The pathology of trauma
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An example of a head injury 'above the hatbrim-line'.

This short video illustrates a simple injury located on the head above the so-called 'hatbrim-line'.

Richard Jones's insight:

This video illustrates a (minor) head injury located above the so-called 'hatbrim-line'. Such injuries are frequently said to occur as a consequence of assault, rather than being sustained accidentally (for example, see http://www.ncbi.nlm.nih.gov/pubmed/18471221).

 

Watch the first half of the video and then pause for thought; can you say what sort of injury it is? How would you describe it in the patient's notes if you were examining them in an emergency medicine setting? What might have caused this injury?

 

When you think you can answer these questions, watch the remainder of the video to see what actually caused this injury (to me!).

 

You can see that there is evidence of contact between the scalp and the corner of the shelving unit - a small amount of blood, hairs and a bit of skin - which is something that forensic pathologists would take care to look for at the scene of the discovery of a body (or the location in which injury was thought to have been sustained). Such bodily traces could be sampled for subsequent DNA analysis by forensic scientists should that be necessary for 'reconstructing' the incident.

 

This example also shows that 'hard and fast rules' about the significance of the location of an injury on the head must always be treated with caution in forensic medicine, and one must consider potential explanations for an injury which do not involve assault.

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The course of the right internal carotid artery (via BioDigital Human)

The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform
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This 3D model exposes the course of the right internal carotid artery into the skull. The right side of the skull (and right cerebral hemisphere) has been removed to ease visualisation.

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The skull with the frontal bone removed (via BioDigital Human)

The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform
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A simple 3D anatomical model of the skull, with the frontal bone removed to reveal the brain and blood vessels of the Circle of Willis.

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The skull and carotid arteries (via BioDigital Human)

The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform
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A simple 3D model illustrating the relationship between the carotid arteries and the skull.

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Wounds and injuries - implements and weapons 4 - YouTube

A short video to complement undergraduate medicine education in forensic pathology. 

Richard Jones's insight:

An addition to the short videos dealing with implements and weapons capable of causing injury. This video examines the 'anatomy' of a pistol, and what happens when such a weapon is fired. When you watch this video think about the sorts of injuries handguns can cause, and how you might go about describing them in your injured patient's medical notes.

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▶ Implements and weapons - wounds and injuries 2 - YouTube

A short video to complement undergraduate medicine education in forensic pathology.

Richard Jones's insight:

This short video examines the features of a selection of implements/ weapons. When you watch the video try to think about the injuries that such implements might cause. How would you classify them? How would you describe them in your patient's medical notes?

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▶ Penetrating head injury - YouTube

This short video illustrates a penetrating skull injury caused by a captive bolt pistol/ humane stunner.
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Using a sheep's skull, this short video illustrates the damage caused by a captive bolt pistol, which causes a rod-shaped 'projectile' to penetrate the skull. The bony damage is reminiscent of that caused by bullets.

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▶ The Chemistry of Fear - Bytesize Science - YouTube

With Halloween just a few days away, millions are flocking to horror films and haunted houses for their annual dose of terror. Our latest video uncovers the ...
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This is a nice (short) video exploring the neurochemical basis of the 'fight or flight' response to fear.

 

The emotional response to frightening/ stressful stimuli is important in forensic pathology as it is relevant to reconstructing the circumstances of a death following an assault, provides an insight into how purposeful activity can ensue following an individual sustaining subsequently fatal injuries, and provides a possible explanation for the 'triggering' of cardiac arrhythmias.

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E-Learning in Trauma Anaesthesia and critical care | ATACC

E-Learning in Trauma Anaesthesia and critical care | ATACC | The pathology of trauma | Scoop.it
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This website hosts 3 volumes of the ATACC elearning course in trauma anaesthesia and critical care, an outstanding resource for all aspects of trauma care from the scene to theatre.

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Neurotransmitter and Cell Death

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An online neuroscience and anatomy text, including this chapter dealing with neuronal injury (with animations) and head injury.

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Intracranial Hemorrhage

Intracranial Hemorrhage | The pathology of trauma | Scoop.it
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A series of video tutorials covering the essential features of intracranial haemorrhage, including the relevant anatomy and radiology.

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Approach to Trauma

Approach to Trauma | The pathology of trauma | Scoop.it
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A further series of tutorials on the management and treatment of the trauma patient, with some great descriptions of the anatomical/ radiological basis for the complications of trauma, such as pneumothorax.

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Sentinel injuries in infants evaluated for child physical abuse. - PubMed - NCBI

Sentinel injuries in infants evaluated for child physical abuse. - PubMed - NCBI | The pathology of trauma | Scoop.it
Pediatrics. 2013 Apr;131(4):701-7. doi: 10.1542/peds.2012-2780. Epub 2013 Mar 11. Evaluation Studies; Research Support, Non-U.S. Gov't
Richard Jones's insight:

This is an interesting paper examining the significance of suspicious injuries in infants - such as intraoral injury, or bruising in a pre-cruising infant - prior to admission to hospital for severe physical abuse.

 

The term 'sentinel injury' is used, and is defined as an injury “... reported to have been visible to at least 1 parent before the events leading to the current admission and was suspicious for abuse because the child was not able to cruise or there was an implausible explanation offered.”

 

It makes several points of relevance to all medical practitioners who examine infants and children, including:

 

"The history of a sentinel injury should prompt a medical provider in any setting to consider abuse, and should heighten the suspicion for abuse in an infant with an injury of indeterminate etiology."

 

The authors conclude their paper with the following:

 

"Many definitely abused infants have a history of minor injuries that occurred before cruising, whereas such injuries are rare in infants evaluated for abuse and found not to be abused."

 

Recognising the potential significance of injuries in infants who can not cruise is an important skill for all medical practitioners who examine infants and children, to enable timely referral to child protection experts who can investigate further.

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Skull base and Circle of Willis relations (via BioDigital Human)

The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform
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A simple 3D anatomy model to help visualise the relations between the Circle of Willis and the skull base.

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Looking into the skull at the right internal carotid artery (via BioDigital Human)

The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform
Richard Jones's insight:

A simple 3D anatomical model of the skull; the frontal bone has been removed, as well as the right cerebral hemisphere, to allow visualisation of the blood vessels of the Circle of Willis.

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▶ Bones and Sutures of the Skull - YouTube

Learn the bones and sutures of the skull, with Dr. Alan Detton.
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A nice little video illustrating the anatomy of the skull using a CT-derived 3D model, from Stanford University.

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▶ Implements and weapons - wounds and injuries 3 - YouTube

A short video to complement undergraduate medicine education in forensic pathology. 

Richard Jones's insight:

This video examines some important features of an axe/ hatchet, and a meat cleaver. When you watch it try to think about the sorts of injuries that they might cause. How would you classify those injuries, and how would you describe them in your patient's medical notes?

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▶ Implements and weapons - wounds and injuries 1 - YouTube

A short video to complement undergraduate medicine education in forensic pathology. 

Richard Jones's insight:

This video examines a selection of knives. When you watch it, think about the types of injuries that might be caused by the knives, and how you would classify those injuries. What terms would you use to describe the injuries in your patient's medical notes?

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Wound Care in the ED - HQMedEd.com

Wound Care in the ED - HQMedEd.com | The pathology of trauma | Scoop.it
  We will be covering the basics of wound care in this post. During your rotation in the emergency department you will encounter all types of wounds. After this you should have a good foundation of knowledge to apply to your next shift. Please remember that should you have any questions while on shift, ask …
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A whole host of video tutorials on how to treat wounds in the Emergency Department, to help you get to grips with wound management skills!

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ABC of Domestic and Sexual Violence (ABC Series): Amazon.co.uk: Susan Bewley, Jan Welch: Books

ABC of Domestic and Sexual Violence (ABC Series): Amazon.co.uk: Susan Bewley, Jan Welch: Books
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This introductory text provides an fairly comprehensive overview of the issues relevant to gender-based and domestic violence, albeit with a UK-heavy bias.

 

It is right up-to-date, and incorporates case-studies throughout, although the pathology of trauma is not covered in detail (and the language used to describe injuries - particularly 'cuts' - is imprecise in places).

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Fewer Helmets, More Deaths

Fewer Helmets, More Deaths | The pathology of trauma | Scoop.it
More states are being pressured to repeal their universal motorcycle helmet laws. But when those laws are changed, the number of fatalities starts to rise immediately.
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What happens when motorcyclists do not wear helmets? This website presents data from the USA clearly showing that deaths on the road increase.

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AnatomyZone | Neck Posterior triangle • 3D Anatomy Atlas • AnatomyZone

AnatomyZone | Neck Posterior triangle • 3D Anatomy Atlas • AnatomyZone | The pathology of trauma | Scoop.it
Explore and learn about the muscles within the posterior triangle fo the neck with our 3D interactive anatomy atlas
Richard Jones's insight:

A new and expanding section of the Anatomy Zone now utilises the excellent BioDigital human 3D anatomy models to aid revision of defined body regions via a customised model.

 

This particular model illustrates the skull, cervical spine and upper thorax, with posterior neck muscles exposed. Click on each muscle to identify it, and rotate the model to see it in the context of its neighbouring structures.

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Penetrating Neck Trauma

Penetrating Neck Trauma | The pathology of trauma | Scoop.it

In the first video we'll look at the anatomy of the neck. It is important to know what structures are contained within so you know what may be damaged. 

Richard Jones's insight:

Video tutorials covering a topic of interest to forensic pathologists - penetrating trauma of the neck (such as a stab injury, or gunshot wound).

 

Knowledge of the anatomical structures in the neck, and their relative positions, will help guide management of the live patient presenting with a penetrating neck injury.

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▶ Burn Part 1 - YouTube

This is Part 1 of the Approach to the burn patient. We will discuss the classification of severity and extent of burn. 

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An overview tutorial on the assessment of burn injuries (mainly the depth and area of injury). This forms part of a series on the management of the burns patient.

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