How to write injury notes by Dr Aman

1. Injury Note InEmergency
Dr. Aman
Registrar
Casualty block II
DMCH

2. Step to write injury note in emergency duty
1) Particulars of patient:Name,age,Father/Husband
Name,Address
2) Date and Time of Occurance & Examination
3) Name of Identified Person
4) Site,Description and position of injury on the body
5) Age,Size,Length,Width,Depth of injury
6) Kinds of weapon used
7) Nature of injury
8) Remark

3. Section of Law of Injury According to “The
Penal Code-1860”
Section 323 : Blunt Weapon-Simple Hurt
Section 324 : Sharp Weapon-Simple Hurt
Section 325 : Blunt Weapon-Grievous Hurt
Section 326 : Sharp Weapon-Grievous Hurt

4. Criteria of Grievous Hurt According To“ThePenal
Code-1860,Section 320”
. The following kinds of hurt only are designated as "grievous”
Firstly:Emasculation
Secondly : Permanent privation of the sight of either eye.
Thirdly : Permanent privation of the hearing of either ear.
Fourthly : Privation of any member or joint.
Fifthly : Destruction or permanent impairing of the powers of any member or
joint.
Sixthly : Permanent disfiguration of the head or face.
Seventhly : Fracture or dislocation of a bone or tooth
Eighthly : Any hurt which endangers life or which causes the sufferer to be during
the space of 20days in severe bodily pain or unable to follow his ordinary
persuits.

5. .

6. • .

7. Defination of injury
A wound or injury is defined as termination of the natural continuity
of any of the tissue of the living body.
Legally,as per section 44;injury is defined as any harm caused
illegaly to any person in his body,mind,reputation or property.

8. Classification of MechanicalInjuries:
1)Blunt ForceInjuries:
2)Sharp ForceInjuries:
Abrasions
Contusions
Lacerations
Incised Wounds
Stab Wounds
Incised Looking Wound
3)Fractures
4)FireArm Injuries
5)Degloving Injury

9. Medicolegal Classification
1)Depending upon severity: Simple Injuries
Grievous Injuries
2)Depending on medical issue:Suicidal
Homicidal
Accidental
3)Depending upon moment of death: Antemortem Injuries
Postmortem Injuries.

10. Abrasion
Abrasion are injuries where there is discontinuity in the skin due to loss
of only superficial layer (Epidermis).
These are produced as a result of -
.fall on a rough surface
.Finger-nails
.Teeth bite
.Slide of being dragged in vehicle accident

11. Type of Abrasion
1)TangentialAbrasion: a) LinearAbrasion-Finger nails abrasion
b) BrushAbrasion-Road Rush in traffic accident
2)CompressionAbrasion: a) PatternedAbrasion-typically obserbed in
torture
.Impact Abrasion-person getting hit by car
.Pressure Abrasion-Hanging Mark

12. Age ofAbrasion
On 12-24hrs: Bright red scab
On 2-4 days: Reddish brown scab
On 4-7 days: Healing process starts
On 8-10days: Epithelium grows & dried scab falls

13. Injury note of Abrasion
There is a abrasion
over the extension
aspect of the right
forearm 10cm away
from the elbow joint
measuring about
10*4cm in diameter.

14. Contusion /Bruise
Contusion is an Effusion of blood into the tissue due to rupture of blood
vessels (venules & arterioles) by application of blunt force such as
.Stick
.Stone
.Fist
.Whip
.Boot etc

15. Age ofBruise
A Superficial Bruise - bright red discolouration.
A Deep Bruise - may take several hrs to 2 days to appear.
Time
Fresh
Fewhrs to 3days
4th day
5thto 6thday
7thto 12thday
Changes
Bright Red
Bluish
Bluish black to
brown
Greenis
h
Yellowis

16. Injury note of contusion
There is a contusion over
the medial aspect of the
right arm measuring about
10*6 cm in diameter

17. Bruise is less value than Abrasion because
1)Size may not correspond to the size of weapon
2)Become visible several hrs or even 1-2 days after the injury
3)May appear away from the actual site of injury
4)They do not indicate the direction in which the force was
applied.

18. Laceration
A laceration is a rupture or tear or a split in the skin, mucous
membrane,muscle,or underlying tissue
as a result of application of blunt force such as Blows
with-
.club
.stones
.bricks
.punch
.kicks,iron bars etc.

19. Laceration
.Has tearing of
tissue
.Has tissue
bridging

20. Diagnostic Criteria
Margin: Frequently Abraded
Edges:Irregular,Ragged,Inverted,Swollen,Bruised
Angles:Irregular
Base:Uneven,non uniform depth
Hairs bulbs: Crushed Blood
Vessels:Crushed Skin:Flapping
FB:Usually Found

21. Age ofLaceration
Initially: Bleeding
After 12-24hrs:Clotting
After 18-36hrs: Pus formation
After 1-2wks: Granulation tissue formation
After 4-8wks:Healing

22. Incised Wound
It is a wound produced by a sharp weapon such as
knife,blade,scalpel,razor,scissors etc and is a clean cut through the tissue
which
is longer than its depth.

23. Characters- Margin
.Clean-cut,well defined and
everted
.No abrasion or contusion

24. Characters-Width
.Width > edge of
weapon

25. Characters-Length
.Length >
Width
.Length >
Depth

26. Characters-Direction
.Deeper at Beginning (Head of Wound)
.Shallow at End (Tailing of Wound)

27. .

28. Injury note of Incisedwound
There is a incised wound over the flexion aspect of
right hand 5cm proximal from the right wrist joint
transversely situated measuring about 3*2*2 cm in
diameter.

29. Stab /PunturedWound
A Stab wound is an injury caused by a sharp pointed weapon
when the sharp tip is thurst into the body.

30. Feature of StabInjury
1)Margin :-Edge of wound are clean cut
-Usually no abrasion or bruishing of margin
-Margin is abraded & ragged if cutting edge is
blunt
2)Length :Length of wound is slightly less than width
3)Depth :Depth is greater than width and length
4)Shape :Shape of wound correspond to the weapon
used.

31. Injury note of Stab Wound
A stab wound over the left 5th ICS 2cm left
lateral measuring about 4*2*2 cm in
diameter

32. Incised looking wound
Def: Wound produced by a blunt weapon on
by a fall when inflicted on tense structure
covering the bones such as scalp,eyebrow,iliac
crest,knee or elbow
Character: Edges are irregular with bruising and
small piece of tissue may be seen at the bottom
bridging across the margin.

33. Digloving Injury
Is a form of soft tissue injuries where
avulsion of soft tissue, in which an
extensive portion of skin and subcutaneous
tissue detached exposing the underlying
muscle, neuromuscular bundle
Types: 2types- 1)Open Digloving Injury
2)Closed Digloving Injury-
Looked like Bruise

35. References
1)Essential of Forensic Medicine & Toxicology-Dr.K.S.Narayan
Reddy 2)Siddheshwar Forensic Science Book-Dr. Satish
Shindadkar 3)Forensic Medicine & Jurisprudence -
Dr.S.K.Singhal
4)Olshaker et al.Forensic Emergency Medicine.Lippincott
Williams & Wilkins:2001
5)Knight B. Forensic Pathology.2nd
Ed.London:Amold,1996;PP.232
6)Polson CJ.Gee DJ And Knight B.The Essential of Forensic
Medicine.4th Ed.Oxford:Pergamon Press,1985;PP.125-127
7)DiMailo DJ,DiMailo VJM.Forensic Pathology.2nd
Ed.Boca Raton,Florida.CRC Press,LLC;2001

37. THANK YOU
ALL