Lesson 2.

1:
Causes of Physical Injuries

Lesson Summary
This lesson tackles the different causes of physical injuries and the various classifications of
wound. It also includes the different musculoskeletal injuries.

Learning Outcomes
1. Enumerate the causes of physical injuries;
2. Learn about the classification of wounds; and
3. Identify the different musculoskeletal injuries.

Motivation Question
How is learning the different causes of physical injuries helpful in crime investigation?

Discussion

What is Physical Injury?

 It is defined as those caused by physical violence (such as blow or wound), hot or cold
temperature (such as frostbite and burns), electrical energy (such as electrocution), and change of
atmospheric pressure (such as Caisson’s disease).

There are lots of causes of Physical Injuries and they are as follows:

A. Physical Injury due to Physical Violence

B. Physical Injury due to Heat or Cold
C. Physical Injury due to Electrical Energy
D. Physical Injury due to Change of Atmospheric Pressure

PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

 The effect of the application of physical violence on a person is the production of wound. A
wound is the solution of the natural continuity of any tissue of the living body. It is the disruption of the
anatomic integrity of a tissue of the body. In several occasions, the word physical injury is used
interchangeably with wound.

PHYSICAL INJURIES DUE TO COLD TEMPERATURE

When the body is exposed to cold or freezing temperature, the dissociation power of oxygen from
hemoglobin will become less thus diminishing the tissues to utilize the oxygen. Prolonged exposure may
cause necrosis and gangrene (decay) of the tissues. The degree of damage depends upon the decrease of
temperature, duration of exposure, vitality of the tissues involved, sex and condition of the body.

Local Effects of Cold Temperature

Local effects of cold temperature refer to the effects of cold to certain parts of the body that is
exposed to cold or freezing temperature. The following are the local effects of cold temperature.

 Frostbite – is an injury caused by freezing of the skin and underlying tissues. First the skin
becomes very cold and red, then numb, hard and pale. It is most common on the fingers, toes,
nose and ears, cheeks and skin. Frostbite occurs in three stages, frost nip, superficial frostbite,
and deep frostbite.

 Trench foot – occurs when the feet are wet for long period of time in conjunction with
temperature below 10 degrees. It leads to swelling, pain and sensory disturbances in the feet and
can lead to damage to the blood vessels, nerves, skin and muscles. Trench foot is characterized by
numbing of the affected foot, erythrosis (turning red) or cyanosis (turning blue) as a result of
poor vascular supply.

 Immersion foot – also known as “tropical immersion foot” or “paddy foot”. It is a skin
condition of the feet seen after continuous immersion of the feet in water or mud of temperature
above 22 degrees Celsius for two to ten days. Immersion foot is characterized by maceration
(soaked), blanching (pale), and wrinkling of the soles, padding (enlargement) of toes and padding
of the sides of the feet.

PHYSICAL INJURIES DUE TO HEAT

Generalized or Systematic Effects of Heat

This refers to the effects of heat in the whole system of the human body. The following are the
Generalized or systematic effects of heat:

 Heat Cramps – painful muscle spasms that occur due to dehydration and loss of nutrients from
excessive sweating. Heat cramps are most common in the abdomen, back, arms or legs.

 Heat Exhaustion or Heat Collapse – it is a condition whose symptoms is may include heavy
sweating and a rapid pulse, a result of the body overheating.
  Heat Stroke or Sun Stroke – is type of severe heat illness that results in a body temperature
greater than 40-degree Celsius and confusion. Other symptoms may include red skin, headache
and dizziness.

Local Effects of Heat

This includes the effect of heat to certain parts of the human body that is exposed to it. The
following are the local effects of heat:

 Scalds – are caused by contact with hot liquids, e.g. boiling or hot water and cooking oil. The
contact occurs through splashing, pouring, or immersion. It is characterized by redness, pain and
blister formation. The injury in scalds depends upon the temperature of the liquid, duration of
contact, underlying clothing and tissues involved.

 Burns – it is an injury due to application of physical heat in any form to the body, and is
characterized by redness, and heat coagulation of tissues, fractured charring. The effects of burns
to the body is influenced by the intensity of heat, duration of contact, tissues involved and
accompanying complications. Burns are classified into three, the First-Degree burn, involves the
superficial layer of the skin and is considered mild compared to other burns. The Second-Degree
Burn, affects the epidermis and dermis (inner layer of skin), it is characterized by pain, redness
and swelling. Third-Degree Burn goes through the dermis and involves nerves, muscles and
bones. It is characterized by white or blackened, charred skin that may be numb. Third degree
burn is the most severe burn because the victim usually dies from loss of fluid and electrolytes.

PHYSICAL INJURY DUE TO ELECTRICAL ENERGY

Electricity is a form of energy observable in positive and negative forms that occurs naturally or
is produced and that is expressed in terms of the movement and interaction of electrons. It has become an
integral part mankind, so have the incidents of electrocution and electric shock. Electrocution refers to
death due to electric current passing through the body.

PHYSICAL INJURY DUE TO CHANGE OF ATMOSPHERIC PRESSURE

The normal atmospheric pressure at sea level is 760 mm Hg which is conducive to life and health.
When a person goes several feet or fathoms under water, pressure becomes greater. The gases in the body
such as oxygen, carbon dioxide and nitrogen will accumulate and liberate in the circulation blocking
small caliber blood vessels. Gas bubbles block the blood vessels producing injury to the distal part
supplied by the blood this condition is called, “air embolism”. This condition is farther accelerated when
a person underwater goes abruptly from increased pressure to normal pressure environment. The post-
mortem finding show gas bubbles in different organs.
CLASSIFICATION OF WOUNDS

1. As to severity

a. Mortal Wound – wound which is caused immediately after infliction or shortly thereafter that
is capable of causing death. Parts of the where the wounds inflicted are considered mortal: (a) heart (b)
brain and upper portion of the spinal cord (c) lungs (d) stomach, liver, spleen and intestines.
b. Non- mortal Wound – wound which is not capable of producing death immediately after
infliction or shortly thereafter.

2. As to the kind of instrument used:

 a. Wound brought about by blunt instrument (contusion, hematoma,).

b. Wound brought about by sharp instruments (1) sharp- edged instrument – incised wound (2)
sharp pointed instruments – punctured wound (3) sharp edged and sharp pointed instrument – stab
wound.

c. Wound brought about by tearing force (lacerated wound).

d. Wound brought about by change of atmospheric pressure (barotrauma).

e. Wound brought about by heat or cold (frostbite, scald and burns).

f. Wound brought about by chemical explosion (gunshot or shrapnel wound).

g. Wound brought about by infection.

3. As to the manner of infliction

a. Hit – by means of bolo, blunt instruments, axe.

b. Thrust or stab – bayonet dagger.

c. Gunpowder explosion

d. Siding or rubbing or abrasion

4. As regards to the depth of the wound

a. Superficial – when the wound involves only the layers of the skin.

b. Deep – when the wound involves the inner structure beyond the layers of the skin as in (1)
Perforating – when the wounding agent produces communication between the inner and outer portion of
the hollow organs. It may also mean piercing or traversing. (2) Penetrating – one in which the wounding
agent enters the body but did not come out or the mere piercing of a solid organ or tissue of the body.

5. As regards to the relation of the site of the application of force and the location of injury

a. Coup Injury – physical injury which is located at the site of the application of force.

b. Contre- Coup Injury – physical injury found opposite the site of the application force.

c. Coup Contre- Coup Injury – physical injury located at the and also opposite site of
application of force.

d. Locus Minoris Resistencia – physical injury located not at the site nor opposite the site of the
application of force but in some areas offering the least resistance to the force applied.
 e. Extensive Injury – involving a greater area of the body beyond the site of the application of
force.

6. Special Types of Wounds

a. Defense Wound – the result of a person’s instinctive reaction of self- protection.

b. Patterned Wound – wound in the nature and shape of the object or instrument and which
infers the object or instrument causing it. (e.g. a person run over by a wheel of car, tire marks are shown
on the body.

c. Self- inflicted Wound – is a wound produced on oneself. As distinguished from suicide, the
person has no intention to end his life.

Types of Wounds

1. Closed Wounds – there is no breach of continuity of the skin or mucous membrane.

a. Superficial Closed Wounds
 Petechiae – extraversion of blood in the subcutaneous tissue or mucous membrane.
 Contusion or bruise – damage of small blood vessels
 Hematoma – extravasations of blood in a newly-formed cavity
 Ecchymosis – a form of hematoma only that the extent of extravasation of blood is wider but
thinner.

b. Deep Closed Wounds

 Sprain – partial or complete disruption in the continuity of a muscular or ligamentous support of a
joint. It is usually caused by a blow, kick or torsion force.
 Dislocation – displacement of the articular surface of bones entering into the formation of a joint.
 Fracture – solution of continuity of bone resulting from violence or some existing pathology.
 Close or Simple Fracture- fracture wherein there is no break in continuity of the
overlying skin or where the external air has no point of access to the site of injury.
 Open or Compound Fracture- the fracture is complicated by an open wound caused by
the broken bone which protruded with other tissues of the broken skin.
 Comminuted Fracture – the fractured bone is fragmented into several pieces.
 Greenstick Fracture – a fracture wherein only one side of the bone is broken while the
other side is merely bent.
 Linear Fracture – when the fracture forms a crack commonly observed in flat bones.
 Spiral Fracture – the break in the bone forms a spiral manner as observed in long bones.
 Pathologic Fracture – fracture caused by weakness of the bone due to disease rather than
violence.

2. Open Wound – there is a breach of continuity of the skin or mucous membrane.

a. Abrasion – characterized by the removal of the superficial layer of the skin brought about by
friction against a hard-rough surface.
  Linear - An abrasion which appears as single line. It may be a straight or curved line. Pinching
with the fingernails will produce a linear curved abrasion, while sliding the point of a needle in
the skin will produce a straight linear abrasion.
 Multi- Linear - An abrasion which develops when the skin is rubbed on a hard-rough object
thereby producing several linear marks parallel to one another. This is frequently seen among
victims of vehicular accidents.
 Confluent - An abrasion where the linear marks on the skin are almost indistinguishable on
account of the severity of friction and roughness of the object.
 Multiple - Several abrasions of varying sizes and shapes may be found in different parts of the
body.

b. Stab Wound – produced by a sharp-pointed and sharp edge instruments like knife, saber,
dagger and scissors.

c. Punctured Wound – produced by a sharp-pointed instrument like needle, icepick, spear.

d. Lacerated – produced by forcible contact of the body with a blunt instrument or by heat with a
piece of wood, iron bar, stone, and butt of firearm.

e. Mutilation – cutting-off a part of the body.

f. Avulsion – soft tissue injury where a flap of tissue has been removed.

g. Incised Wound – cut, slash, sliced by a sharp-edged or sharp linear-edged instrument, like
knife, razor, bolo, metal sheet, glass.

Gunshot Wounds

Generally, the wounds of entry are typical neat round holes with an even gray ring around them and from
which emerges comparatively small quantities of blood.

On the other hand, the wounds of exit are much larger than the bullet, are ragged, torn, and generally the
escape of blood is much greater than in wounds of entry.

Difference between Entrance and Exit (Gunshot Wound)

Entrance Wound Exit Wound

 Appears to be smaller than Always bigger than missile
the missile except for contact
fire
 Edges inverted Edges everted
 Usually rounded Variable shape
 Contusion collar present Contusion collar absent
 Other product of Always absent
combustions when firing is
near
 Paraffin test may be positive Always absent

Paraffin test – forensic test conducted to indicate whether a person has recently fired a gun.
Determination of the distance of fire

a. Contact fire – intense laceration and undermining of the point of entrance. Entrance wound is
normally bigger than exit.

b. Distance of six inches- presence of tattooing (red to orange or brownish abrasion caused by unburned
gunpowder).

c. Beyond six inches but within thirty-six inches – presence of tattooing.

d. Beyond thirty- six inches – only the gunshot wound will be present.