have to hide anymore You dont have to face this on your own You dont have to hide anymore 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 youve been His scars will heal you if you let Him You dont have to hide You dont have to hide anymore You dont have to face this on your own You dont have to hide anymore

Patterns of Injury HANGING Hyoid bone injured Ligature mark inverted V-shape Ligature at level of hyoid Ligature groove deepest opposite site of the knot Vertebral injury frequent Cause of Death HANGING Simple asphyxia Congestion of venous blood vessels in the brain Lack of arterial blood in the brain Syncope due to pressure on the vagus and carotid sinus paralysis of the medullary autonomic sensors Injury of the spinal cord 3.

STRANGULATION BY LIGATURE Hyoid bone spared Ligature mark is horizontal Ligature below the pharynx Ligature groove is uniform in depth Vertebral injury not observed

STRANGULATION BY LIGATURE Asphyxia due to compression of larynx Coma due to arrest of cerebral circulation Shock or syncope Inhibition of the respiratory center due to pressure on the vagus and sympathetic nerves Vertebral injury not observed

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 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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