Examination of adjacent or underlying subcutaneous soft tissues may aid in distinguishing between contusion, in which there will be hemorrhage due to rupture of blood vessels, and lividity, a postmortem change in which blood is contained within blood vessels. Primary, secondary, and tertiary surveys are important, with appropriate intervention and resuscitation as required.īlunt impact injuries usually manifest immediately after impact however, deep contusions may not be visible on the skin surface for several days after the injury occurs. This entails obtaining a history of mechanism, events, comorbidities, allergies, medications, and last meal. Patients presenting with acute blunt trauma should be carefully assessed to ensure serious injuries are not missed. Fractures heal through the process of callus formation and bony remodeling, features which can be examined microscopically to estimate the approximate age of the fracture and time since the injury. Postmortem abrasions will demonstrate a more tan/yellow, parchment-paper-like appearance indicating the absence of blood flow at the time the injury occurred. Similarly, recent abrasions and lacerations are typically red/purple and heal through the process of scab formation which imparts a tan/brown, crusted appearance to the wound. In general, a red/purple contusion will be more recent than a yellow/green contusion on the same patient. Recent contusions are typically red/purple and go through a series of color changes as they heal. Pathophysiologyīlunt trauma may result in internal or external hemorrhage depending on location and mechanism. Head trauma and exsanguination are the most common early causes of death due to blunt traumatic injury. Alternatively, a smaller force applied to a smaller area will result in less tissue damage for example, the impact of a thrown baseball to the shoulder of an individual will likely cause minor blunt trauma. A large, crushing force applied to a sizable area over several minutes will result in vast tissue damage for example, failure of the integrity of a retaining wall at a construction site will likely cause significant blunt impact injury if the wall collapses on and traps the legs of an individual. The appearance of wounds depends on multiple factors, including the force, speed, length of time of impact, the surface area of contact, and elasticity of tissues impacted. Epidemiologyīlunt impact injuries are commonly seen in living and deceased patients. Blunt impact of significant force to a bone results in a fracture. Contusions and lacerations may also be present on internal organs. A laceration results from the blunt impact of significant force to tear the skin, leaving strands of subcutaneous tissues bridging the wound. Contusions and abrasions may show distinct patterns which can be used to match a specific wound to a potential weapon or implement for example, a contusion over the forehead with multiple parallel, zig-zag lines may be matched to the sole of a shoe collected at the crime scene. A contusion results from the blunt impact of significant force to rupture capillaries underneath the skin surface while leaving the skin surface intact, while an abrasion results from scraping off of the superficial epidermis. Blunt impact injuries result from direct contact of a blunt object with a body.
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