well done

1. Blunt trauma wounds
GROUP 1

2. Group members
◦ Ayesha (005)
◦ Bukhtiar (006)
◦ Nokhaiz (007)
◦ Abdulraouf (009)
◦ Illiyyeen (011)
◦ Abubakar (025)
◦ Umair (028)
◦ Umer (031)
◦ Sufyan (032)
◦ Zikiriya (033)
◦ Mehran (034)
◦ Abubakar (036)

3. •What is blunt trauma?
Blunt trauma, also known as non-penetrating trauma or blunt force trauma,
refers to injury of the body by forceful impact, falls, or physical attack with a dull
object. Penetrating trauma, by contrast, involves an object or surface piercing
the skin, causing an open wound. Blunt trauma can be caused by a combination
of forces, including acceleration and deceleration (the increase and decrease in
speed of a moving object), shearing (the slipping and stretching of organs and
tissue in relation to each other), and crushing pressure.

4. Classified into:
Blunt trauma can generally be classified into four categories: contusion,
abrasion, laceration, and fracture. Contusion—more commonly known as a
bruise—is a region of skin where small veins and capillaries have ruptured.
Abrasions occur when layers of the skin have been scraped away by a rough
surface. Laceration refers to the tearing of the skin that causes an irregular or
jagged-appearing wound. Lastly, fractures are complete or partial breaks in
bone. Such injuries can often occur in motor vehicle crashes, sports injuries,
physical assaults, and falls.

5. Abrasion
In abrasion, the outer layers of the skin are removed leaving a bare area with minimal or no
bleeding. It is often the most superficial of the injuries, and with regard to medical intervention,
generally minor. However, in trauma forensics, it is by no means insignificant. It could be quite
revealing about the dynamics of interactions between an object or objects and the body of the
patient. Abrasion tells an important story as follows:
i. An object has come into contact with the skin
ii. The impingement is at an angle of less than 90 degrees
iii. There is a relative movement between the object and the body
iv. There is friction between the object and the body.

6. Therefore, when a patient has abrasions, it is crucial to enquire about how they
come about the injury and to document every detail provided. It is important to
bear in mind that the role of the surgeon is to provide a medical assessment that
could be relevant to any potential legal issues that may arise. Often, the
abrasion may occur together with more severe injuries. The patient or the carer
may not even be aware of the abrasion nor take cognisance of its presence.
However, the abrasion may hold a significant clue to how the other associated
injuries on the body may have come about.

7. Bruise or Contusion
Bruise / Contusion:
“It is an extravasation of blood into tissue due to application of blunt force”.
Damage may not be so evident macroscopically but may be appreciated microscopically.
Clinical Manifestations:
• Pain.
• Redness.
•Swelling.
•Epidermis may not show any damage.
Appearance:
Shape may or may not corresponding the shape of the weapons.

8. Factor controlling appearance of bruise:
1. Type of tissue.
2. Color of skin.
3. Age.
4. Natural disease.
5. Vascularity.
6. Gender.

9. Medicolegal Importance Of Bruise
1. It is evidence of application of blunt force.
2. Helps in identification of weapon.
3. Indicates degree of violence.
4. Tells time of infliction of injury.

10. Colour Changes
Fresh: is Red colour _ due to oxygenated Hb.
After 12 hours: Blue colour _ due to deoxygenated Hb.
1-2 days: Blackish Blue or Brown _ due to Haemosiderin.
After 3 days: Greenish colour _ due to Haemotoidin.
After 7 days: Yellowish due to Bilirubin.
After 2 weeks: Complete disppearence.

11. Laceration
Laceration can be caused by any imaginable blunt object and incidents such as kicking, a fist, a
piece of rock, a rod, a hammer, an axe, falls, road traffic crashes, etc. The mechanism of damage
to the issue is either from a direct blow to the area or a tear from the stretching of the tissue.
The characteristic features of the injury include ragged margins with associated bruising and an
irregularly torn base. Occasionally, one may require the aid of a hand-held magnifying lens to
correctly identify a laceration and differentiate it from an incision (especially on the scalp),
which is a type of wound with a different mechanism of causation, which will be discussed in the
next broad category of traumatic injuries. However, the presence of a ragged and bruised margin
confirms the impression. Meanwhile, like abrasion, it is of forensic significance to look for trace
elements and document and process them accordingly.

12. In the medical evaluation of the patient, the following determinations are of forensic significance and should
engage the thoughts and consultation of the surgeon:
i. The nature of the object that may have caused the injury
ii. The degree of applied force
iii. The number of blunt force impacts with attendant injuries
iv. The severity of external injuries
v. Internal injuries may be associated with the external traumatic impact.
Photo documentation is a critical aspect of the management of lacerations. It is necessary to have sets of both
before and after images to show what the injury looks like before treatment and following wound care that has
taken place in the medical intervention. In major lacerations where wound debridement has taken place with
other required surgical interventio

14. What is blunt trauma death?
Blunt trauma death refers to physical trauma to the body by way of fall, impact,
or attack, that results in death. Head trauma and severe loss of blood are the
most common causes of death due to blunt traumatic injury. Severity of the
injury depends on the mechanism and extent of injury. Typically, a large force
applied to a sizable area over several minutes will result in vast tissue damage,
which increases the chance of death. Whereas a smaller force applied to a
smaller area will result in less tissue damage.

15. Severity of injury also depends on the underlying age and health of the
individual. For example, elderly patients have been identified as having some of
the highest injury-related mortality rates. This has been attributed to several
factors including reduced cardiopulmonary reserve, which is a measure of heart
and lung function, as well as poor nutritional status, and propensity for bleeding
after fractures.

16. What organs are most likely be injured by
blunt trauma:
The majority of blunt trauma cases are from motor vehicle crashes and
pedestrian injuries often resulting in abdominal injuries. These injuries are
typically attributed to collisions between the individual and the external
environment, or to acceleration and deceleration forces acting on the
individual’s internal organs.

17. Within the abdomen, the spleen is the most commonly injured organ, followed
by the liver. The kidneys, bladder, diaphragm, and the large and small
intestines may also be affected. Injuries to the internal organs can lead to
hemorrhage (release of blood from damaged blood vessels). This may result
in hypotension, or a decrease in blood pressure, and more
severely, hypovolemic shock. This occurs when the volume of blood in
the body is too low, resulting in circulatory failure. Hypovolemic shock can be
life-threatening and can lead to organ failure.

18. How is blunt trauma diagnosed?
When assessing possible abdominal trauma, physicians look for abdominal pain,
tenderness, nausea, and vomiting. In cases of motor vehicle crashes, the
presence of a positive ‘seatbelt sign’, appearing as bruising in a horizontal or
diagonal band that corresponds to a seatbelt across the abdomen, chest, or
neck, indicates an increased likelihood that the individual has an intra-
abdominal injury. If serious trauma is suspected, imaging techniques, such as X-
rays, CT scans, and ultrasound imaging, can also be used to detect fractures and
internal injury.

19. If a hollow organ, such as the small or large intestine , ruptures upon injury, it is
considered a medical emergency and requires immediate medical attention. In
addition to diagnostic imaging, providers may use a diagnostic peritoneal lavage
to determine if there is free floating fluid, such as blood, in the abdominal cavity.
The procedure entails inserting a catheter into the peritoneal cavity, or the sac
around the abdominal cavity. After insertion, any free floating blood or fluid is
drawn out. If necessary, sterile saline is then infused to wash out the cavity.

20. In cases like:
Blunt force trauma is routinely involved in cases classified as accidents, as
well as in cases of suicide and homicide. People dying natural deaths often have
minor blunt force injuries that do not contribute to death—small abrasions or
contusions on the skin are commonplace at autopsy

21. For purposes of death certification, it should be noted that blunt force trauma
may be the underlying (proximate) cause of death in cases in which the
immediate cause of death is a natural disease process. For example, individuals
may die of infections, thromboemboli, or organ failure that occurs as a delayed
result of previous blunt force trauma. In some cases, the injury may have
occurred many years before death.

22. Scene Findings
As with most types of traumatic deaths, scene findings often play an important
role in the death investigation process. Examples include blood spatter
evaluation and DNA analysis in homicide cases involving multiple blows with a
blunt object, such as a baseball bat, and scene reconstruction following motor
vehicle collisions.

23. In certain cases, it may be helpful to examine the skin surface and wounds for
trace evidence. This may involve looking for paint, metal, or glass fragments on a
body that was struck by a hit-and-run motor vehicle; identifying embedded
fragments of a weapon used to assault someone; or identifying a tool mark left
in a bone underlying a blunt force impact site. Such trace evidence may be used
by forensic science technicians to help identify the vehicle or weapon that
caused the injuries.

24. Gross Examination
The individual types of blunt force trauma discussed above do not always occur
individually; they often occur in combination. That is, one may encounter
abraded contusions, abraded lacerations, and lacerated contusions (as depicted
in the images below). The appearance of a blunt force injury is determined by
several variables, including the impacting weapon or surface, the anatomic site
impacted, and individual factors including skin elasticity and coagulability status.

26. Example
One common type of blunt force injury is the so-called brush-burn abrasion.
Brush-burn abrasions are broad, dried abrasions that often have a yellow-orange
or orange-red coloration. These abrasions are caused by dragging or scraping
the surface of the skin against a rugged surface; they are most often
encountered when a body slides on pavement. These abrasions are sometimes
called "road rash.

28. Documentation
Measurements and descriptions of blunt force injuries on the skin surface
should be documented on a body diagram. Injuries to deeper tissues and
internal organs must also be documented either on the same diagram or
elsewhere in the case file. When generating the autopsy report, it is often best
to divide the description of injuries into subsections for the head and neck,
trunk, and extremities. Furthermore, one should describe the injuries "from the
outside in." That is, a description of a laceration on the scalp should be followed
by that of any deeper scalp hemorrhage, then associated skull fractures, then
associated intracranial hemorrhages and any traumatic injuries to the brain.

29. Thank you