Transcript 4 - wounds.ppt
ميحرلا نمحرلا الله مسب
Wounds
Definition:
1.
2.
3.
Classification of wounds:
Anatomical Legal classification: Medico- legal classification:
Anatomical classification
Skin bone Muscle Mucous membrane Hollow organ
Legal classification:
Simple wound
Dangerous wound:
Fatal wound:
3-Medico- legal classification: Sharp Blunt Firearm. Physical injuries.
A-Wounds caused by sharp instruments Incised (Cut) wounds.
Stab wounds.
Stab penetrating wounds.
NB Transfixing wounds.
Defense wounds
I-Incised (cut) wound: Definition : Characters: 1- The edges 2- The length 3- Gaping of the edges 4- Bleeding 5- Liability to sepsis 6- Healing
Its age can be determined to know the time of its infliction by histological examination
30 minutes – 4 hours
: Margination of polymorph nuclear leucocytes
48 hours:
Pus may be present if sepsis occurs.
10-15 days:
Complete healing by primary intention if no sepsis.
Its age can be determined to know the time of its infliction by histological examination 3 weeks: Red scar .
3 months: Scar becomes coppery.
6 months: Scar is thin and pale,
II- Stab wound
Definition:
Unibladed knife or Bibladed knife Characters: More deep than long The edges The shape of the wound may be changed if They are very dangerous A broken tip of the weapon may be found in the wound .
Different Blades
Types of stab wounds: Ordinary stab wounds.
Punctured wounds. Penetrating wounds (3PMS) .
Transfixing wounds .
Hemopericardium
Fabricated wound:
Definition
Characters:
Aims
Defense wounds
Definition: 1- Injuries sustained by grasping the weapon: 2- Injuries sustained during raising the hand
Defense wounds
2 Wounds caused by blunt instruments:
Abrasions.
Bruises (contusion).
Lacerations.
1-Abrasion 1.
2.
3.
4.
5.
Definition Causative instrument Types linear Sliding Pressure Impact Bite
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ML importance of abrasions 1.
2.
3.
4.
5.
Violence Its shape Its site Its age Cut and contused wounds
2- Contusions Definition Types :ecchymosis –bruise-contusion -
Factor affecting size of contusion Age Sex Color of the skin.
Gravity.
Blood Diseases Force Onset of death: ML importance
Age of contusion 1st day : red in color (oxy HB) After 1-3 days : blue ( reduced Hb).
After 2-5 days : green ( biliverdin) After 5-8 days : yellow (bilirubin) Bruises fade away ( heal) in 2-3 weeks.
Color changes
Bruises may be dangerous if : They occur in a trigger zone.
They are extensive.
They become infected They hide a more serious injury : e.g. rupture organ.
3-Contused wounds Definition: Characters: simulate cut wounds
Deference between cut and contused W 1.
2.
3.
4.
5.
6.
7.
8.
The edges Instruments Hair Bleeding Liability to sepsis Abrasion &contusion.
Healing BRIDGING OF Tissues
Complications of wounds: 1- Neurogenic or primary shock.
2- Traumatic shock (secondary shock).
3- Hemorrhage.
4- Embolism 5- Infection.
6- Crush syndrome.
1- Neurogenic or primary shock.
A- Parasympathetic inhibition of the circulation (vagal inhibition). Or B- Sympathetico-adrinal stimulation of the circulation.
2- Traumatic shock (secondary shock).
*It occurs due to: release of histamine like substance from the severely lacerated tissues that causes increase in the capillary permeability and loss of capillary tone
3- Hemorrhage: (oligaemic shock): Factors affecting the gravity of hemorrhage: a- Amount of blood lost: b- Rate of hemorrhage: c-site of hemorrhage: d- General condition of the patient: e- sex:
Types of hemorrhage:
1- Primary hemorrhage: It is directly due to the wound, it is either internal or external.
2- Secondary hemorrhage: 3-Reactionary hemorrhage:
4- Embolism
1- Air embolism: a- venous air embolism b- arterial air embolism 2- Thromboembolism: 3- Fat embolism:
5- Infection.
Contused and lacerated wounds are the most liable to severe infection particularly, tetanus and Gangrene due to devitalized tissue of the wounds.
6- Crush syndrome:
Severe crushing of muscles → liberation of myoglobin→ blocking of renal tubules→ acute renal failure
Thank you