HISTORY TAKING OF MEDICO-LEGAL CASES

MEDICO-LEGAL CASES
 Motor Vehicular Accident
 Mauling Incidents/ Child abuse
 Stab Wounds
 Gunshot Wounds

Types of Wounds
1. Closed Wound- no breach of continuity of skin or mucous membrane
2. Open Wound- there’s a breach of continuity of skin or mucous membrane

Closed Wounds
1. Superficial- when the wound is just underneath the layers of the skin or mucous membrane
a. petechiae
b. contusion
c. hemetoma

2. Deep
a. Musculo-skeletal Injuries
a.1.sprain a.4. strain
a.2. dislocation a.5. subluxation
a.3. fracture
b. Internal Hemorrhage
c. Cerebral Concussion

Open Wounds
1. Abrasions
2. Incised Wounds
3. Stab Wounds
4. Punctured Wounds
5. Lacerated wounds

Closed Wound- Petechia

 Circumscribed extravasation of blood in the SQ tissue or underneath the mucous membrane
 Cause of passage of blood from the capillaries is due to increased intra-capillary pressure or increased permeability of the vessel
 Hemorrhage may be small but several petechia may coalesce to form a bigger hemorrhagic area
 not always a product of trauma
 may be a postmortem finding in asphyxial death, coronary occlusion & blood disease
 gravitation of blood into most dependent part of the body leading to rupture of over-distended capillaries

Closed Wounds- Contusion

 effusion of blood into tissues underneath the skin on account of the rupture of the blood vessels as a result of the application of
blunt force or violence
 When the blunt force is applied, it compress the blood vessels at the point of contact, forcing the blood out of the area
temporarily and setting up a fluid wave under pressure
 when the pressure exceeds the cohesive force of the cells forming the capillary, arteriole or venule wall, the vessel ruptures
 size of the contusion is usually greater than the size of the object causing it
 the location may not always indicate the site of the application of force ( ex. black-eye)
 on the medico-legal viewpoint, a contusion as indicated to the shape of the object or weapon used to produce it
 its extent may suggest the possible degree of violence applied
 its distribution may indicate the character and manner of injury as in manual strangulation around the neck
 the age of contusion can be appreciated from its color changes
 the size tends to be smaller from the periphery to the center and passes through a series of color changes as a result of
disintregation of the red blood corpuscles and liberation of hemoglobin
 age of contusion
a. red to purple- after its complete development
b. green- 4 to 5 days
c. yellow- 7 to 10 days
 gradually disappears on the 14th or 15th day
 ultimately disappears in 1 to 4 weeks depending upon the severity & contitution of the body

Closed Wounds- Hematoma

 blood cyst, blood tumor, “bukol”
 extravasation or effusion of blood in a newly formed cavity underneath the skin
 develops when blunt instrument is applied in part of the body where bony tissues is superficially located lead head & chest

Closed Wounds- Sprain

 partial or complete disruption in the continuity of a muscular or ligamentous support of a joint
 usually caused by a blow, kick or torsion force

Closed Wounds- Dislocation

 displacement of the articular surface of bones entering into the formation of a joint

Closed Wounds- Fracture

 linear deformation or discontinuity of bone produced by forces that exceeds the ultimate strength of the material
a. closed or simple
- no break in continuity of the overlying skin or where the external air has no point of access to the site of injury
 b. open or compound
- complicated by an open wound caused by the broken bone to protrude w/ of the tissues of the broken skin
c. comminuted
- fracture is fragmented into several pieces
d. greenstick
- only one side of the bone is broken while the other side is merely bent
e. linear
- forms a crack commonly observed in flat bones
f. spiral
- break in the bone forms a spiral manner as observed in long bones
g. pathologic
- caused by weakness of the bone due to disease rather than violence

Closed Wounds- Strain

 Over-stretching, instead of an actual tearing or rupture of a muscle or ligament w/c may not be associated w/ the joint

Closed Wounds- Subluxation

 Incomplete dislocation

Closed Wounds- Internal Hemorrhage

 Rupture of vessels w/c may cause hemorrhage:
a. traumatic intracranial hemorrhage
b. rupture of parenchymatous organs
c. laceration of other parts of the body

Closed Wounds- Concussion

 jarring or stunning of the brain characterized by more or less complete suspension of its function
 much more severe when moving or mobile head struck a fixed hard object as compared when the head is fixed & struck by a hard
moving object
 loss of memory for events just before the injury is a constant effect (retrograde amnesia)

 Signs & symptoms:

1. unconsciousness w/c is more or less complete
2. muscles are relaxed & flaccid
3. eyelids are closed & the conjunctivae are insensitive
4. body surface is pale, cold & clammy
5. respiration is slow, shallow & sighing
6. pulse is rapid, weak, faltering & scarcely perceptible to the fingers
7. temperature is subnormal
8. sphincters are relaxed perhaps w/ unconscious evacuation of the bowel & bladder
9. reflexes are present but sluggish & in severe cases may be present

Open Wound- Abrasion

 an injury characterized by the removal of the superficial epithelial layer of the skin caused by a rub or friction against a hard
surface
 whenever, there is forcible contact before friction occurs, there may be a contusion associated w/ abrasion
 the shape varies & the raw surface exudes blood & lymph w/c later dries & forms a protective covering known as scab or crust

 Characteristics:
1. develops at the precise point of impact of the force causing it
2. grossly or w/ the aid of a hand lens the injury consists of parallel linear injuries w/c are line w/ direction of the rub or friction
causing it
3. it may exhibit the pattern of wounding material
4. it is usually ignored by the attending physician for it does not require medical treatment but it has far reaching importance
in the medico-legal viewpoint
a. abrasion caused by fingernails may indicate struggle or assault & usually located in the face, neck, forearms &
hands
b. abrasion resulting from friction on the rough surfaces, either intentional or accidental are located on bony parts
of the body & usually associated w/ contusion or laceration
c. nature of the abrasion may infer degree of pressure, nature of rubbing objects & the direction of movement
5. unless there is supervening infection, abrasion heals in short time & leaves no scar. If the whole thickness of the skin is
involved, healing may be delayed & occasionally w/ scar formation

 Forms:
1. Linear - an abrasion w/c appears as a single line. It may be straight or curved line. Pinching w/ fingernails w/
curved abrasion, sliding the point of a needle on the skin will produced a straight linear abrasion
2. Multi-linear - an abrasion w/c develops when the skin is rubbed on a hard rough object thereby producing several linear
marks parallel to one another
- frequently seen among victims of vehicular accidents
3. Confluent - linear marks on the skin are almost indistinguishable on account of the severity of friction & roughness of
the object
4. Multiple - several abrasion of varying sizes & shapes may be found in different parts of the body

 Types:
1. Scratch - caused by a sharp pointed object w/c slides across the skin, like a pen, thorn or
fingernail.
- injury is always parallel to the direction of the slide
- commencement & termination are well defined & the depth depends on the pressure applied
- fingernail scratch may be broad at the point of commencement & may terminate w/ a tailing
 2. Graze - same as scratch
3. Impact or Imprint
a. marks of the grid of the radiator may be imprinted on the skin
b. tire thread marks
c. muzzle imprint in contact fire gunshot wound of entrance
d. teeth impression mark in skin bites
4. Pressure or friction abrasion
- caused by pressure accompanied by movement usually observed in hanging or strangulation

Open Wound- Incised Wound

 also called cut, slash or slice
 produced by a sharp edged (cutting) or sharp-linear edge of the instrument like a knife, razor, bolo, metal sheet or glass
 when the wounding instrument is a heavy cutting instrument like an axe or bolo, the wound produced is called a chop or hack
wound
 may be suicidal, homicidal or accidental

 Characteristics:
1. edges are clean-cut & both extremities are sharp, except in areas where skin is loose or folded at the time of infection
2. wound is straight & may be shelving if infected w/ the wounding instrument applied w/ an acute angle to the surface of the
body involved
3. usually the wound is shallow near the extremity & deeper at the middle portion. However, this finding may be modified by
the shape of the wounding instrument & part of the body involved
4. because the blood vessels involved are clean-cut, profuse hemorrhage is invariably a feature
5. gaping is usually present due to the retraction of the edges but its presence & degree of retraction depends on the direction
of the incised wound w/ the line of cleavage ( langer’s line)
6. if the incised wound is located in parts of the body covered w/ clothes, the clothing itself will show clean-cut of its texture
7. in the absence of complication & or when there is deeper involvement present, healing is relatively fast & the scar may not
or may develop conspicuously
8. incised wound caused by broken edge of glass may be irregular & may appear like a punctured or stab wound. Examination
w/ the aid of magnifying lens is necessary to determine the presence & removal of particles of flakes of glasses in the wound

 Changes that occur in an incised wound:

after 12 hours - edges are swollen; adherent w/ blood & w/ leucocyte infiltration
after 24 hours - proliferation of the vascular endothelium & connective-tissue cells
after 36-48 hours - capillary network complete, fibroblast running at right angle to the vessels
after 3-5 days - vessels show thickening & obliteration

Open Wound- Stab Wound

 produced by the penetration of a sharp pointed, & sharp edges instrument, like a knife, saber, dagger & scissors
 may involve skin or mucous membrane
 if the sharp edge portion of the wounding instrument is the first to come I contact w/ the skin, the wound produced is an incised
wound, but if the sharp pointed portion first come in contact, the wound is a stab wound
 as a general rule, the edges are clean-cut, regular & distinct like an incised wound

Open Wound- Punctured Wound

 result of a thrust of a sharp pointed instrument. The external injury is quite small but the depth is to a certain degree
 commonly produced by an ice pick needle, nail, spear, pointed stick, thorn, fang of animal & hook
 the nature of the external injury depends on the sharpness & shape of the end of the wounding instrument
 external hemorrhage is quite limited although internal injuries may be severe
 direct involvement of blood vessels & bloody organs may cause fatal consequence unless appropriate medical intervention is
applied
 usually accidental but in rare instances, it may be homicidal or suicidal
 Characteristics:
a. opening of the skin is very small & may become unnoticeable because of clotted blood & elasticity of the skin. The wound is
much deeper than its wide
b. external hemorrhage is limited although internally it may be severe
c. sealing of the external opening will be favorable for the growth & multiplication of anaerobic microorganisms

Open Wound- Lacerated Wound

 is a tear of the skin & the underlying tissues due to forcible contact w/ a blunt instrument
 if the force applied to a tissue is greater than its cohesive force & elasticity, the tissue tears & laceration is produced
 may be homicidal or accidental but rarely suicidal

 Characteristics:
a. shape & size of the injury do not correspond to the wounding instrument
b. the tear on the skin is rugged w/ extremities irregular and ill-defined
c. the injury developed is at the site where blunt force is applied
d. the borders of the wound are contused & swollen
e. it is usually developed on the areas of the body where the bone is superficially located
f. examination w/ the aid of hand lens shows bridging tissues joining the edges & hair bulbs intact
g. bleeding is not extensive because the blood vessels are not severed evenly
h. healing process is delayed & has more tendency to develop scar

 Classification:
1. Splitting- caused by crushing of the skin between two hard objects
ex. cut eyebrow of a boxer
2. Overstretching of the skin
- when pressure is applied on one side of the bone, the skin over the area will be stretched up to a breaking point to
cause laceration & exposure of the fractured bone
 3. Grinding compression
- the weight & the grinding movement may cause separation of the skin w/ underlying tissues
4. Tearing
- may be produced by a semi-sharp edged instrument w/c causes irregular edges on the wound like hatchet & choppers

Gunshot Wound
 Entrance Wound Characteristics:
1. appears to be smaller than the missile owing to the elasticity of the tissue
2. edges are inverted
3. usually oval or round depending upon the angle of approach of the bullet
4. “contusion collar” or “contusion ring” is present due to invagination of the skin & spinning of the missile
5. tattooing or smudging may be present when firing is near
6. underlying tissues are not protruding
7. always after fire
8. paraffin test may be positive

 Exit Wound Characteristics:

1. always bigger than the missile
2. edges are everted
3. does not manifest any definite shape
4. “Contusion collar” is absent
5. tattoos or smudging are always absent
6. underlying tissues may be seen protruding from the wound
7. may be absent if missile is lodged in the body
8. paraffin test always negative

HISTORY
Considerations:
1. NOI- Nature Of Injury
2. DOI- Date Of Injury
3. TOI- Time Of Injury
4. POI- Place Of Injury