Richard Harruff, M.D., Ph.D.Chief Medical ExaminerSeattle - King County

Medical Examiner’s Office

Richard Harruff, M.D., Ph.D.Chief Medical ExaminerSeattle - King County

Medical Examiner’s Office

PATTERNED INJURIES AND STRANGULATION

PATTERNED INJURIES AND STRANGULATION

CLASSIFICATION OF WOUNDS

CLASSIFICATION OF WOUNDS

• Blunt force wounds• Sharp force wounds• Firearm (gunshot) wounds• Asphyxia (strangulation)• Thermal burns

• Blunt force wounds• Sharp force wounds• Firearm (gunshot) wounds• Asphyxia (strangulation)• Thermal burns

TERMINOLOGY OF BLUNT FORCE WOUNDS

TERMINOLOGY OF BLUNT FORCE WOUNDS

• Contusion (bruise)• Abrasion (scrape)• Laceration (tear)• Avulsion

• Contusion (bruise)• Abrasion (scrape)• Laceration (tear)• Avulsion

BLUNT FORCE WOUNDS:ABRASION, CONTUSION, LACERATION

BLUNT FORCE WOUNDS:ABRASION, CONTUSION, LACERATION

APPEARANCE OF CONTUSIONAPPEARANCE OF CONTUSION• Location (body site)• Weapon (pattern injury)• Depth (dermal or deep)• Age of wound• Individual factors:

Age of individualDisease (e.g. cirrhosis)Medications (e.g., aspirin, warfarin)

• Location (body site)• Weapon (pattern injury)• Depth (dermal or deep)• Age of wound• Individual factors:

Age of individualDisease (e.g. cirrhosis)Medications (e.g., aspirin, warfarin)

CONTUSION: Origin of a

“Black Eye”

CONTUSION: Origin of a

“Black Eye”

CONTUSION: RAILROAD TRACK PATTERN

CONTUSION: RAILROAD TRACK PATTERN

LACERATIONLACERATION

A LACERATION

is a TEAR!!

A LACERATION

is a TEAR!!

STRANGULATIONSTRANGULATIONEssential ConceptsEssential Concepts

Mechanism, Injury, InvestigationMechanism, Injury, Investigation

•• Compression of vital neck structuresCompression of vital neck structures•• Essential injury: Cerebral HypoxiaEssential injury: Cerebral Hypoxia•• Documentation of injuries:Documentation of injuries:

Primary physical signsPrimary physical signsSecondary physical signsSecondary physical signsSymptomsSymptoms

COMPRESSION OF NECK COMPRESSION OF NECK STRUCTURESSTRUCTURES

StructureStructure Pounds of forcePounds of forceJugular veins Jugular veins 77Carotid arteriesCarotid arteries 11 11 –– 1515AirwayAirway 3030Vertebral arteriesVertebral arteries 6060

Carotid sinusCarotid sinus UnknownUnknown

NECK STRUCTURES IN STRANGULATIONNECK STRUCTURES IN STRANGULATION

NECK STRUCTURES IN STRANGULATIONNECK STRUCTURES IN STRANGULATION

ESSENTIAL INJURY IN ESSENTIAL INJURY IN STRANGULATION:STRANGULATION:

Failure to Deliver Oxygen to BrainFailure to Deliver Oxygen to Brain

Asphyxia, Cerebral HypoxiaAsphyxia, Cerebral Hypoxia

•• Interference with victimInterference with victim’’s s ability to breathability to breath

•• Reduced blood flow to victimReduced blood flow to victim’’s s brainbrain

NECK COMPRESSIONNECK COMPRESSION

Vascular vs. AirwayVascular vs. AirwayCompressionCompression

TYPES OF STRANGULATIONTYPES OF STRANGULATION

•• LigatureLigature•• ManualManual•• Neck holdsNeck holds•• Others, e.g., burkingOthers, e.g., burking

PRIMARY PHYSICAL SIGNSPRIMARY PHYSICAL SIGNS

•• Specific:Specific:Pattern injuries Pattern injuries –– ligature abrasion, ligature abrasion, fingernail abrasionsfingernail abrasions

•• Nonspecific:Nonspecific:ErythemaErythema, swelling, abrasions, , swelling, abrasions, contusionscontusions

SECONDARY PHYSICAL SIGNSSECONDARY PHYSICAL SIGNS

•• Facial skin congestion, cyanosisFacial skin congestion, cyanosis•• PetechiaePetechiae

Facial skin esp. Facial skin esp. periorbitalperiorbitalConjunctivae of eyes, eyelidsConjunctivae of eyes, eyelidsOral mucosaOral mucosa

INTERNAL NECK INJURIESINTERNAL NECK INJURIES

•• Soft tissue contusionsSoft tissue contusionsPerilaryngealPerilaryngeal hemorrhage, hemorrhage, hematomahematomaLaryngeal (vocal cord) edema,Laryngeal (vocal cord) edema,hemorrhagehemorrhage

•• FracturesFracturesHyoid boneHyoid boneLaryngeal cartilageLaryngeal cartilage

LARYNX FRACTURELARYNX FRACTURE

HYOID FRACTUREHYOID FRACTURE

DOCUMENTATION OF INJURIESDOCUMENTATION OF INJURIES

• Photography• Diagrams• Statements• Medicolegal examination• Voice recording (911 call)• Medical records• Radiography

SYMPTOMSSYMPTOMS

•• Impairment of Impairment of consciousnessconsciousness

•• AmnesiaAmnesia•• SeizuresSeizures

SYMPTOMSSYMPTOMS

•• PainPain•• HoarsenessHoarseness•• Painful swallowingPainful swallowing•• CoughingCoughing•• Breathing difficultiesBreathing difficulties

SYMPTOMSSYMPTOMS

•• NauseaNausea•• VomitingVomiting•• Incontinence*Incontinence*

* * must ask must ask