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How to Examine an Injury in Casualty Outdoor (COD)
About Dr Fayyaz Ahmad
OBJECTIVES
1- Interest: Interest of the Examiner & Examinee is different in Medicolegal
examination. Examiner wants to give medicolegal certificate (MLC) on merit while
Examinee wants an exaggerated result.
2- Approach: Approach of CMO should be factual and whatever he
writes, he will be then answerable to court also.
3- Thorough Examination: His examination must extend beyond
injury as he has to examine clothes for stains, mud & for other trace
evidence. So his examination should be complete.
4- TQA (Total Quality Assurance): This is a dynamic process of
planning & implementing ways and means to improve the working & image of
an organization.
In case of COD, Total Quality Assurance comprises of Doctors, Patient &
Physical conditions.
Patient wants an immediate examination & proper treatment without delay.
Doctor should be a willing worker working in suitable working conditions. So
there should be ways & means to attain all the goals.
DEFINITIONS
1- Trauma: Diseased condition of the body produced by
external violence. It includes
emotional and mental stress resulting into a disorder.
2- Wound: It is not legally defined in
Pakistan. Medically, it is defined as breech in the integrity of a tissue caused
by force/energy.
3- Injury: (legal term) Defined in
Sec.44 PPC. " Injury denotes any harm whatsoever caused illegally to a
person in body, mind, reputation and property ".
4- Hurt: (legal term) Defined in Sec 332
PPC. " Causing of pain, harm, disease, infirmity, injury or impairing,
disabling, dismembering any organ of the body or part there of without causing
death ".
CLASSIFICATION
1- Medical Classification
a- Closed Wounds: Where whole thickness of skin has not gone. e.g.
bruise, abrasions.
b- Open Wounds: Where whole thickness of skin has gon. e.g. laceration,
cuts, stab wounds.
2- Legal Classification
( According to
Qisas & Diyat Ordinance) 3- Based Upon
Weapon
a- Blunt weapon:
- Bruises.
- Abrasions.
- Lacerations.
b- Sharp edged weapon:
- Incised Wounds.
c- Pointed Edged weapons.
- Stab wounds.
d- Firearm Injuries. TYPES OF INJURIES
Bruises
- Collection of blood under the skin due to damage to
capillaries.
- Skin is intact.
- Pain, swelling & inflammation present. Abrasions
- Damage is only to the outer layers of the skin and full
thickness of skin is NOT penetrated.
- Epidermis may pile up at one end giving direction of force.
- Tailing may be present. Lacerations
- Breach or tear in the tissue involving whole thickness
of skin, maybe reaching upto the bone.
- Maybe due to crushing of tissue between 2 hard objects. eg. split laceration.
- Over stretching of tissue. e.g. stretch laceration.
- Grinding compression.
- By heavy edged weapon as hatchet. e.g. cut laceration. Incised
Wounds
- Involvement of clothes. i.e. corresponding cuts.
- Clear regular margins.
- Cutting of hair bulbs.
- Tailing is present. Stab Wounds
- Depth is greatest dimension.
- Maybe penetrating or perforating.
- Corresponding cuts may not coincide.
- Shape may resemble the weapon used. Self
Inflicted
- Multiple.
- Superficial.
- Parallel.
- On accessible part.
- On history & experience, we can decide. INSTRUMENTS
REQUIRED
1- Footrule or measuring tape.
2- Torch.
3- Proper lighting.
4- Magnifying glass.
5- Cotton. PRECAUTIONS
- History should be taken in case of every injury.
- Clinical assessment is essential.
- If patient is serious, CMO should accompany him to emergency to note the
injuries.
- No alteration should be done in any injury as shaving of hair around the wound
before examining the patient.
- Probe should not be used.
- Terms as 'Bone deep' are obsolete. Instead 'Bone exposed' and 'Bone not
exposed' should be written.
- Wound should be examined by magnifying glass.
- Either an injury should be KUO or Declared. Declaring 'at present' should be
discouraged.
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