Medicolegal Update
(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)
How a doctor will assess the severity of stab wounds by external examination? (Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)
The severity is based exclusively on the location and depth of penetration seen in autopsy.
·
The important medical considerations
include the type of weapon used e.g. knife length, shape, straight or serrated,
and manner of assault, whether the stabbing is overhand/underhand.
·
The gender of the assailant may have
some importance, in that women tend to stab "overhand." Penetration
tends to be deeper with the "underhand" thrust.
·
Stab wounds to the chest should always
be considered dangerous and likely to cause death until proven otherwise.
·
Central stab wounds, below the
clavicles and to either side of the breastbone means sternum, can result in
penetration of the heart. Chest wounds can result in puncture and rupture of
the lung or marked bleeding within the chest cavity causing hemothorax.
·
Stab wounds to the abdomen will often
result in an exploratory laparotomy to rule out serious damage. Slow bleeding
inside the abdomen is extremely difficult to diagnose, and should be considered
a possibility in every case.
·
Stab wounds to the upper back can
involve the lung or heart.
·
Stab wounds to the lower and middle
back can involve the kidneys and ureters. Evaluation of stab wounds to the back
that may have punctured the kidney will require intravenous pyelography for
evaluation. The presence of blood in the urinalysis indicates injury to the
kidney, bladder or ureter.
·
Examination for sensation, movement and
pulses of the victim should be carefully done and documented in case of stab
wounds to the hands/legs that do not lacerate nerves, blood vessels, or tendon
structures.
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