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GUNSHOT WOUNDS

Things coming out of the gun muzzle after the fire:


1.bullet
2.flame
3.heated, compressed and expandable gas
4.residues coming from:
a)bullet-fragment, lubricant
b)powder particles-powder grains, soot, graphite
c)primer-lead, barium, etc.
d)barrel-scraping from bullet by previous fire
e)cartridge-copper, zinc, etc.
Movements of the bullet as it moves out of the muzzle:
1.forward movement-velocity depends upon the propulsion created by
ignition of the propellant
2.spinning movement-due to passage of bullet at spiral landings and
grooves of the barrel
3.tumbling movement (end-over-end rotation)-bullet rotating on the long
axis of its flight while the nose and the base are
alternating ahead in its flight
4.wabbling movement (tailwag)-tail end of bullet vibrates vertically or
sidewise in its flight
5.pull of gravity-bullet gradually pulls downward
Determination of the trajectory of the bullet inside the body of victim:
A.external exam
1.shape of the wound of entrance
-circular-bullet entered at right angle, except in near fire
-oval-when fired at another angle
2.shape and distribution of abrasion collar
-gen.rule-abrasion collar is widest at the side of acute angle
approach of the bullet
-if bullet hits the skin perpendicularly-collar will have
uniform width around the wound, except when the
bullet is deformed or in near fire
3.difference in level between the entrance and exit wounds
--measuring the wounds from the fixed references in the body
(ex. sole of the foot), or by drawing a horizontal line across the
and body using it as reference pt.
4.by probing the wound of entrance
-applied w/o too much force so as not to create a new course
B.internal exam
1.actual dissection and tracing the course of the wound at autopsy
2.fracture of bones and course in visceral organs
3.location of bone fragments and lead particles
4.X-ray exam-bone spicules
C.Other evidences to show trajectory
1.difference in vertical location of the entrance from the exit in the
clothing
2.position and distance of the assailant from the victim in the
reconstruction / reenactment of the crime
3.testimony of witnesses
A. Gunshot Wound of Entrance
-entrance defect/inshoot; higher caliber, greater size
-characteristics-oval/circular w/ inverted edges(except in near
shot or in grazing), presence of contusion or
abrasion collar, usually the size is smaller than
the caliber of the wounding bullet(due to
retraction of CT)
B. Gunshot Wound of Exit
-outshoot
-characteristics-may be slit-like, stellate, irregular(due to
absence of external support beyond the skin),
edges are everted, larger than entrance
Entrance Wound Exit Wound
-smaller than the missile -always bigger than the missile
-inverted edges -everted edges
-oval /round (angle) -no definite shape
-presence of contusion collar -absence of contusion collar
-presence of tattooing/smudging -always absent
-no protrusion of underlying tissue there may be protrusion of tissue
-always present after fire -may be absent
-paraffin test may be positive -paraffin test always negative

Abrasion collar (contusion collar/marginal abrasion)


-caused by the pressure of the bullet on the skin causing the skin
to be depressed and the depressed part will rub w/surface of bullet
Smoke (soot/smudging/fouling/smoke blackening)
-seen w/ a distance of up to 12 inches
-its presence infers a near shot
-shape may be useful in determining trajectory
-circular shape deposition-perpendicular approach
of bullet
-elliptical shape deposition-acute angle approach
Powder grains
-responsible for the production of tattooing (stippling,
peppering) around the wound of entrance; up to 24 inches
-close range-powder grains penetrate the skin and may cause
hemorrhage in deeper tissue; microcontusion
Powder burns
-blackening of the margin of the wound of entrance
-primarily due to smoke smudging and gunpowder tattooing
(soiling of the target)
Range
-as the distance of the gun muzzle to the target increases, the area
of destruction increases, but the density of tattooing decreases
-contact fire/ near fire
-wound of entrance is large, everted edges, tattooing,
smudging, singeing of hair, muzzle imprint, abrasion collar
medium range(>15cm but <60cm)
-inverted edges, abrasion collar present, skin burn and
singeing absent, tattooing and smudging present
-distance of >60cm
-wound of entrance has no burning, smudging, tattooing,
abrasion collar present, wound is circular/oval

Instances when the gunshot wound of entrance is bigger than


the caliber of firearm:
1.in contact/near fire-force of expanded gases
2.deformity of bullet which entered-hit a hard object
3.bullet may have entered the skin sidewise
4.acute angular approach of bullet
Instances when wound of entrance is smaller than caliber of firearm:
1.fragmentation of bullet before penetrating the skin
2.contraction of elastic tissues of skin
Odd and Even Rule
-if the number of gunshot wounds of entrance and exit found in
the body of the victim is even, the presumption is that no bullet
is lodged in the body; if the number of the gunshot wounds of
entrance and exit is odd, the presumption is that one or more
bullets might have been lodged in the body
Gunshot wounds of entrance is less than wounds of exit:
1.a bullet may have entered the body but split into several
fragments, each of which made a separate exit
2.one of the bullets may have entered a natural orifice of body
but produces a wound of exit
3.2 or more bullets which entered the body thru a common
entrance but making individual exit wounds
4.in near shot w/ a shotgun, the pellets may have entered a
common wound but making separate wounds of exit
Gunshot wounds of entrance more than wounds of exit:
1.one or more bullets are not thru and thru and the bullet is
lodged in the body
2.all the bullets produced thru and thru wounds but one or more
made an exit in a natural orifice s of the body
3.different shots produced different wounds of entrance but
2 or more shots produced a common exit wound
No gunshot wound of exit and bullet not found in the body:
1.bullet lodged in GIT and expelled thru the bowel
2.near fire w/ blank cartridge-wound of entrance present
3.deflection of bullet-same wounds of entrance and exit
Suicidal Gunshot Wound
-shot fired in closed or locked room, in an isolated place
-weapon near the victim (cadaveric spasm)
-muzzle of gun in contact w/ part of body involved-signs of muzzle
impression, burning, smudging and tattooing
-wound of entrance in accessible part of body to wounding hand
-shot is solitary
-direction of the fire is compatible w/ the usual trajectory of bullet
-personal problems/mental disease
-hand may show presence of gunpowder
-entrance wound do not involve clothings
-fingerprints of victim on butt of firearm
-suicide note; no disturbance in place of death
Homicidal Gunshot Wound
-location of entrance wound has no point of election
-victim at some distance from assailant
-signs of struggle present
-disturbance in crime scene
-firearm usually not found at crime scene
Accidental Gunshot Wound
-solitary shot
-no special area of body involved
Determination of the Presence of Gunpowder and Primer
Components
Importance of determining the gunpowder on the skin:
1.determination of the distance of the gun muzzle from
the victims body when fired
2.determing whether a person has fired a firearm

Procedures in determining the presence of gunpowder:


1.gross exam or exam w/ the use of hand lens
-fine black powder particles seen at the gunshot wound of
entrance, dorsum of hand, outer surface of apparel
2.microscopic exam
-fine particles may be magnified
3.chemical tests
-lab. test to determine firearm residues-minute
particles of burning and unburned residues and
primer constituents
Tests for the Presence of Powder Residues:
1.on the skin (dorsum of the hand or site of the wound of
entrance)
Dermal nitrate test (Paraffin test)
-blue reaction of particles upon contact w/ Lungs reagent
-not self-incriminatory
-not conclusive-positive or negative result
2.on clothings
Walkers test (C-acid test or H-acid test)
-dark red or orange-brown spots on the paper if unburned powder grains
are present
Tests for the presence of primer components:
1.Harrison and Gilroy test
-w/ sodium rhodisonate-red color iif lead and barium are present
-addition of HCL-blue-violet-if lead is present
-bright pink-if barium is present
2.Neutron Activation Analysis
-extremely sensitive
-determine the elemental composition of the residues
3.Flameless Atomic Absorption Spectroscopy
-determines the presence of barium, antimony and lead
-metallic elements are quantitated by absorption spectroscopy
4.Scanning Electron Microscope w/ a Linked X-ray Analyzer
-more specific-characteristics size and shape of residues are noted
Factors responsible for the injurious effects of missile:
1.factors inherent in missile
a)speed of bullet-greater velocity, greater destruction
b)size and shape of bullet-bigger diameter, greater injuries
c)character of missiles movet in flight-spinning, yawing,
stumbling movet cause more destruction
2.nature of target
a)density of target-greater density of tissue, greater damage
b)length of tissue involvement in its course-longer distance
traveled by missile in the body, more destruction
c)nature of media traversed-bullet passing air spaces is less
destructive; solid/liquid media, more destruction
d)vital organs-fatal consequence
Destructive mechanism of gunshot:
1.laceration and permanent cavity in bullet trajectory
-pressure of speeding bullet produces pressure on tissues and
organs
2.temporary cavity
-instantaneous radial displacement of soft tissues during
passage of bullet
3.hydrostatic force
-bullet traversing organs w/ fluidfluid displaced radially away
from bullet pathkinetic energy acts on fluid w/c acts as
secondary projectile causing destruction of tissues not on the
path of bullet
4.shock wave
-dissipation of kinetic energy in a radial direction perpendicular
to the path of bullet
-greater intensity of shock wave, more destruction
5.fragmentation/disintegration of bullet
-bullet hits a hard object or bullet velocity is more than
2000ft/secdisintegrate--.each fragment has sufficient kinetic
energy to cause injury
6.fragmentation of hard brittle object in the trajectory
-bone fragment may cause additional damage on tissues
7.muzzle blast in contact fire-penetrate the tissues
8.other effects-wound as a source of hemorrhage, infection
Ballistics-study of physical forces reacting on projectiles/missiles
Forensic ballistics (firearm identification)
-deals w/ the exam of fired bullets and cartridge cases in a
particular gun to the exclusion of all others
Medical ballistics-deals w/ the penetration, severity and appearance
of the wound due to bullet

*wound of the auricle is more fatal compared to that of the ventricle


*death in firearm wound of the heart is due loss of blood or tamponade
THERMAL INJURIES OR DEATH
I.Death or Injury from Cold
-the primary cause of death is due to decreased dissociation of oxygen
from hemoglobin
Effects of cold:
1.local effect (frostbite, immersion foot, trench foot)
1st-blanching and paleness of skin due to vascular spasm
2nd-erythema, edema and swelling due to vascular dilatation, paralysis and
increased capillary permeability
3rd-blister formation
4th-necrosis, vascular occlusion, thrombosis and gangrene
2.systemic effects
-s/s-gradual lowering of body temperature accompanied by stiffness,
weariness and drowsiness; lethargy, delusion, convulsion, coma
II.Death or Injury from Heat
1.systemic effects
a)heat cramps (miners cramps, firemans cramps, stokers cramps)
-involuntary spasmodic painful contraction of muscles due to
dehydration and excessive loss of chlorides by sweating
b)heat exhaustion (heat collapse, syncopal fever, heat syncope,
heat prostration)
-due to heart failure caused by heat and precipitated by muscular
exertion and warm clothing
c)heat stroke (sunstroke, heat hyperpyrexia, thermic fever)
-occurs among those working in ill-ventilated places w/ dry and
high temperatures or due to direct exposure to sun
-medico-legal importance
-usually accidental
2.local effects
a)scald
-tissue destruction by moist heat
-geographical lesion
b)burns
-thermal, chemical, electrical, radiation, friction
Classification of burns by degree (Dupuytrens classification)
1. First degree
-redness of the skin ass. w/ inflammation and slight swelling
2. Second degree
-vesicle formation w/ acute inflammation
-superficial layers of the epidermis are desroyed
3. Third degree
-destruction of the cuticle and part of true skin; very painful due to
exposure of nerve endings; scarring
4. Fourth degree
-surface is ulcerated; dense fibrous scar
5. Fifth degree
-involvement of the deep fascia and muscles
-severe scarring and deformity
6. Sixth degree
-charring of the limb involving subjacent tissues,
organs and bones
-death may ensue immediately

Burns Scalds
-by dry heat -by moist heat
-at or above the site of contact -at or below the site of contact
-singeing of hair is present -singeing of hair absent
-boundary not clear -boundary is distinct
-injury may be severe -injury is limited
-clothings are involved -clothings usually not involved
Medico-legal aspect of burns and scalds
-burning and scalding are usually accidental
-arson
-murder
-chemical burns-physical injuries
PHYSICAL INJURIES OR DEATH BY
LIGHTNING AND ELECTRICITY
Effects of lightning in the human body
-injures-burns
-death-usual immediate effect
-accidental

Effects of electricity in the human body


-death-due to shock
-injuries-burns-electrical necrosis, current markings
DEATH OR PHYSICAL INJURIES DUE TO
CHANGE OF ATMOSPHERIC
PRESSURE(BAROTRAUMA)
Increase of Atmospheric Pressure (Hyperbarism)
-observed underwater by scuba divers, salvage divers,etc
-normal atmospheric pressure at sea level-760 mmHg
-as the diver goes deeper into the body of water, the atmospheric pressure is
subjected to increases=as a consequence, there is an increase in the amount
of gas dissolved in the blood and other body fluids
-nitrogen-80% of air in the lungs
-dissolved in the body fluid-nitrogen necrosis
-difference in pressure in pulmonary tissue and pulmonary circulation causes
pulmonary edema
-rapid ascent from high atmospheric pressure-release of air bubbles in the
circulation-air embolism
Decrease of Atmospheric Pressure (Decompressure)
1.Hypobarism
a)bends-air emboli during decompression lodged in capillaries of joints
b)chokes-due to bubble formation in pulmonary capillaries or
from effects of extravascular mediastinal bubbles
exerting pressure on mediastinal contents and
pulmonary tissue
c)substernal emphysema-bubbles underneath the skin-crepitation
d)trapped gas
2.anoxia
AUTOMOTIVE CRASH OR ACCIDENT
Injuries
-abrasion, laceration, fracture, crashing injury of
the neck
-rear impact crash-acceleration-deceleration injury
or whiplash
-run over injuries-tire tread marks
Homicide by motor vehicle
-driver may be reckless or under the influence of
drugs/alcohol
DEATH OR INJURIES DUE TO ATHLETIC
SPORTS
Boxing
-potential injuries
-laceration-eyebrow and cheek; lip and buccal mucosa
-spectacle hematoma
-cauliflower ear
-fracture of nasal septum, mandible, maxillary bone, skull
-retinal detachment
-peri-renal hemorrhage or laceration of kidney
-intracranial injuries-cerebral concussion, subdural hemorrhage,
pontine hemorrhage(boxers hemorrhage)
-punched-drunkenness or traumatic/pugilistic encephalopathy