patterned injuries and strangulation · 2013. 1. 16. · appearance of contusion • location (body...
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Richard Harruff, M.D., Ph.D.Chief Medical ExaminerSeattle - King County
Medical Examiner’s Office
Richard Harruff, M.D., Ph.D.Chief Medical ExaminerSeattle - King County
Medical Examiner’s Office
PATTERNED INJURIES AND STRANGULATION
PATTERNED INJURIES AND STRANGULATION
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CLASSIFICATION OF WOUNDS
CLASSIFICATION OF WOUNDS
• Blunt force wounds• Sharp force wounds• Firearm (gunshot) wounds• Asphyxia (strangulation)• Thermal burns
• Blunt force wounds• Sharp force wounds• Firearm (gunshot) wounds• Asphyxia (strangulation)• Thermal burns
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TERMINOLOGY OF BLUNT FORCE WOUNDS
TERMINOLOGY OF BLUNT FORCE WOUNDS
• Contusion (bruise)• Abrasion (scrape)• Laceration (tear)• Avulsion
• Contusion (bruise)• Abrasion (scrape)• Laceration (tear)• Avulsion
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BLUNT FORCE WOUNDS:ABRASION, CONTUSION, LACERATION
BLUNT FORCE WOUNDS:ABRASION, CONTUSION, LACERATION
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APPEARANCE OF CONTUSIONAPPEARANCE OF CONTUSION• Location (body site)• Weapon (pattern injury)• Depth (dermal or deep)• Age of wound• Individual factors:
Age of individualDisease (e.g. cirrhosis)Medications (e.g., aspirin, warfarin)
• Location (body site)• Weapon (pattern injury)• Depth (dermal or deep)• Age of wound• Individual factors:
Age of individualDisease (e.g. cirrhosis)Medications (e.g., aspirin, warfarin)
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CONTUSION: Origin of a
“Black Eye”
CONTUSION: Origin of a
“Black Eye”
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CONTUSION: RAILROAD TRACK PATTERN
CONTUSION: RAILROAD TRACK PATTERN
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LACERATIONLACERATION
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A LACERATION
is a TEAR!!
A LACERATION
is a TEAR!!
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STRANGULATIONSTRANGULATIONEssential ConceptsEssential Concepts
Mechanism, Injury, InvestigationMechanism, Injury, Investigation
•• Compression of vital neck structuresCompression of vital neck structures•• Essential injury: Cerebral HypoxiaEssential injury: Cerebral Hypoxia•• Documentation of injuries:Documentation of injuries:
Primary physical signsPrimary physical signsSecondary physical signsSecondary physical signsSymptomsSymptoms
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COMPRESSION OF NECK COMPRESSION OF NECK STRUCTURESSTRUCTURES
StructureStructure Pounds of forcePounds of forceJugular veins Jugular veins 77Carotid arteriesCarotid arteries 11 11 –– 1515AirwayAirway 3030Vertebral arteriesVertebral arteries 6060
Carotid sinusCarotid sinus UnknownUnknown
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NECK STRUCTURES IN STRANGULATIONNECK STRUCTURES IN STRANGULATION
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NECK STRUCTURES IN STRANGULATIONNECK STRUCTURES IN STRANGULATION
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ESSENTIAL INJURY IN ESSENTIAL INJURY IN STRANGULATION:STRANGULATION:
Failure to Deliver Oxygen to BrainFailure to Deliver Oxygen to Brain
Asphyxia, Cerebral HypoxiaAsphyxia, Cerebral Hypoxia
•• Interference with victimInterference with victim’’s s ability to breathability to breath
•• Reduced blood flow to victimReduced blood flow to victim’’s s brainbrain
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NECK COMPRESSIONNECK COMPRESSION
Vascular vs. AirwayVascular vs. AirwayCompressionCompression
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TYPES OF STRANGULATIONTYPES OF STRANGULATION
•• LigatureLigature•• ManualManual•• Neck holdsNeck holds•• Others, e.g., burkingOthers, e.g., burking
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PRIMARY PHYSICAL SIGNSPRIMARY PHYSICAL SIGNS
•• Specific:Specific:Pattern injuries Pattern injuries –– ligature abrasion, ligature abrasion, fingernail abrasionsfingernail abrasions
•• Nonspecific:Nonspecific:ErythemaErythema, swelling, abrasions, , swelling, abrasions, contusionscontusions
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SECONDARY PHYSICAL SIGNSSECONDARY PHYSICAL SIGNS
•• Facial skin congestion, cyanosisFacial skin congestion, cyanosis•• PetechiaePetechiae
Facial skin esp. Facial skin esp. periorbitalperiorbitalConjunctivae of eyes, eyelidsConjunctivae of eyes, eyelidsOral mucosaOral mucosa
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INTERNAL NECK INJURIESINTERNAL NECK INJURIES
•• Soft tissue contusionsSoft tissue contusionsPerilaryngealPerilaryngeal hemorrhage, hemorrhage, hematomahematomaLaryngeal (vocal cord) edema,Laryngeal (vocal cord) edema,hemorrhagehemorrhage
•• FracturesFracturesHyoid boneHyoid boneLaryngeal cartilageLaryngeal cartilage
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LARYNX FRACTURELARYNX FRACTURE
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HYOID FRACTUREHYOID FRACTURE
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DOCUMENTATION OF INJURIESDOCUMENTATION OF INJURIES
• Photography• Diagrams• Statements• Medicolegal examination• Voice recording (911 call)• Medical records• Radiography
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SYMPTOMSSYMPTOMS
•• Impairment of Impairment of consciousnessconsciousness
•• AmnesiaAmnesia•• SeizuresSeizures
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SYMPTOMSSYMPTOMS
•• PainPain•• HoarsenessHoarseness•• Painful swallowingPainful swallowing•• CoughingCoughing•• Breathing difficultiesBreathing difficulties
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SYMPTOMSSYMPTOMS
•• NauseaNausea•• VomitingVomiting•• Incontinence*Incontinence*
* * must ask must ask