HAEMORRHAGE
external
- body cavities
- organs
incisions
stab wounds
external haemorrhage
firearm injury trajectory through the head
external
haemorrhage
through the wounds
resultant bleeding
- hard to estimate retrospectively
- depends on numerous factors
MRI appearance
liver
subcapsular
haematoma
delayed
intraperitoneal
bleeding
"bleeding in two
periods
INFECTION
modern medical services
bacteria
- suppurated wounds and burns, gaseous
gangrene
peritonitis
local infection
suppurated
burns
site of injury
hypostatic pneumonia
kidneys
bilateral cortical necrosis
EMBOLISM
an embolus - a foreign bolus which migrates
through the vascular system, causing damage
when it lodges at some place in circulation
solid
liquid
gaseous
PULMONARY THROMBOEMBOLISM
phlebothrombosis - predisposing factors Virchows triad:
lesion of the blood vessel
increased blood coagulability
disturbance of circulation slowed blood flow
ORIGIN OF PHLEBOTHROMBOSIS:
natural
large thromboemboli
- impact in the right
heart, pulmonary
trunk and its
branches
rapid death
(cor pulmonale acutum)
FAT EMBOLISM
fat embolism occurs to some degree in
involving
bone
or
embolism:
- sudden death - cor pulmonale acutum
- delayed death - respiratory failure
(ARDS, pneumonia)
if
CLINICAL MANIFESTATION
Fat Embolism Syndrome FES after a latent interval
(several hours or a few days) triad of:
1.
2.
3.
fat embolism
petechial haemorrhages of the
skin in axillary fold
clinical
and
autopsy
finding
fat emboli in
capillaries of the lung
fat emboli in
capillaries of
kidney glomeruli
discharge list
pedestrian - fatal
outcome 4 days
after injuring
negative CT scan
of the head
AIR EMBOLISM
cardiac embolism
considerable volume of air gains access
suction effect
due to negative
pressure
suction effect
due to negative
pressure
homicidal incisions
with an axe
skull fracture
- producing DIC
fluid, fetal squames, lanugo, vernix lipoid
homicide gunshot
injury
the entrance wound
in the precordial
region
ARDS
a complication of many traumatic incidents (blunt
RENAL FAILURE
extensive muscle damage burns
tubules may be blocked with casts of myoglobin
or disintegrated erythrocytes
haemoglobinuric nephrosis
SUPRARENAL HAEMORRHAGE
haemorrhage into the adrenal glands,
sometimes bilateral
STRESS ULCERATIONS
injuries accompanied with haemorrhagic shock,
injury
brain contusion
bone fracture
consequence
complication
injury
consequence
bleeding
brain contusion
gliosis
bone fracture
callus
complication
Q
injury
consequence
complication
bleeding
infection
brain contusion
gliosis
abscess
bone fracture
callus
osteomyelitis
MEDICOLEGAL IMPORTANCE:
(1) Complication as a possible
cause of death
when an injured person dies after trauma
possibility
of
(observation)
certain
complication
if
if
VITAL REACTIONS
important medicolegal issue - whether the
cases
exsanguination
(fatal blood loss)
lack of livores
thrombosis of the
left common
carotid artery
consequent
infarction of the
left cerebral
hemisphere
fat emboli in
capillaries of the lung
aspiration
of soot
absolute
vital
reaction
aspiration
of soot
absolute
vital
reaction
combustion of
laryngeal and
tracheal mucosa
due to inhalation
of hot air
in the fire
absolute vital
reaction
combustion of
laryngeal and
tracheal mucosa
due to inhalation
of hot air
in the fire
absolute vital
reaction
traces of soot
around the nose
and mouth
deglutition
(swallowing) of soot
in the oesophagus
deglutition
(swallowing) of soot
in the oesophagus
aspiration of blood
absolute vital
reaction
aspiration of blood
a 17-year-old girl
committed suicide
using her
grandfathers pistol
the entrance wound
in the left temporal
region
multiple fractures of
the skull base
resultant massive
aspiration of blood in the
lungs
aspiration of blood
POST-MORTEM BLEEDING
due to passive leakage of blood
dependent parts, scalp wounds, pleural and peritoneal
cavity (up to 1000 ccm from the cut aorta)
throttling
brusies and abrasions
bruises
fist fight
2 days
3 days
lack of
bruises as a
vital reaction
POST-MORTEM BRUISES
hypostatic purpura (vibices)
skin abrasion
purulent (pjurulnt)
suppurate (spjureit)
Immobilization (imoubilaizein)
SLIDES
1.
hemoptoja dva slajda iz prirodne smrti (broj 6 i 9)
2.
ubodine, suicid S-208/92 sa odecom - external haemorrhage
3.
ubodine, suicid S-208/92 bez odece - external haemorrhage
4.
ubistvo dve sekotine vrata sa krvarenjem S-870/71
5.
ubistvo, les external haemorrhage
6.
ubistvo, les u krupnijem planu, external haemorrhage
7.
ubistvo, krv na krevetu external haemorrhage
8.
S-648/81 les, bio u histoloskoj kolekciji, external haemorrhage
9.
S-648/81 krv na krevetu, bio u histoloskoj kolekciji, external haemorrhage
10. les i krv oko njega, stolica pored lesa, bio u histoloskoj kolekciji, external haemorrhage
11.
krvni izliv haemothorax L-512/66
12. krvni izliv haemopericardium S-987/74
13. krvni izliv haemoperitoneum L-523/65
14. extradural haemorrhage S-140/88
15. extradural haemorrhage S-786/90
16. subcapsular spleen haematoma S-295/88
17. histological collection 127 purulent meningitis
18. histological collection 171 posttraumatic myocardial abscess
19. histological collection 172 renal abscess with groups of bacteria
20. histological collection 241 purulent bronchopneumonia
21. fat embolism 13 Swedish collection I
22. fat embolism 14 Swedish collection I
23. fat embolism 15 Swedish collection I
24. fat embolism 1 Swedish collection I
25. fat embolism 2 Swedish collection I
26. fat embolism 11 Swedish collection I
27. fat embolism 17 Swedish collection I
28. fat embolism 19 Swedish collection I
29.
30.
31.
32.
33.
34.
35.
36.
37.
PHOTOS
od dr Nikolica makroskopski nalaz kod masne embolije kozne petehije, tackasta krvarenja u velikom mozgu i
mozdanom mostu S-45/2000 L-42/69
- aspiracija gara
tromboembolija