I.

Medico Legal Investigation of Physical Injuries

 Physical Injuries – is the effect of some stimulus on the body.
- Includes injuries caused by mechanical trauma, heat and cold,
electrical discharges, changes in pressure, and radiation.
 Wound – an injury to living tissues caused by a cut, blow, or other impact, typically one in
which the skin is cut or broken.
 Causes of physical injuries:
1. Physical violence
2. Heat or cold
3. Electrical energy
4. Chemical energy
5. Radiation by radioactive substances
6. Change in atmospheric pressure
7. Infections

CLASSIFICATIONS OF WOUNDS

1. As to severity:
a. Mortal wound - capable of causing death immediately after infliction or shortly thereafter
Parts of body where wound is inflicted
considered mortal:
• Heart and big blood vessel
• Brain and upper portion of spinal cord
• Lungs
• Stomach, liver, spleen and intestine

b. non-mortal wound - not capable of causing death immediately

2. Kind of instrument used:

a. blunt instrument (contusion, hematoma, lacerated wound)
b. sharp instrument: sharp-edged instrument (incised wound) sharp-pointed (puncture wound)
sharp - edged and sharp - pointed (stab
wound)
c. tearing force (lacerated wound)
d. change of atmospheric pressure (barotrauma)
e. heat or cold (frostbite, burns or scald)
f. chemical explosion (gunshot or shrapnel wound) f-regulated Learning Module
15
3. As to manner of infliction:
a. hit - means of bolo, blunt, instrument, axe
b. thrust or stab - bayonet, dagger
c. gunpowder explosion - projectile or shrapnel wound
d. sliding or rubbing or abrasion

4. Depth of wound:
a. superficial - only layers of skin
b. deep - inner structure beyond layers of skin
• penetrating - wounding agent enters the body but did not come out or mere piercing of solid
organ or tissue or body
Penetrating wound - wound where dimension of depth and direction is an important factor in its
description. It involves the skin or mucous surface and the deeper underlying tissues or organs
caused directly by the wounding instrument. Example: punctured, stab, gunshot wounds.
• Perforating - wounding agent produces communication between the inner and outer portion of
the hollow organs. Traversing pr
piercing completely a particular part of body

5. Relation of site of application of force and location of injury:

a. coup injury - physical injury which is located at the site of application of force
b. contre - coup injury - physical injury found opposite the site of application of force
c. coup contre - coup injury - physical injury located at site and also opposite the site of application of
force (fixed head is hit with moving
object then falls on another hard object)
d. locus minoris Resistencia - PI located not at the side or opposite the site of application of force but
in some areas offering the least resistance
to the force applied. Blow on forehead may cause contusion at region of eyeball because of fracture
on the papyraceous bone forming
roof of orbit.
e. Extensive injury - PI involving greater area of body beyond site of application of force -not only
wide are of injury but various types of injury. (Fall from height or run-over of victim in vehicular
accident)
*Stationary head is hit by moving object, contusion is with the site of impact.; when moving head hits
a firm fixed and hard object,
Brain contusion may develop at opposite side of impact.

II. Types and classification of open and closed wounds to include gunshot and
defense wounds

OPEN AND CLOSED WOUNDS

1.Closed wound – no breach of continuity of the skin or mucous membrane.

a. Superficial – When the wound is just underneath the layers of the skin
or mucous membrane.
a. Petechiae – is a circumscribed extravasation of blood in the subcutaneous tissue or underneath
the mucous membrane.
b. Contusion – is the effusion of blood into the tissues underneath the skin on account of the
rupture of the blood vessels as a result of the application of blunt force or violence.
-size of contusion greater than the size of the object.
c. Hematoma - the extravasations or effusion of blood in a newly formed cavity underneath the
skin when the blunt instrument hit a hard part of the body like a bony part, which is superficially
located
 contusion vs. hematoma: contusion is a mild to moderate injury that causes the small
blood vessels to break and leak under the skin. This leaves the skin tender and discolored
going from red shade to blue or purple shade. Hematoma occurs when a larger blood
vessel is damaged. It is a moderate to severe injury that causes the blood to collect, pool
and clot under the skin which gives it a spongy, rubbery or lumpy feeling.
2.Open wounds – a type of injury that involves a break in the skin that leaves the internal tissue
exposed.

a. Abrasions (scratch, graze, friction marks, impression marks) – an injury characterized

by the removal of the superficial epithelial layer of the skin caused by a rub or friction
against a hard – rough object
b. Incised wounds (cut, lash, slice) – produced by a sharp – edged instrument.

3.Gunshot wound – a wound caused when a bullet or other projectile is shot into or through the
body. It may cause serious injury including severe bleeding, damage to tissues and organs, broken
bones, wound infections, and paralysis.

a. Contact (muzzle against the body) – No blackening around entry; have muzzle
imprint and/or star-shaped, often with flaps directed outward. 3-5 Inches.
Presence of Singeing and Scorching.
b. Close (less than 18 inches) - Blackening around entry; grains of powder and
deposits of powder residue. Close - range wounds may show wide zone of
powder stippling but lack muzzle imprint and laceration
c. Distant (18 inches or more) - they lack the characteristics exhibited by close and
contact gunshot wounds. Typically, a distant wound will exhibit a circular skin
defect known as a marginal abrasion ring around the entrance wound edges.
d. Entry wounds - re generally smaller and more regular than exit wounds. Entry
wounds show invagination of tissue into the wound, while exit wounds show
outward beveling of tissue. The skin surrounding the entry wound will show the
above characteristics, depending on the distance as described later; this includes
the presence of flame burns and singeing, soiling and redding from gas, as well as
tattooing from unburnt particle and metal scraps. Similarly, the presence of an
abrasion rim and grease collar around the wound also indicate that it is an entry
wound. However, an abrasion rim may also be present on the exit wound, where
the skin is shored against a hard surface.
e. Exit wounds- in comparison, are larger and more irregular. They show outward
beveling of the soft tissue and the margin. Entry wounds will be free of
characteristics, including flame burns and singeing, soiling and redding from gas,
 as well as tattooing from unburnt particles and metal scraps. They do not have an
abrasion rim or grease collar, except when the skin is shored against a hard
 Entrance and exit wounds – exits are larger than that of the entrance wound; however,
this is not always the case. In most cases it is advisable to not make assumptions as to the
entrance or exit wounds at the scene of a crime or within a report. The autopsy process
will be the one to determine which wounds are associated with the entrance or the exit
of the projectile/s.

4.Defense wound - result of person’s instinctive reaction of self - protection; injuries suffered by a
person to avoid or repel potential injury from aggressor (injury on flexed forearms when about to be
hit by blunt object; incised or stab wound on palm when about to be stabbed by another)

III. Type of weapon/ instrument used that caused the wound/injury

Type of wound Weapon/instrument that caused it

Incised wound

Incisions are caused by sharp objects such as

knives, razors, shards of glass, box cutters,
scalpel and etc.

Stab wound
Normally caused by knives, other instruments
including forks, scissors, screwdrivers, arrows,
ice picks, pens and other sharp, pointy objects.
Puncture wound

Caused by sharp, pointed instruments such as

nails, ice picks, knives, needles, dagger, chisel,
and even teeth.

Lacerated wound

Produced by sharp edged instruments such as

axes, hatchet, piece of broken glass, a gun

Firearm wounds
Types of firearm wound:
- contact Produced by a projectile fired from a gun.
- close

- distant

Defense wounds These may be caused by sharp objects such as

knives or by guns it may also be caused by the
defendant’s fingernails and/or teeth.
Strangulation Strangulation through ligature may be caused
Ligature: by cord - like objects such as rope, wire, chain,
shoelaces, blanket and etc.
Manual strangulation is caused by strangulation
by hands.

Manual:

Self - inflicted wounds Is usually caused by blade or knife, pointed

objects such as needle, broken glass or ceramic.

Patterned wound The injury and its pattern may be caused by

 impact of a weapon or other object on the body,
or contact of the body with a patterned surface.

IV. Characteristics of wound and its healing periods

1. Incised wounds

 Healing Duration:4-24 days. You can help the healing process by keeping on track by
keeping the tissue on wounds clean and hydrated.

2. Stab wounds

 Healing Duration: It depends on how large or deep the cut is. It may take up to a few
years to completely heal. An open wound may take longer to heal than a closed wound.
According to Johns Hopkins Medicine, after about 3 months, most wounds are repaired

3. Puncture

 Healing Duration:2 days to 2 weeks. Puncture wounds are painful but the pain should
subside as the wound heals. Over-the-counter medications can help with inflammation
and pain. These include ibuprofen (Motrin, Advil) or naproxen sodium (Aleve). On
average, it can take two days to two weeks for an injury to heal. Recovery time is based
on the depth of the puncture.

4. Laceration
  Healing Duration: 4-24 days. You can help the healing process by keeping on track by
keeping the tissue on wounds clean and hydrated.

5. Defense wounds

 Healing Duration: 4-24 days. You can help the healing process by keeping on track by
keeping the tissue on wounds clean and hydrated

6. Strangulation

 Healing duration: ligature – usually 4-6 weeks; manual - if it is considered a minor injury
and no bleeding is involved, this may take between 3-7 days depending on your health
and age. Skin abrasion healing time for a second-grade abrasion, this kind of injury
damages your lower layer of skin so requires a little bit more time about 15 to 20 days for
proper healing. Moderate to severe contusions may take two or more months to heal.
It’s important not to resume intense physical activity until your healthcare provider clears
you to do so. You may start to feel better in fewer than two months, but the contusion
may not have healed fully.

Nota Beta: Wounds generally heal in 4 to 6 weeks. Chronic wounds are those that fail to heal within
this timeframe.

V. Changes in the body of the dead

1. Insensibility – the inability to feel something, you are not aware of what’s happening
around you.
2. Loss of voluntary movements – you will lose muscle control; it will lead to paralysis.
3. Cessation of respiration – absence of breathing.
4. Cessation of circulation – occurs when the heart stops beating.
5. Cessation of nervous system functions – sudden onset of one or more symptoms,
such as numbness, tingling, weakness, or inability to move a part or all of one side of
the bod. Dimness, blurring, double vision, or loss of vision in one or both eyes. Loss of
speech, trouble talking, or trouble understanding speech.
 VI. Poisoning and changes of the human body due to poison
 Poisoning - injury or death due to swallowing, inhaling, touching or injecting various
drugs, chemicals, venom or gases.

CHARACTERISTICS:

The four components of poisoning are the poison, the poisoned organism, cell damage, and
symptoms and indicators of death. The cause, subject, effect, and consequence of poisoning are
represented by these four components. The creature is exposed to the harmful chemical which
starts the poisoning. The injury to the cells that results when a hazardous amount of the chemical
builds up in the cells of the target tissue or organ alters the cells’ regular structure or function. Once
symptoms and toxic indicators start to appear death could happen if the toxicity is severe enough.

TWO TYPES OF POISONING

1. Accidental poisoning - Poisoning is the most common cause of nonfatal accidents in the
home. Young children, because of curiosity and a tendency to explore, are particularly
vulnerable to accidental poisoning in the home, as are older people, often due to confusion
about their drugs. Because children often share found pills and substances, siblings and
playmates may also have been poisoned. Also vulnerable to accidental poisoning are
hospitalized people (by drug errors) and industrial workers (by exposure to toxic chemicals).
2. Deliberate poisoning- Poisoning may also be a deliberate attempt to commit murder or
suicide. Most adults who attempt suicide by poisoning take more than one drug and also
consume alcohol. Poisoning may be used to disable a person (for example, to rape or rob
them). Rarely, parents with a psychiatric disorder poison their children to cause illness and
thus gain medical attention (a disorder called factitious disorder imposed on another
previously called Munchausen syndrome by proxy).

CHANGES OF THE HUMAN BODY DUE TO POISONING

 The effects of poisoning depend on the substance, amount, type of contact. The age, weight,
and state of mental health also affect the symptoms.

Listed below are the symptoms that someone is experiencing poisoning:

Nausea and/or vomiting. Trouble breathing

Diarrhea Dilated pupils (bigger than normal) or

constricted pupils (smaller than normal)
Rash
Confusion
Redness or sores around the mouth
Fainting
Dry mouth
Shaking or seizure
Drooling or foaming at the mouth

HOW TO TREAT POISONING

1. Support vital functions such as breathing, blood pressure, body temperature, and heart
rate
2. Prevent additional absorption.
3. Increase elimination of the poison
4. Give specific antidotes (substances that eliminate, inactivate, or counteract the effects of
the poison), if available
5. Prevent preexposure.

The usual goal of hospital treatment is to keep people alive until the poison disappears or is
inactivated by the body. Eventually, most poisons are inactivated by the liver or are passed into the
urine.

VII. Types, degrees, and characteristics of burned, scald, and frostbite

 Burns – injuries caused by exposure to heat, chemical, electrical, or radiation.

1.) TYPES
 a. Thermal burns- caused by contact with heat sources such as flames, hot liquids, or hot
surfaces
b. Electrical burns- caused by contact with an electrical current
c. Chemical burns- caused by contact with strong acids, alkalis or other chemicals.

2.) DEGREES

a. First degree burn- superficial burns that only affect the top layer of skin
b. Second degree burns- affect the first and second layer of skin and can cause blistering and
more severe pain
c. Third degree burns- affect all layers of skin and may result in charring, numbness, and sever
pain.

3.) CHARACTERISTICS

a. Redness and swelling

b. Pain or discomfort
c. Blisters or open wounds
d. Charred Skin
e. Loss of sensation in the affected area

SCALDS- injuries occur when the skin is exposed to hot liquids or steam.

1.) TYPES

a. Thermal scalds- caused by contact with hot liquids or steam

b. Electrical scalds- caused by contact with an electrical current
c. Chemical scalds- caused by contact with strong acids, alkalies or other chemicals

2.) DEGREES

a. First degree scald- superficial burns that only affect the top layer of skin
b. Second degree scald- affect the first and second layer of skin and can cause blistering and
more severe pain
 c. Third degree scald- affect all layers of skin and may result in charring, numbness, and sever
pain.

3.) CHARACTERSITICS

a. Redness and swelling

b. Pain or discomfort
c. Blisters or open wounds
d. Charred Skin
e. Loss of sensation in the affected area

FROSTBITE- injuries occur when the skin and underlying tissues freeze due to exposure to cold
temperature.

1.) TYPES

a. Superficial Frostbite- affects only the skin and underlying tissues

b. Deep Frostbite- affects muscles, bones, and tendons

2.) DEGREES

a. First Degree Frostbite- affects only the skin and causes redness and numbness
b. Second Degree Frostbite- affects the skin and underlying tissue and can cause blisters,
swelling, and severe pain.
c. Third Degree Frostbite- affects muscles, tendons, and bones and can cause blackened, dead
tissue.

3.) CHARACTERSITICS

a. Coldness, numbness, or tingling in the affected area

b. Discoloration of the skin, ranging from pale to blue to black
c. Hard or waxy-looking skin
d. Blisters or open sores
e. Loss of sensation in the affected area
 VIII. Other related and relevant forms of injury

1. Animal bites - an injury caused by the mouth and teeth of an animal (including humans). There
may be bruising, deep anatomic structure disruption, introduction of infectious agents, and
envenomation (injection of toxin by a bite or sting).
Animal bites can result when an animal is provoked. Provoked bites may occur if you try to remove food
while a dog is eating. They can also happen if you tease your family pet. However, in many cases animal
bites are unprovoked.
2. Bruises - a mark on your skin caused by blood trapped under the surface. It happens when an
injury crushes small blood vessels but does not break the skin. Those vessels break open and
leak blood under the skin. Bruises are often painful and swollen. You can get skin, muscle and
bone bruises.
3. Dislocation - a separation of two bones where they meet at a joint. This injury can be very
painful and can temporarily deform and immobilize the joint. The most common locations for a
dislocation are shoulders and fingers, but can also occur in elbows, knees, hips and feet.
4. Electrical injury - a damage caused by generated electrical current passing through the body
5. Fracture - a break, usually in a bone. If the broken bone punctures the skin, it is called an open
or compound fracture. Fractures commonly happen because of car accidents, falls, or sports
injuries.