OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

CAUSES OF INJURY FACTORS RESPONSIBLE FOR PASSENGER AND

 Mauling DRIVER INJURY
 Domestic injury  Impact within structures
 Industrial accident  Ejection
 Vehicular accident  Direct impact with other vehicle occupants
 Sports injury  Acceleration – deceleration injury (whiplash)
 Stabbing injuries - Sprain on extensor muscles and ligaments
 Gunshot injuries of the neck

MAULING PEDESTRIAN VEHICLE COLLISION

 Results from a violent altercation between 2
persons or group of persons
 Injury may be sustained by:
- The feuding parties
- Bystanders
DOMESTIC AND INDUSTRIAL ACCIDENTS
 Usually results from the myriad of
combinations of accidents at home or at work
 A physician must note whether there is
presence of alcohol on the patient
 Common in elderly
- Pelvic and Femoral fracture
- Secondary to fall
 Common also in children
- They lack discernment
- They don’t know if the thing they are
doing can cause injury
- Ex. Electrical socket injury
 If intoxicated upon industrial accident
- Insurance and benefits are invalidated
VEHICULAR ACCIDENT
 Factors responsible for VA’s
- Human factor
- Environment factor
- Mechanical factor
- Social factor
- Pedestrian
HUMAN FACTORS
 Mental attitude
 Perception defects – glasses removal
 Delayed or sluggish reaction times
 Disease
 Chemical factors – drinking alcohol
 Primary Impact
- Causes injuries such as bumper fractures as
well as patterned wounds of the front grills
 Secondary Impact
 Run Over Injuries
- Usually results to patterned injuries such as
tire tread contusion as well as patterned
abrasions
 Hit and run Injuries
 Tibial plateau fracture
- Commonly due to primary impact
- X-ray of the knee cannot reveal the
fracture in AP view
- Must do x-ray on oblique view because
the patella obscures the view
 Hit and run injury
- Criminal liability
MOTORCYCLE INJURIES
 Is the leading cause of vehicular accidents
 Reason for increase:
- Increasing number of motorcycles
- Relatively small profile of motorcycles
- Continued failure to use mandated safety
equipment
- Very little material in a motorcycle to
cushion the impact
SPORTS INJURIES
 Boxing
 Wrestling
 Newer sports with attendant risks:
- Mixed martial arts
- Extreme games
- Sky diving

Trans by: URACIL MD 1

 OLFU COLLEGE OF MEDICINE CLASS 2017
Legal Med Physical Injury: Part 3
INJURIES COMMON IN COMBAT SPORTS
 Lacerations to the eyebrow and malar region
(cheek)
 Hemorrhage secondary to the blood vessel
rupture or fracture of the orbital plate of the
frontal bone known as spectacle hematoma
 Hematoma of pinna with auricular cartilage
necrosis known as cauliflower ears
 Cerebral concussion
 Subdural hemorrhage (most common)
 Pontine hemorrhage (known as boxer's
hemorrhage)
STABBING INJURIES
 Anything with an edge could be used for
injuries of this type
- Knives → Stabbing
- Bolo/machete → Hacking
- Broken bottles
- Scalpels
- Sharpened instruments such as shanks
LEGAL CLASSIFICATION
MUTILATION (ART 262 RPC)
- Intentionally depriving a person, totally or
partially of some of the essential organs of
reproduction
- Intentionally depriving a person, totally or
partially of any part other than that of the
essential organs of reproduction
 Vasectomy and Tubal Ligation
- If without consent → mutilation
- Must only be done if the patient
consented
SERIOUS PHYSICAL INJURIES (ART 263 RPC)
 Done by:
- Wounding
- Beating
- Assaulting
- Administering injurious substances without
the intent to kill
 Graduated
- Prison mayor
 Person shall become insane, imbecile,
impotent or blind
Trans by: URACIL MD
3rd year
Dr. Lising
- Prison correctional (minimum to medium)

Person skull become deformed

Loss of any other member of his body

Loss the use thereof

Becomes ill or incapacitated for the
performance of work habitually engaged
in for more than 90 days
- Prison correctional (medium to maximum)
 Loss of the use of speech, power to
hear/smell, loss of an eye, hand, foot,
arm and leg
 Loss of use of any such members
 Becomes incapacitated for the work in
which he was brutally engaged
LESS SERIOUS PHYSICAL INJURIES (ART 265 RPC)
 Incapacitated the offended party from labor
for more than 10 days
 Requires medical attendance for more than
10 days
 Qualified by:
- Manifest intent to insult or offend the
injured person
- Circumstance adding ignominy
- Victim is the offender's parents,
ascendants, guardian, curators or teachers
- Victim is a person of rank or authority
 Ignominy
- Deep humiliation and disgrace
- Example: Sexual intercourse in an
unnatural or unusual position
SLIGHT PHYSICAL INJURIES (ART 266 RPC)
 Incapacitate the offended party from labor for
1 – 9 days (arresto menor)
 Causes injury which do not prevent the
offended party from working nor require
medical attendance (arresto menor, censure)
 Illtreatment by deed
 Arresto menor
- Put to jail for 1 – 30 days
2
 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

PHYSICAL INJURIES INFLICTED IN A  As to the nature of the magazine

TUMULTUOUS AFFRAY (ART 252 RPC) - Cylindrical revolving magazine
 There is a tumultuous affray - Vertical or horizontal magazine
 Participants suffered from serious physical
injuries COMPONENTS OF A WEAPON
 Persons who inflicted could not be identified  Cartridge
 All those who appear to have used violence  Firearm
upon the offended party shall be penalized by
arresto from 5 – 15 days CARTRIDGE
 The cartridge case or shell
PD 169  Primer
 A physician must report cases of serious and  Powder or propellant
less serious physical injuries  Bullet or projectile
 The attending physician of any hospital,
medical clinic, sanitarium or other medical CARTRIDGE CASE OR SHELL
establishments, or any medical practitioner,  Cylindrical structure with base which houses
who has treated any person for serious or less the different parts of ammunition
serious physical injuries as those injuries are  May be:
defined in Articles 262, 263, 264 and 265 of - Cartridge with a rim
the Revised Penal Code shall report the fact of - Rimless cartridge
such treatment personally or by fastest - Semi-rimless cartridge
means of communication to the nearest - Belted cartridge
Philippine Constabulary unit without delay

GUNSHOT INJURIES
 Firearm
- An instrument used for the propulsion of a
projectile using expansive force of gases
coming from the burning of gunpowder.
Includes:
 Rifles
 Muskets
 Shotguns
 Revolvers PRIMER
 Pistols  Functions to transform the mechanical energy
of the firing pin to chemical energy by its
CLASSIFICATION OF FIREARMS rapid combustion
 As to wounding power  Located at the base of the cartridge and
- Low velocity firearms (<1,400 fps) covered by a small disc of soft metal known as
- High power firearms (>1,400 fps but usually percussion cap or primer cap
2,200-2500 fps)  Center fire cartridge
 As to the nature of the bore - Percussion cap located at the center
- Smooth bore - Most common
- Rifled bore  Rimfire cartridge
 As to manner of firing - Primer is placed inside the rim of the shell
- Pistol – single handed weapon - Common in 0.22 caliber firearm
- Rifle – shoulder fired weapon  Firearm with a pin

Trans by: URACIL MD 3

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

GUNPOWDER / PROPELLANT  Bullet with plastic sabot

 Primary propulsive force in the cartridge
 Types of propellant
- Black powder
 80% KNO3, 15% S, 10% C
- Smokeless powder
 Single base (either cellulose nitrate or
nitroglycerin)
 Double base (contains both)
 Has a more proficient means of
propulsion → so efficient that it can
explode the propulsive case
 Semi-smokeless powder
- 80% black, and 20% smokeless
- Bullet has plastic covering
- When fired, it removes above
characteristics of bullet → rifle cannot be
identified
 Bullet with secondary explosion
 Soft point bullets
- Non lethal
- For practice
TYPES OF FIREARMS OF MEDICOLEGAL INTEREST
 Pistol

BULLET
 The projectile attached to the free end of the
cartridge case
 Classification
- Shape of the tip
 Conical  Revolver
 Hemispherical
 Wad cutter (square nose)
 Hollow point
- Presence or absence of jacket
 Naked lead bullet
 Jacketed bullet
- Full jacketed bullet
- Semi-jacketed bullet

SPECIAL BULLETS  Machine gun

 Armour piercing bullets
- 2 Kinds
 Teflon coated bullet
- Penetrates Kevlar vest that is multiple
layered
 Hardened tip bullet
- Can penetrate tank armor
 Phosphorous flare or tracer bullet  Shotgun
- Glows orange or green
 Plastic bullet
- Used in Israel
- Non-lethal ammunition
- Can be lethal depending on range

Trans by: URACIL MD 4

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

PARTS OF THE FIREARM OF MEDICOLEGAL RIFLINGS

IMPORTANCE  Number – varies from 2 – 12
 Trigger with firing pin  Twist rate – expression of 1 complete twist
- Part of the firearm which causes the firing  Direction – clockwise or counterclockwise
evolution  Width
- Classification
 Relation of cocking and trigger pressure  Twist rate and Direction
- Single action firearm - Determines the type of firearm
- Double action firearm
 No. of shots on pressure on the trigger
DETERMINATION OF CALIBER
- Single shot firearm
 Distance of the barrel between 2 lands
- Automatic firearms
 Barrel
MECHANISM OF FIREARM ACTION
- Riflings
 Series of parallel spiral grooves on the
whole length
- Land
 Space between 2 grooves

 Single action firearm

-
When pulled out one shot comes out
 Double action firearm  Deposits and other substances inside must
- After a shot another is ready to be come out with the bullet
pulled again - Determines the distance of shooter from
 Single shot the victim
- 1 shot = 1 fire
 Automatic firing THINGS THAT COMES OUT OF THE MUZZLE
- Continuous firings until no bullets are AFTER FIRING
left  Bullet
 Flame
 Heated, compressed and expanded gas
 Residue coming from
- Bullet
 Fragment
 Lubricant
- Primer
- Powder particles
 Powder grains
 Soot
 Graphite
- Barrel
 Lubricant
 Rust
 Dust
 Scraping from previous fire
- Cartridge case

Trans by: URACIL MD 5

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

BULLET MOVEMENT HEATED, COMPRESSED, AND EXPANDED GAS

 Forward  Brought about by the limited space in the
 Spinning chamber of the firearm
- Cuts air resistance to become more  Responsible for the propulsion of the
accurate projectile
- Tumbling effect is removed due to change  Responsible for the muzzle blast
of vector from the force of gravity
 Tumbling SMOKE
- Example is AK-47  Product of the complete combustion of the
- Once it enters the body it keeps on gunpowder and the propellant
tumbling  Light, almost black and only covers the skin
 Wobbling  May be readily wiped off
- Decreases accuracy  May be seen up to a distance of 12 inches
 Gravitational pull
- Makes the bullet drop down POWDER GRAINS
 Product of the incomplete combustion of the
FACTORS RESPONSIBLE FOR INJURIOUS EFFECT gunpowder and the propellant together with
OF THE BULLET graphite
 Inherent on the bullet  Relatively heavier than smoke
- Speed of the bullet  May not be readily wiped off and penetrates
- Size and shape of the bullet the dermal and epidermal layer of the skin
 The bigger the bullet the ↑ the injury  Responsible for the production of tattooing
- Character of the missile's momentum in  May be seen up to a distance of 24 inches
flight
 Bullet movements
 Nature of the target
- Density of the target
 Damage to bone → Fracture
 Bones are more projectile than soft tissue
- Length of tissue involvement
 Longer tissue → Bullet loses power
- Nature of media traversed
 Fluid → Loses power faster than air
- Importance of the organ involved

FLAME
 Brought about by the ignition of the
propellant
 Does not usually go beyond a distance of 6
inches and in pistols is often less than 3 inches
 Causes burning of the skin in contact or near
fire
 Shooter is close if there is a burn present on
the victim’s body

Trans by: URACIL MD 6

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

CONTUSION COLLAR
 Caused by the pressure of the bullet on the
skin
- Due to rebound of the skin outward from
initial pressure

DESTRUCTIVE MECHANISM OF GUNSHOTS

 Laceration and permanent cavity of the
bullet trajectory
 Temporary cavity
- The greater the velocity, the greater the
cavity
- Instantaneous radial displacement of the
soft tissue during the passage of the bullet
- Secondary to the liberation of kinetic
energy CLASSIFICATION OF POINT OF ENTRY
 Caused by bullet as it passes through  Caliber of the wounding weapon
 Can be filled with blood → hematoma  Characteristic inherent to entrance wound
 Closes spontaneously  Direction of fire
 Shape and composition of missile
 Hydrostatic force  Range
- The bullets kinetic energy is impaired upon  Kind of weapon
the fluid in the fluid filled cavities creating a
secondary projectile POINT OF ENTRY: CONTACT FIRE
 Example  Where bone is superficial
- Bladder → Hemorrhagic cystitis - Wound is large and stellate shaped
- Edges may be everted
 Shockwave - Burns, tattooing, smudging and singeing of
- Dissipation of kinetic energy in a radial hair is present
direction perpendicular to the path of the - Muzzle imprint on the skin
bullet  Where bone is deeply located
 Causes nerve and vessel damage along - Wound is usually large, circular and without
the temporary cavity radiating laceration
- Edges may be everted, some tissue may be
 Fragmentation of the bullet found in the gun barrel
- Bullet breaks apart into multiple projectiles - Burns, tattooing, smudging and singeing of
 Fragmentation of hard brittle object in the hair is present
bullet trajectory - Muzzle imprint on the skin present
- Bone fragmentation
 Muzzle blast POINT OF ENTRY: NEAR CONTACT FIRE
- Occurs in contact fire  Wound is usually large and circular depending
 Other complication on the angle of fire
- Hemorrhage  Contusion collar distinct
- Infection  Burns, tattooing, smudging and singeing of
- Paralysis hair is present
- Loss of function  Muzzle imprint on the skin present
 Blackening of the bullet tract

Trans by: URACIL MD 7

 OLFU COLLEGE OF MEDICINE CLASS 2017 3rd year

Legal Med Physical Injury: Part 3 Dr. Lising

POINT OF ENTRY: SHORT RANGE FIRE SHOTGUN WOUNDS

 1 – 15 cm distance  Classes of shot in a shotgun shell
 Edges of the wound inverted - Birdshot
 Contusion collar distinct  Small and measuring 0.05 to 0.15
 Tattooing and smudging is present diameter
 If within 3 inches (7.5 cm), burns may be  Loaded from 200-400 shots in the shell
present  Incapacitates – rarely kills
- Buckshot
POINT OF ENTRY: MEDIUM RANGE FIRE  Shot ranges from 0.24 to 0.33 inch in
 More than 15 – less than 60 cm distance diameter
 Edges of the wound inverted  Standard 12 gauge shotgun contains 9
 Contusion collar distinct shots
 Tattooing and smudging (if > 30cm) is present - Single projectile
but of lesser density  Rifled slug
 Burns and singeing is absent  Single shot or slug in a shell

 Tattooing TYPES OF SHOTGUN

- Incompletely combusted  As to number of barrels
 Smudging - Single barrel
- Completely combusted - Double barrel
 Over and under
 Side to side
 As to the manner of firing and reloading
- Bolt action
 The action of bolt ejects the fired shell
and loads the next one
- Lever action
POINT OF ENTRY: MORE THAN 60 CM DISTANCE  When the lever is swing down it ejects
 Edges of the wound inverted the fired shell and loads the next shot
- Pump action
 Contusion collar distinct
 There is a cylindrical magazine which can
 Tattooing, smudging, burns and singeing is
accommodate up to 6 shells, end to end,
absent
beneath the barrel
- Auto-loading
POINT OF EXIT (OUTSHOOT)
 A pull of the trigger not only fires and
 No characteristic shape
ejects the shell but also reloads the next
 Edges are usually everted
shot and locks it for firing
 For military use
SPECIAL CONSIDERATION ON BULLETS
 Souvenir bullet
- Does not come out of the skin ◦○ END ○◦
- Become enclosed in fibrous tissue Sources:
 Bullet migration - Dr. Lising 2015 lecture
- Goes along the flow of the blood - Solis Legal Med
 Tandem bullet - 02/08/14 Legal Med Trans
- Happens when the first shot is fires but
does not come out due to wet powder
- The second shot has 2 bullets

Trans by: URACIL MD 8