CLINICAL SKILL HANDOUT FORENSIC MEDICINE AND ..., Schemes and Mind Maps of Medicine

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CLINICAL SKILL HANDOUT FORENSIC MEDICINE AND MEDICOLEGAL Clinical Skill Lab Forensic Medicine-Medicolegal Medical Faculty of Hasanuddin University Makassar 2015 Forensic Medicine-Medicolegal 1 TABLE OF CONTENT Handout Cover Table of Content ..................................................................................................... 1 Preface ................................................................................................................... 2 Wound Examination (theoretical background) ....................................................... 3 Learning Objective .................................................................................................. 6 Learning Strategies ................................................................................................. 7 Body Sketch ........................................................................................................... 8 Wound Examination Procedure ............................................................................. 11 Evaluation ............................................................................................................... 15 Reference ................................................................................................................ Forensic Medicine-Medicolegal 4 - incised wounds - stab wounds - fractures - bite marks - defense injuries Abrasions (Scrapes) An abrasion is denuded skin caused by friction. A wound may be either deep or superficial depending on the force and the coarseness of the surface which caused the abrasion. A person who slides across pavement might have a deeper and rougher wound than a person who slides across a rug. Occasionally, the direction of the force can be determined. If one end of a wound has margins with raised skin, for example, the force originated from the opposite side. Contusions (Bruises) Contusions are discolorations of the skin caused by bleeding into the tissues from ruptured blood vessels. In general, the older a person, the easier the vessels will rupture. There is no way, however, to determine exactly how much force is needed to produce a contusion. The age of a contusion is difficult to determine because of the great variability of a body’s reaction to trauma. People with blood disorders and liver disease may develop more severe contusions than healthy individuals. As healing occurs, a contusion changes color from blue or red, to red-blue, to green, to brown, and finally yellow. These color changes, however, may appear out of order and may overlap. There is no way to know how long each color stage will last. Occasionally a recent contusion will have a brown tinge. Lacerations (Tears) Tears of the skin from blunt trauma are called lacerations. Many tears are associated with both contusions and abrasions. For example, a blow to the head with ahammer may cause tearing of the scalp with adjacent abrasions. If blood escapes into the surrounding tissues, the skin can also be bruised. A laceration must be distinguished from a cutting Forensic Medicine-Medicolegal 5 injury. A laceration usually has bridges of tissue connecting one side of the wound to the other. Cutting and incised wounds have no tissue bridges because a sharp object cuts the wound cleanly from the top to the bottom of the wound. Deaths due to blunt trauma may have some or none of the above external signs of trauma. This is particularly true of fatal blows to the abdomen. Blunt trauma to the head Blunt trauma to the scalp and face can produce contusions, lacerations, and abrasions. However, there may be no external signs of trauma to the head if a person has a full head of hair. Obvious external injuries are not necessary for a death to be caused by head trauma. Occasionally, the weapon leaves a characteristic identifyingpattern on the scalp. Unfortunately, this is the exception rather than the rule. Battle’s sign — a bluish discoloration of the skin behind the ear that occurs from blood leaking under the scalp after a skull fracture. Spectacle hemorrhage (raccoon’s eyes) — a discoloration of the tissues around the eyes usually due to a fracture of the skull. The hemorrhages may involve one or both eyes and may be mistakenly interpreted that the decedent had been struck about the face and eyes. When a person receives a significant blow to the head there will be bleeding under the scalp even if there are no external injuries. Depending on the amount of force there may be skull fractures. There are many different types of skull fractures; however, the specific type is not as important as recognizing a pattern such as a circular fracture caused by a hammer. Forensic Medicine-Medicolegal 6 LEARNING OBJECTIVE General Objective After conducting the skills in this manual, students are expected to be able to master the skill of assessing different types of wounds. Spesific Objective After finishing the skills training in this manual, students are expected to be able to conduct : 1. Proper observation and identification skill 2. Correct assessment of different types of wound 3. Correct description of different types of wound found on patient body 4. Correct identification of the object / weapon that cause the injury using the characteristic of the wound. LEARNING STRATEGIES Instruments and Tools : - Manual book of CSL for wound - Handscoen / Surgical gloves - Standart measurement / Ruler - Surgical Tapes - Patient status (body sketch), ballpoint - Audio-visual / Digital Camera Learning Method : 1. Demonstration due to manual book 2. Discusssion 3. Active participation (simulation) 4. Evaluation using check list Forensic Medicine-Medicolegal 9 Forensic Medicine-Medicolegal 10 Wound Examination Procedure No Activity 1 Check all the administration and the equipment required: a. External examination request letter (SPV) b. Body label (big and small) c. Material label (big and small) d. Pen e. Digital camera f. Handscoen (gloves) g. Measurement standart 2 Write down the required information from the external examination request letter (SPV) to the body label and to the body chart: a. Police request number b. Victim’s name / age c. Case register number d. Examiner name e. Examiner ID number f. Date of the examination g. Time of the examination 3 Wear the surgical gloves (handscoen) 4 Describe the wound and write it down on the body chart I. Number of wound II. Type of wound III. Location (anatomical region) IV. Wound measurement (length and width) V. Location (absis and ordinat) VI. Wound characteristic  Wound border : shape of wound; wound border – even or serrated; end of wound – pointed or blunt  Area inside the wound border : interior slope – even or serrated, type of tissue; tissue bridging; base od wound  Area surrounding the wound border : bruises; blood clot; soot; tattoage; etc. Forensic Medicine-Medicolegal 11 Reference Dorland’s Ilustrated Medical Dictionary E-Book 32nd edition. Elsevier Health Science. 2011. Dolinak D, Evan et al. Forensic Pathology Principle and Practice. Elsevier Academic Press. London. 2005 Skhrum, Micheal J, David A Ramasay et al. Forensic Pathologic of Trauma: Common Problem for the Pathologist. Human Press. New Jersey. 2007