Term
| does the definition of sexual abuse require genital trauma? |
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Definition
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Term
| what specimens are obtained in a sexual abuse workup? |
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Definition
| oral/nasal/vaginal/rectal swabs - to collect DNA sample (don't be too gentle - want good sample). also depends on if person is alive/dead to determine which specimens to concentrate on. |
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Term
| why may head/pubic hair and nail clippings be beneficial in a sexual abuse case? |
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Definition
| head/pubic hair: a control which provides trace evidence. nail clippings: useful in all hand-to-hand combat with grabbing/scratching - also check for broken nails |
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Term
| what is the purpose of all specimens obtained in a sexual abuse case? |
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Definition
| to match the perpetrator to the crime |
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Term
| why might animal hair or carpet fibers be useful specimens in sexual abuse cases? |
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Definition
| animal hair/carpet fibers may link the perpetrator to certain locations. (also paint, glass fragments etc) |
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Term
| what are some specimens which used to be more commonly used but may not be anymore? |
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Definition
| sperm (before DNA test - only proved presence, not identity) and P30/acid phosphatase (indicates ejaculate, not identity) |
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Term
| what is the gold standard specimen in sexual assault cases? |
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Definition
| DNA - often difficult to acquire due to emotions. dried semen may be used. pts need to abstain from showering/changing clothes until this is collected (over a white sheet). |
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Term
| what findings are important in sexual assault? |
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Definition
| signs of strangulation, sharp force injury, and blunt force injury - all trauma is evidence (need to document). |
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Term
| what does evidence of strangulation consist of? |
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Definition
| external/internal neck injury (confirm intact hyoid bone, r/o muscular hemorrhage), suffused head/face (jugular veins only take 5 lbs pressure to occlude, but carotids take 10 - so blood cannot drain), and petechiae (in conjunctiva/sclera, over skin of head, due to increased capillary pressure). ligature marks may be observed. pts who have been strangulated may have amnesia (so still need to look for evidence - even if not reported). |
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Term
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Definition
| marked *vasodilation but *lack of profusion, leading to more venous type blood than arterial = darker/dusky appearance. |
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Term
| how long does it take to strangle someone to death? |
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Definition
| the brain has 10 sec of consciousness w/complete occlusion, after which the pt will survive for ~ 3 min - but permanent damage occurs after 1 min. petechiae confirm that strangulation took place for long enough for this to occur. |
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Term
| what is the theory on vagal stimulation of the neck in sexual assault? |
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Definition
| grabbing the neck may stimulate a vagal response, dropping the heart rate to the point of dysrhythmia (no petechiae). |
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Term
| what do sharp force injuries related to sexual assault consist of? |
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Definition
| cut (incised), stab, chop (blunt+sharp force trauma), and puncture wounds |
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Term
| what characterizes cut wounds in terms of sexual assault? |
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Definition
| these are *longer in length than in depth*. can be superficial/deep and may be life threatening. they may also be self inflicted or defense injury (sacrifice less important parts of body to protect vital structures). |
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Term
| what characterizes stab wounds in terms of sexual assault? |
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Definition
| these are the opposite of a cut wound and (*deeper than length) *depth is very important as is the *type of tissue penetrated (muscle, fat, bone, cartilage). depth and type of tissue can determine force generated. |
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Term
| what is important to look for in term of evidence w/stab wounds? |
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Definition
| the mark left by the blunt edge of the knife can impart some clues about the weapon used |
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Term
| why might feet be important to evaluate in sexual assault cases? |
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Definition
| there may be damage to the feet, indicating an attempt at running away (*don't clean the victim too quickly). |
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Term
| can a 3 inch blade produce a 6 inch deep stab wound? |
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Definition
| yes if the pt leans forward. there would often be a hilt mark accompanying this. |
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Term
| what are the different categories of blunt force trauma? |
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Definition
| abrasions, contusions, lacerations, and fractures |
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Term
| what characterizes an abrasion as a subtype of blunt force trauma? |
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Definition
| abrasions are superficial injuries of the epidermis (scrapes of the skin) which typically do not bleed (unless the dermis is involved). they are not lethal but the location, size, pattern, the multiplicity can be very *important in investigating assault cases. |
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Term
| what are the different kinds of abrasion? |
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Definition
| tangential, fingernail, patterned, and post-mortem |
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Term
| what characterizes a tangential abrasion as a subtype of blunt force trauma? |
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Definition
| tangential abrasions are caused by lateral rubbing of skin against a rough surface (usually at an oblique angle - road rash). the direction may be determined by tags of epidermis dragged to the end of the wound. it may be hard to determine if they occurred ante/postmortem (not a lot of hemorrhage). |
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Term
| what characterizes a fingernail abrasion as a subtype of blunt force trauma? |
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Definition
| these are seen in child abuse, sexual assault and strangulation. if they appear linear, it implies the fingernails were dragged down the skin (seen more on perpetrators - may be DNA) and if they appear curved, it implies a gripping of the skin (seen more on victims). common sites: breast, inside thighs, buttocks, face, neck, and extremities. |
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Term
| what characterizes a patterned abrasion as a subtype of blunt force trauma? |
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Definition
| patterned abrasions usually occur w/force being applied at a 90 degree angle (as opposed to tangential) to the skin. common patterns: tires, firearm muzzles, and shoes. |
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Term
| what characterizes contusion as a subtype of blunt force trauma? |
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Definition
| contusions or bruises are often associated with abrasions and lacerations and consist of collections of extravascular blood that has leaked from blood vessels damaged due to mechanical impact. |
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Term
| what might raise a red flag of abuse in terms of contusions? |
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Definition
| the color in contusions will change (hemoglobin begins to break down into hemosiderin) from purple to greenish, to yellowish, to golden brown. if you see a pt with many different contusions of different color - can raise a red flag for possible abuse. |
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Term
| why would the center of a contusion due to the pt being struck by a bat be clear? |
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Definition
| the blood gets pushed to the sides of impact |
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Term
| what characterizes laceration as a subtype of blunt force trauma? |
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Definition
| lacerations are *not cut wounds, they are tearing of the skin due to impact from blunt objects. one object can produce many different looking lacerations. lacerations will often be accompanied by other types of blunt traumas – abrasions, contusions, fractures, etc. |
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Term
| how do cut wounds and lacerations compare? |
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Definition
| *cut wounds: clean margins, no tissue bridging, no abrasion (usually), caused by sharp object. *laceration: irregular margin, tissue bridging, often has abrasion, and caused by blunt object. |
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Term
| what are some miscellaneous findings common to sexual abuse cases? |
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Definition
| bite marks (often on perpetrator), signs of "over kill" (multiple stab wounds), abrasions on knees/back, and nail marks on the thighs/breasts/buttocks. |
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Term
| what are the possible components of bite marks? |
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Definition
| teeth injury, suck mark (hickey), and tongue thrust (soft tissue stuck between tongue/teeth). bite marks may look very subtle - may look like ring worm. |
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