Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?
24. Stab wounds
Tools with a sharp end and a cutting edge have a complex effect, i.e., such tools not only pierce, but also cut tissues when immersed in them.
A stab wound has the following elements:
1) an inlet in the skin;
2) wound channel in tissues or organs;
3) sometimes an outlet (with through damage).
Stab-cut wounds have their own characteristic features that distinguish them from both stab and cut wounds:
1) spindle-shaped and slit-shaped stab wounds are more common. The shape of the wounds can also be arcuate, angular, etc. In cases where the tool, when it is removed from the wound, rotates around its axis, an additional incision occurs, in addition to the main one;
2) the edges of stab-cut wounds are usually even, without sedimentation or with slight sedimentation, respectively, in the area of action of the butt;
3) the shape of the ends of the wound in the case of the action of a double-edged blade - in the form of an acute angle. With one-sided sharpening of the tool, one end of the wound is sharp, and the other from the butt is rounded or U-, M-, L-shaped;
4) the wound channel in more or less dense tissues has a slit-like character, its walls are even, smooth, fatty lobules of subcutaneous tissue can protrude into the lumen of the wound channel. The depth of the wound channel will not always correspond to the length of the tool blade: the blade may not be completely immersed in the body, then the depth of the wound channel will be less than the length of the tool blade. When such a pliable part of the body as the abdomen is injured, the blade of the weapon can be completely immersed in the wound and, when pressed, the anterior abdominal wall can be moved backwards. In such cases, after removing the instrument from the wound, it may turn out that the depth of the wound channel will be greater than the length of the wedge of the injury instrument. The depth of the wound channel can also change with a change in the position of the body with a change in the relative position of the injured organs.
In most cases, fatal stab wounds to the chest involve the heart or aorta. Death due to lung injury alone is less common.
Most deaths from stab wounds are homicide. In such cases, there are usually many widely scattered wounds on the body. Most of them are often shallow and therefore not life-threatening. Death usually occurs rather quickly, due to the large loss of blood.
Infliction of a stab wound with the intent of suicide is a rarity. When a person decides to stab, he usually unbuttons or turns away his clothes to expose the part of the body where he is going to stab. In most of these cases, stab wounds are found in the middle and left side of the chest and there are many of them, most of them minimally damaging the skin.
Expert opinion No. -09M
In the period from April 30 to May 4, 2009, on the basis of a written application from the lawyer of the Bar Association of the Republic of Dagestan (lawyer's office) Dzhavadov M.I. dated 02.04.2009 for ref. No. 16-09, specialist in forensic medicine, Honored Doctor Russian Federation, candidate of medical sciences ZOSIMOV Sergey Mikhailovich, having a higher medical education, special training in forensic medicine, including forensic traumatology, a specialist certificate and the highest qualification category in the specialty "forensic medical examination", work experience in this specialty since 1965, studied the photocopy of the expert opinion No. 50 dated 12/26/2006 - 01/26/2007 presented by the lawyer (examination of the corpse of a citizen of ————— born in 1962, in order to answer the questions posed.
Questions posed to the specialist
1. Does the number of bodily injuries on the body of —————- in the form of stab wounds, found and indicated in the conclusion of the forensic medical examination No. 50 dated 12/28/2006 and in a photocopy of the emergency operating journal of the surgical department of the Derbent Central City Hospital— correspond? ——————.and do they match in localization? If not, what kind of bodily injuries are not displayed in the conclusion of the SME?
2. What is the likely sequence of infliction————————. stab wounds?
3. Whether the medical data on the localization, nature and features of the injuries established during the examination of the corpse correspond to the testimony of the accused————————. about the method of causing damage that led to the death of the victim?
4. What, at the time of infliction of stab wounds, is his most likely relative position in relation to the attacker?
5. Is a forensic medical expert authorized to draw conclusions on the questions raised, or is it necessary to conduct a commission or comprehensive examination with the involvement of specialists from another field?
circumstances of the case
From the written statement of the lawyer Dzhavadov M.I. in the name of the head of the Center for Medical Forensic Research it is known: “... December 27, 2006, at about 18 o’clock, in Derbent Republic of Dagestan on the street. 345 DSD near the house number 10 —————- were inflicted on————————, born in 1962, multiple stab wounds, from which he died in the Derbent Central City Hospital of the Republic of Dagestan on 28.12.2006.
Cloth---------. lost during the preliminary investigation, as well as his medical history. For clothes————————-. examination was not carried out for the reasons stated above.
December 28, 2006 on the corpse————————. a forensic medical examination was carried out, which was completed on 26.01.2006.
According to the conclusion of the forensic medical examination of the corpse ———————# 50, the following penetrating wounds were found on it:
- a wound in the region of the left half of the chest at the level of the 2nd and 3rd ribs along the midclavicular line, penetrating into the left pleural cavity with damage to the upper lobe of the left lung;
- a wound in the 5th intercostal space, penetrating into the left pleural cavity with damage to the heart;
- a wound in the 6th intercostal space along the anterior axillary line, which
penetrates into the left pleural cavity with damage to the lung and heart;
- a wound on the posterior surface of the chest along the scapular line on the left, penetrating into the pleural cavity with damage to the lower lobe of the left lung;
- a wound in the region of the left superciliary arch.
Given that the edges of the above wounds are even, smooth, linear in shape, the ends of the wounds are sharp, these injuries were caused by a piercing and cutting object such as a knife, are classified as serious and have a direct causal relationship with death, caused by one tool.
3. On the body of a corpse gr.———————. only 5 (five) stab wounds were found, including 4 wounds on the left half of the chest and one wound in the region of the left superciliary arch.
4. At the time of infliction of the above injuries, the victim could be in a vertical position or closer to him, and in the course of inflicting 2,3,4 wounds (damages), the position of the body could change, i.e. he could be in any position: sitting, lying on his back, face down, etc.
5. Medico-forensic examination of 3 sections of the skin ———————- established one through wound each. These wounds are stab-cut and caused by the effects of a flat single-edged, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of not more than 17-18 mm, the blade of a piercing-cutting tool.
According to a photocopy of the operating journal of the surgical department of the Derbent Central City Hospital (TsGB) RD, the postoperative diagnosis in————————————, born in 1962, is as follows: “Penetrating multiple wounds into the pleural cavity on the left (three), two penetrating wounds of the heart. Cardiac tamponade. Multiple wounds of the left lung (5 wounds). Left hemothorax. Hemorrhagic shock 3 tbsp. (clinical death)"
We cannot provide a medical history due to its loss.
From the testimony of the defendant————————. in court on February 06, 2009: “... he and I (———————) clashed. That day there was ice and I fell on my back, he (————————) was on top of me and began to choke me. When I began to choke from his grip, I found a knife under my hand, grabbed it and began to swing it. I didn't want to kill him. Then I felt his grip on my neck loosen and he moved away from me. Headed towards the beer bar "Magrad". And the next day I found out that this guy had died.
An investigative experiment to verify the testimony of the guilty person —————————- to determine the possibility of causing bodily harm——————————. and the mechanism of their formation, localization, has not been carried out.
Study
1. From a photocopy of expert opinion No. 50 dated 12/23/2006 - 01/26/2007.(examination of a corpse) it is known that the state forensic expert of the Republican Bureau of Forensic Medical Examination of the Republic of Dagestan————————-. in the premises of the Derbent SME, he performed a forensic medical examination of the corpse —————————--1962 year of birth. The expert opinion contains the following information:
«… Questions to ask the expert:
– What kind of bodily injuries are there on the body———————., what is their nature, mechanism and duration of formation, what kind of health damage do they refer to and what is the sequence of damage?
- Was the victim able to perform any independent actions after causing damage to him - to move, scream, etc.?
- What kind of weapon, one or several, and how exactly the damage was done————————.?
- What is the shape of the piercing tool that was damaged, the dimensions of the cross section and the approximate length?
— What was the most probable relationship———————. and the attacker at the time of the first bodily injury?
— What is the cause of death——————. And what kind of damage was the cause of death?
Did the victim take shortly before death alcoholic drinks, if accepted, in what degree of alcoholic intoxication was he?
- What is the blood type of the victim?
Medical records details:
From the history and illness No. 048-7P in the name of—————-. born 1962 It is known that he was delivered by ambulance to the intensive care unit of the Central City Hospital of Derbent on December 27, 2006 at 18.25. in an agony state. BP 0/0 mmHg The patient was immediately taken to the operating room. When shifting the patient from the stretcher to the operating table, clinical death occurred. Held indoor massage heart and connected to hardware breathing. Cardiac activity was restored after 15-20 minutes. 27.12.06 Operation — thoracotomy on the left, drainage of the pleural cavity. Under intubation anesthesia produced thoracotomy in the 5th intercostal space on the left. In the pleural cavity about 2.5-3 liters of blood, cardiac tamponade. The pericardium was promptly opened. About 1500-2000 g was released from the pericardial cavity. (!) blood. In the region of the left ventricle, there are two through wounds measuring 1.5x1 cm with jet bleeding in the form of a fountain. Bleeding wounds of the heart are covered with a finger and sutures are applied. Blood from the pleural cavity was collected for reinfusion. Blood clots were removed from the pleural cavity. During the revision of the lungs, there were about 5 lung injuries. The lung tissue in the area of injury was extensively imbibed with blood. Lung wounds are sutured with continuous sutures. The wounds of the chest were sutured from the inside. Further inspection revealed no other damage. The pleural cavity is dried, drained in the 8th intercostal space on the left along the posterior axillary line and in the 2nd intercostal space along the mid-clavicular line. Wound hemostasis. Layered sutures on the wound, bandage. Postoperative diagnosis: Penetrating multiple wounds in the pleural cavity on the left (three). Two penetrating wounds to the heart. Cardiac tamponade. Multiple wounds of the left lung (five wounds). Hemothorax on the left. Hemorrhagic shock 3 tbsp. (clinical death). On December 28, 2006, at 15.00, death was declared ... Outdoor research. The corpse of a man of correct physique, satisfactory nutrition, body length 172 cm ... Damage: In the area of the left half of the chest at the level of 2-3 ribs along the mid-clavicular line, a wound is determined with dimensions of 1.8x0.2 cm with two stitches, at 3 and 9 o'clock. The distance from the plantar (surface of the feet) to the above wound is 135 cm (the skin flap was taken for MKO). In the region of the 4th rib on the left, there is a postoperative wound ... with 20 stitches. 1 cm below the indicated postoperative scar along the mid-clavicular line, a wound is determined with dimensions of 1.5x1.2 cm with 1 suture at 3 and 9 o'clock with smooth edges, sharp ends. The distance from the plantar surface to the above wound is 124 cm (the skin flap was taken for MCO). At the level of the 6th rib on the left half of the chest along the anterior axillary line, the wound was 1.5x0.2 cm in size with two stitches at 12 and 6 o'clock. The distance from the plantar surface to the above wound is 121 cm. At the level of the 8th rib, the wound measures 1.56x1.5 cm (from the drainage tube) along the posterior axillary line. On the posterior surface of the chest in the region of the lower angle of the left shoulder blade, there is a wound measuring 1.5x0.3 cm (MKO). On the left parietal region, a bruise measuring 6x5 cm is determined. In the middle of the forehead, an abrasion measuring 1.5x0.5 cm. In the area of the right knee, an abrasion measuring 3x4 cm is red. In the region of the left superciliary arch, a wound measuring 1.5x0.2 cm with two stitches. In the region of the upper eyelid of the left eye, there was a blue bruise 5x1.5 cm in size. Internal research... By isolating the organocomplex, the bones of the ribs, pelvis, and spine are intact. In the region of the 3rd intercostal space, the wound is 1.8x0.2 cm in size, at the level of the 4th and 5th intercostal spaces the wound is 1.5x0.2 cm in size, at the level of the 6th intercostal space the wound is 1.5x0.2 cm in size. The surrounding soft tissues of the above wounds are saturated with blood ... Similar a wound on the posterior surface of the chest on the left at the level of the 7th and 8th intercostal spaces measuring 1.5x0.3 cm. All of the above wounds penetrate the pleural cavity ... On the anterior surface of the upper lobe of the left lung, two wounds with sutures are determined; in the region of the oblique fissure of the left lung, a wound with a suture. On the posterior surface of the left lung, there is a wound in the projection of 7.8 ribs with sutures, the course of the wound channel goes from back to front, from left to right, slightly from top to bottom, with a total wound length of 12-15 cm ... On the anterior lateral surface of the heart shirt, a wound measuring 7x0.2 cm with sutures. The heart is 11x7x4 cm in size, on the anterior lateral surface of the left ventricle there are two wounds with sutures, the sutures are adequate ... Forensic diagnosis: Multiple blind penetrating stab wounds of the left half of the chest with damage to the heart shirt, heart, left lung. Hemorrhages in the left pleural cavity (2500 ml) and in the pericardial cavity (150 ml). Acute bleeding. Anemia internal organs and fabrics. Stab-cut wound of the left superciliary arch. Hemorrhage (bruising) of the left parietal region, upper eyelid of the left eye. Abrasions in the forehead and anterior surface of the left knee joint ...
Data from additional research methods…
With a forensic chemical examination of blood from a corpse————-. ethyl alcohol was found at a concentration of 0.6% 0 ...
Medico-forensic examination of 3 sections of the skin of the corpse———————. established by one through wound of each. These wounds are stab-cut and caused by the impact of a flat single-edged, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of not more than 17-18 mm, the blade of a piercing-cutting tool ...
The blood of the deceased——————. belongs to the AB group ...
conclusions
1. When examining the corpse gr.———————. found: a wound in the region of the left half of the chest at the level of the 2nd and 3rd ribs along the mid-clavicular line, penetrating into the left pleural cavity with damage to the upper lobe of the left lung. In the region of the 5th intercostal space, a wound penetrates into the left pleural cavity with damage to the heart. In the region of the 6th intercostal space along the anterior axillary line, a wound penetrates the left pleural cavity with damage to the lung and heart. On the posterior surface of the chest along the scapular line on the left is a wound penetrating into the pleural cavity with damage to the lower lobe of the left lung. Wound in the region of the left superciliary arch. Given that the edges of the above wounds are even, smooth, linear in shape, the ends of the wounds are sharp, these injuries were caused by a piercing and cutting object such as a knife, are classified as serious and have a direct causal relationship with death, caused by one tool. The injuries found on the body of the gr-on———————. in the form of bruises and abrasions caused by a blunt and hard object with a limited contact surface. All of the above damages were caused within the period specified in the decision and are lifetime.
2. The death of gr-on———————-. violent, came from penetrating wounds of the left half of the chest with damage to the heart, left lung, hemorrhagic shock (acute blood loss).
3. On the body of the corpse gr. ————————only five stab wounds were found, of which 4 wounds were on the left half of the chest and one wound was in the region of the left superciliary arch.
4. After inflicting the above injuries, the victim could perform independent actions - move, scream, from a few seconds to several minutes.
5. At the time of infliction of the above injuries, the victim could be in a vertical position or closer to him, and during the infliction of 2,3,4 wounds (damages), the position of the body could change, that is, he could be in any position - sitting, lying on his back, face down, etc.
6. During the forensic chemical examination of blood from a corpse————-. ethyl alcohol was found at a concentration of 0.6% 0 ...
7. Blood of the deceased——————. belongs to the AB group ...
8. Medico-forensic examination of 3 sections of the skin of a corpse———————. established by one through wound of each. These wounds are stab-cut and caused by the impact of a flat single-edged, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of not more than 17-18 mm, the blade of a piercing-cutting tool ...
2. From a photocopy of the operational log dated 12/27/2006. it is known: “... full name -————————. Age - 1982, Date of operation - 12/27/2006 ... Operation - thoracotomy on the left, drainage of the pleural cavity. Under intubation anesthesia produced thoracotomy in the 5th intercostal space on the left. In the pleural cavity about 2.5-3 liters of blood, cardiac tamponade. The pericardium was promptly opened. About 150.0-200.0 blood was released from the pericardial cavity. In the region of the left ventricle, there are two through wounds measuring 1.5x1 cm with jet bleeding in the form of a fountain. Bleeding wounds of the heart are covered with a finger and sutures are applied. Hemostasis, dry. Blood from the pleural cavity was collected for reinfusion. Blood clots were removed from the pleural cavity. During the revision of the lungs, there were about 5 lung injuries. The tissue of the lung in places in the area of injury was extensively imbibed with blood. Lung wounds are sutured with continuous sutures. The wounds of the chest were sutured from the inside. Further inspection revealed no other damage. The pleural cavity is dried, drained in the 7th intercostal space on the left along the posterior axillary line and in the 2nd intercostal space along the mid-clavicular line. Wound hemostasis. Layered sutures on the wound, bandage. Postoperative diagnosis: Penetrating multiple wounds in the pleural cavity on the left (three). Two penetrating wounds to the heart. Cardiac tamponade. Multiple wounds of the left lung (five wounds). Hemothorax on the left. Hemorrhagic shock 3 tbsp. (clinical death) ". Erbent on December 27, 2006 by ambulance to the intensive care unit of the Central City Hospital of Imal, then to what degree of alcohol intoxication
Conclusions
Based on the conducted research, in accordance with the questions posed, I come to the following conclusions:
1. Analysis of expert opinion No. 50 dated 12/23/2006 - 01/26/2007 (examination of the corpse of Mr.——————.) gives grounds for the following judgments:
1.1. Forensic examination of a corpse——————. carried out by an expert———————. not in full, in particular:
1.1.1. The localization of the wound on the anterior surface of the chest on the left along the mid-clavicular line is indicated approximately (“at the level of the 2nd and 3rd ribs”), which is unacceptable in the forensic documentation; there is no characteristic of the edges, ends and walls of this wound;
1.1.2. The second wound on the anterior surface of the chest on the left is localized not in relation to permanent anatomical landmarks (ribs, anatomical lines), but in relation to the postoperative wound;
1.1.3. There is no characteristic of the edges, ends and walls of the wound at the level of the 6th rib along the anterior axillary line;
1.1.4. The exact localization (in relation to the ribs and anatomical lines of the chest) of the wound on the posterior surface of the chest on the left is not indicated, there is no characteristic of the edges, ends and walls of this wound, the direction of its length;
1.1.5. The nature of the edges, ends and walls of the wound in the region of the left superciliary arch, the direction of its length are not described;
1.1.6. The direction of the wound channel and its approximate length are indicated only for the wound on the posterior surface of the chest on the left, for the rest of the stab wounds, this extremely important information is not available in the research part of the conclusion;
1.1.7. The method of drainage of the left pleural region in the 2nd intercostal space along the mid-clavicular line is not described;
1.1.8. The exact localization of stab-cut injuries of the left lung and heart is not indicated, and the available description of the localization of stab-cut injuries of the heart is contradictory; the course of the wound channels from specific skin wounds to damage to the left lung and left ventricle of the heart was not traced;
1.1.9. When describing those found on the body ——————. abrasions and bruises, their shape is not indicated, the color of the bruise in the left parietal region, the nature of the surface of the abrasion in the frontal region is not indicated;
There are serious errors in the research part of the conclusion, in particular, it is indicated that 1500-2000 ml of blood was found during surgical intervention in the pericardial cavity (in reality - 150-200 ml).
1.2. Description of the ends of stab wounds on the skin of a corpse——————. (where it exists), namely, both sharp ends of the wound, indicating the use of a double-edged blade, contradicts the results of a forensic medical examination of skin flaps, in which it was established that the active blade had a single blade and a butt with pronounced ribs. This contradiction was not explained by the expert.
1.3. Contrary to the requirements of the Criminal Procedure Code of the Russian Federation and federal law No. 73-FZ “On State Forensic Activities in the Russian Federation”, the conclusions of expert opinion No. 50 are not substantiated in any way, they are declarative and unfounded, while the research part of the opinion lacks information that could justify the expert’s conclusions about causing all found on the corpse of injuries within the time specified in the decision, on the possibility of committing Dzhabrailov C.Ya. purposeful actions after causing all the damage complex found on the corpse, about the mutual position of the victim and the attacker.
The questions about the sequence of damage and about the possible characteristics of the constructive and dimensional data of the current piercing and cutting tool, posed in direct edition in the decision on the appointment of an examination, were left unattended by the expert.
2. Answer to question 1 « Does the amount of injuries on the body match y——————-. in the form of stab wounds, discovered and indicated in the conclusion of the judicialmedical examination No. 50 dated December 28, 2006 and in a photocopy of the emergencyoperating journal of the surgical department of the Derbent Central City Hospital—————-. And do they match in location? If not, what kind of bodily injuries are not displayed in the conclusion of the SME?
In the section of the expert's conclusion No. 50 "Data of medical documents" and in the copy of the operational log submitted to the specialist, it is indicated that y———————. available three stab wounds of the left half of the chest, penetrating into the pleural cavity, while the localization of these wounds is not indicated in the indicated medical documents. The research part of Conclusion No. 50 describes four stab wounds of the left half of the chest, penetrating into the pleural cavity - two wounds on the anterior surface of the left half of the chest along the mid-clavicular line, one wound of the left half of the chest along the anterior axillary line and one wound of the left half of the chest along the scapular line.
Thus, the number of stab wounds of the left half of the chest described in expert opinion No. 50 does not correspond to the number of wounds indicated in the medical documents (in the medical history cited by the expert and in the operating journal of the surgical department of the Derbent Central City Hospital. The indicated contradiction in the expert opinion is not explained and at the present time can only be clarified by investigation.
3. Answer to question 2 “What is the likely sequence of infliction————————. stab wounds?"
The omissions identified in the research part of expert opinion No. 50, in particular, the lack of tracing the course of wound channels from specific skin wounds to damage to the left lung and left ventricle of the heart, currently excludes the development of a scientifically based opinion on the sequence of infliction———————. stab wounds on the left side of the chest.
4. Answer to question 3 “Do the medical data on the localization, nature and characteristics of the injuries established during the examination of the corpse correspond to the indicationsof the accused ——————about the method of inflicting injuries that led to deathvictim?"
According to the expert, the testimony of the accused———————-. on the method of inflicting injuries that led to the death of the victim do not correspond to objective data on stab injuries established during the forensic medical examination of the corpse——————. and general medical laws, namely:
————-. testified that ———————began to choke him and he used the knife only when he began to choke. In accordance with the patterns of development of mechanical asphyxia, compression of the neck due to the cessation of blood outflow from the brain through venous system and the continued flow of blood through the arteries almost instantly leads to the development of a sharp muscle weakness, excluding the possibility of committing active targeted actions by the victim.
—————. testified that he had inflicted stab wounds———————. not with the desire to kill him, but "waving a knife." When specified———————. its mutual position and———————-. due to the close contact of the front surface of their bodies, the anterior surface of the chest———————. (where two stab wounds were found, one of them with heart damage) is not available for inflicting blows with a knife blade.
——————-. testified that after causing————————. stab wounds “…his grip on my neck loosened and he moved away from me. Headed towards the beer bar ... ". If the victim has two stab wounds of the left ventricle of the heart of considerable size (1.5x1 cm each according to medical documents), massive blood loss as a result of bleeding into the cavity of the pericardial sac (pericardium) and into the left pleural cavity leads to a sharp, rapid (within a few seconds) drop in arterial blood pressure, excluding the possibility of committing———————. after causing him a complex of stab wounds of the actions described ——————Therefore, the testimony——————. do not correspond to the truth.
5. Answer to question 4 “What, at the time of infliction of stab wounds, is his most likely relative position in relation to the attacker?”
The localization of stab wounds found on the corpse———————— described in expert opinion No. 50, allows for many mutual positions of the victim and the attacker when each of the indicated wounds is inflicted, while their true mutual position based on the study of the localization of wounds , the direction of the wound channels could not be established. The task of the situational examination appointed in such cases is to establish the conformity of the testimony of the accused, victims or witnesses with objective data established during the production of a forensic medical examination of a corpse. A prerequisite for the production of such an examination is the preliminary production of a series of competently staged investigative experiments with the reproduction of the situation of the incident according to the testimony of these persons.
6. Answer to question 5 “Is the forensic expert solely authorized to draw conclusionsto the questions raised, or is it necessary to conduct a commission or comprehensive examination with the involvement of specialists from another field?
Analysis put before the expert———————. in the decision on the appointment of a forensic medical examination of the corpse———————-. indicates that most of these issues are within the competence of an expert who has special training in forensic medical examination and the highest qualification category.
The question of the possibility of causing received——————-. Injuries in a specific situation are within the competence of the situational examination and are solved by specialists who have special training in this type of forensic medical examination (usually by specialists in the medical forensic department of the bureau of forensic medical examination.
The documents regulating the production of forensic medical examinations do not contain instructions on the production of a situational examination on a commission or individually; this issue can be resolved by the investigator when appointing an expert examination or by the head of the expert institution when accepting the expert examination for production.
Specialist _______________ S. Zosimov
A stab wound is distinguished by its depth, which always exceeds its length, often has a slit-like shape, sharp (or one sharp) ends and even edges. In order to diagnose stab wounds, it is necessary to distinguish the main incision formed by immersing the blade into the body, and an additional arising from the movement of the blade when removing the knife at an angle. In this regard, wounds can also have a carbon-shaped form. Identification of the main and additional incisions is significant not only for diagnosing the piercing-cutting action, but also makes it possible to judge the width of the blade of the traumatic weapon. To distinguish the main incision from the additional one, it must be taken into account that the latter departs at an angle, more often at a certain distance from it, and is better detected with stereomicroscopy.
First of all, the type of blade is determined, and in the presence of a butt (back), its features.
Under the action of a one-sided tool, i.e. a tool with a butt, the end of the wound on this side can be rounded, "p" or "M> shaped, sometimes with tears along the edges. On the side of the action of the blade, the end of the wound is sharp with a receding notch formed from the cutting action.
The peculiarity of the end of the wound from the side of the butt of the knife depends on its thickness, because the butt is thinner than 2 mm and may not affect the skin And leave an acute angle also on the severity of the ribs of the butt, the degree of pressure on it when the knife is immersed. In the latter case, this end may be laid siege to. Sometimes the establishment of even one sign of a knife, for example, the presence of a butt, can exclude the original version and direct the investigation along a different path. The proof of the possibility of using the identified knife will solve the crime.
One of the important features of a piercing-cutting tool is the length of its blade. It is judged by the depth of the wound channel, which is not always technically easy. It should be noted that the length of the channel in abdominal cavity, in malleable soft tissues due to their deviation during immersion, it may be greater than the length of the blade of the "tool itself". Also, we must not forget that it is necessary to add the thickness of clothing to the length of the channel, according to the localization of the wound. In this case, only the length of the embedded part of the blade is usually reflected, except in cases where damage is detected along the edges of the wound from the limiter.
Finally, it should be borne in mind that at the time of injury, the victim could be in a bent position, and when examining a straightened body, the wound channel can be located along one line. When the knife is inserted to the limiter, which is determined by the precipitation from pressure on the skin, it is established that the wound channel displays the entire length of the blade.
For penetrating and non-penetrating wounds, depending on the part of the body, different research techniques are used to determine the length of the blade.
The morphological features of the damage make it possible to judge some details of the structure of the tool. When the blade is completely immersed, as noted above, an abrasion near the edges of the wound can repeat the shape of the contact of the limiter, and if there is a beard that is on penknives, additional damage is detected from the sharp end near it.
The features of the tool include the detection of rust, other contamination of the blade.
These features are better seen with stereomicroscopic examination, sometimes they can only be detected using this method, or by determining metallization using chemical color reactions for iron. Most often, this is the Perls test, when using which a 2% solution of yellow blood salt and 2% hydrochloric acid is poured onto the damaged area, then everything is washed off with distilled water. The formation of a blue-greenish color indicates the presence of iron compounds. You can apply the Tirman reaction, as well as contact-diffusion methods for obtaining an imprint on photographic paper.
2. Forensic medical examination in case of forced sexual intercourse. Inspection
scene. The main features, the methodology for conducting judicial
medical examination of the victim. Laboratory methods research.
Incrimination under articles of the Criminal Code of the Russian Federation.
Rape, according to article 131 of the Criminal Code of the Russian Federation, is sexual intercourse with the use of violence or the threat of its use, as well as the use of the helpless state of the victim. The Criminal Code provides for aggravating circumstances of rape, including the commission by a group of persons; committed with special cruelty to the victim or caused death, serious harm to health or infection with a venereal disease, as well as committed with a 14-year-old or minor.
A healthy woman can only be raped by inflicting injuries, threats of infliction, or in a helpless state. Examination of sexual crimes in connection with severe mental trauma, as well as due to the intimate nature, has its own characteristics.
After getting acquainted with the decision on the appointment of an examination and with the document proving the identity of the woman, her questioning follows.
Of particular importance are semilunar abrasions, oval bruises located on the inner surfaces of the thighs. Given that they are formed from compression of the fingers when pushing the hips apart, they can be considered injuries characteristic of rape. Abrasions and bruises, bite marks on the mammary glands and genitals have a sexual character. The external genital organs are examined in detail, the condition hymen and damage on it, traces of blood or semen on the body, scraps of hair, textile fibers. Great importance is attached to the study of clothing that was on the victim at the time of violence. It may have traces of semen, blood, as well as damage characteristic of wrestling.
Along with these secretions, a smear is taken from the vagina and cervix on a gauze swab, which is transferred to 6 slides, and after drying by the investigator, by a special resolution, it is sent for forensic biological examination. At the same time, a control material is presented. It should be noted the importance of the fastest removal of a smear, which is done by an expert on duty at the scene. By the way, an inspection of the scene, also carried out with a medical expert, allows you to fix the general situation and signs of a struggle, remove torn buttons, buckles, parts of lingerie, blood, hair, sperm.
It should be borne in mind that sexual intercourse, in addition to sperm, is indicated by infection venereal disease sexually, the presence of pregnancy, coinciding in time with rape. Therefore, such an examination is carried out with the participation of a venereologist, an obstetrician-gynecologist.
An expert evaluation of the results obtained should be cautious, firstly, because the simulation of rape is not ruled out. Secondly, voluntary sexual intercourse often does not differ from rape according to objective signs of examination of the victim. In this case, there may be some damage, and vice versa, with forced sexual intercourse, they may not be. Therefore, it is important to emphasize the possibility or exclusion of damage under certain circumstances. As already noted, the conclusion about rape on the basis of an expert opinion and other evidence is made by the investigator.
3. Poisoning with vinegar essence, clinical picture. Sectional and
laboratory diagnostics.
Acetic acid more common in everyday life in the form of vinegar essence. It contains 50-80% acetic acid. Table vinegar contains 6% acetic acid. A lethal dose is 15 ml of vinegar essence or a glass of table vinegar.
After taking acid, there is a strong vomiting of brown masses, emitting a characteristic smell of vinegar. Appear severe pain along the digestive tract, swelling of the upper mucosa respiratory tract, sometimes a sharp cough in case of poisoning with concentrated acid. Death comes quickly. During the experience, the poisoned person develops jaundice due to hemolysis of erythrocytes, diarrhea with brown masses mixed with red blood joins, the temperature rises, blood is found in the urine, women may also appear bloody issues from the vagina. Death can occur in the first hours from shock, during experience - from various complications, and sometimes after a long time after poisoning. The outcome may be the same as with inorganic acid poisoning.
On external examination, this is a chilli burn of the oral mucosa. An internal study is characterized by dehydration and compaction of the tissue. Brownish eschar. Damage to the mucous membrane of the esophagus, stomach, which is perforated in places of prolonged contact, and acid is poured into the abdominal cavity, damaging organs.
TICKET #22
1. Sudden death from coronary artery disease. Causes of death. Section diagnostics.
Laboratory research methods.
sudden death comes amid seeming complete health and unexpectedly for others.
This widespread disease is based on acute and chronic pathological conditions caused by organic lesions coronary arteries heart (thrombosis, atherosclerosis), or a functional state - a spasm of these arteries, which impedes the nutrition of the heart muscle and leads to myocardial infarction or its focal dystrophy, angina pectoris, disturbances, heart rhythm, acute coronary insufficiency.
The conclusion about the cause of death must include established facts that contribute to the onset of sudden death. Such risk factors that suddenly lead to death are: unfavorable meteorological conditions (sudden change in atmospheric pressure, air temperature), physical overstrain (even slight) in patients with coronary artery disease; psycho-emotional impact, especially if it was unexpected.
Spasm, thrombosis, embolism, stenosis. Morphological signs appear 40-60 minutes after onset. Electrical instability is noted. Conduct polarizing microscopy + myocardial staining with secretin orange or Reis B biochemical analysis blood -ALT, ACT, the disappearance of glycogen from the ischemic site, CPK, LDH, K + increase. Macroscopic manifestations in a day. The formation of a white corolla - the 3rd day, then -\u003e red.
2. Forensic significance of bruising. Determining how old it is
origin. Possibilities of identifying an object depending on its shape.
Ways to distinguish from a cadaveric spot.
A bruise is a subcutaneous hemorrhage that can be superficial or deep (hematoma) and is manifested by a change in skin color.
Despite the fact that they do not cause health disorders, bruises are of great forensic significance, as they show that violence was produced in the form of a mechanical action with a blunt object, indicate the place of application of force. Sometimes, according to these skin lesions, a targeted study reveals damage to underlying tissues, internal organs, and fractures. Localization of bruises, taking into account other features, makes it possible to judge the nature of the violence. So, oval bruises on the neck suggest that it is compressed, which happens when strangulated with hands. The same injuries on the inner surface of the woman's thighs are typical for pushing them apart during forced sexual intercourse. Multiple bruises on the back surface of the hands, wrist joint indicate self-defense. The shape of the bruises often repeats the shape of the impact surface of the injured object or that part of it that was in greater contact. Based on these damages, the issue of the approximate prescription of their application is being decided.
At limited In action, the striking surface is smaller than the damaged body surface. When struck with such objects (for example, with a hammer), bruises are formed, often with precipitation along the edges.
The shape and size of the damage depend on the features of the angular edge. At ularah prelmets with a two-sided, straight edge (board, etc.) will form longitudinal bruises or wounds. Objects with a two-sided, arcuate edge, like at the bottom of a bottle, will give bruises or wounds of an arcuate shape.
The degree of severity of bruising in the circumference of the wound depends on the angle between the planes of the object, and the smaller the angle, the weaker the hemorrhage along the edges of the wound. As the angle of the damaging object sharpens, the edges of the wound become more even.
On impact prelmetami with multifaceted(pyramidal^ corners characteristic star-shaped wounds are formed, and the number of rays of the wound often corresponds to the number of edges (ribs) converging at an angle. So, an object with a trihedral angle (for example, the corner of a brick, board) gives a three-beam abrasion or wound, each ray of which is formed by the edge of the corner of the object. These rays, abrasions or wounds can be of various lengths depending on the direction of impact.
trihedral, multifaceted and conical blunt edge angles according to the mechanism of action, they are transitional to piercing tools. At the same time, the sharper the angle, the weaker the bruising and sedimentation along the edges of the formed wound. With a significant impact force and sufficient gravity, a tool with a polyhedral angle produces characteristic depressed or perforated fractures of flat bones.
When examining a corpse, sometimes you can not notice bruises located in the zone of cadaveric spots or on the border with them. In such cases, cruciform incisions are made in suspicious areas: if there is a bruise, limited hemorrhage is visible. Higher parts of the body do not have cadaveric spots.
3. Forensic and forensic significance of fresh traces of blood at the scene: drops, splashes, puddles, streaks, blots, prints. The mechanism of education. Blood sampling for laboratory research. Possibilities of laboratory diagnostics.
Traces of blood - they mean the presence of any amount of blood in environment outside the human or animal body. Traces of dried blood on any subject-carrier are called spots.
The meaning of traces of blood: establishing the presence of blood, its species and group origin; conditions and mechanism of formation of blood traces.
Types of traces of blood form and education mechanism. When describing, we use the classification of elementary traces: 1) Spots from falling drops. A drop is the minimum amount of liquid for given conditions, which took a rounded shape due to the adhesion of its particles. From stationary objects, drops fall vertically downwards under the influence of gravity.
When falling on a horizontal smooth surface, the shape and size of the spot depend on the height of the fall. With a fall height of up to 10 - 15 cm, the spots are round in shape, up to 1 cm in diameter and have smooth edges; when falling from a height of up to 40 - 50 cm, the spot diameter is 1.5 cm, the edges become jagged; at a fall height of up to 1.5-2 m, the spot diameter increases to 2 cm, secondary spatter appears, the edges have a radial shape.
When drops fall from an object moving at a low speed, they form a pear-shaped spot with thinning in the direction of movement; at a high speed, the drops are scattered into sprays.
When drops fall on an inclined surface, the spot lengthens in the direction of the slope and its lower part has a greater thickness.
Spots from burning drops of blood - an indicator of bleeding. These traces help to determine the direction of movement of a wounded person or the transfer of a corpse, to identify the pace of movement, and places to stop.
2) Spatter spots. With additional kinetic energy, a drop of blood, meeting
air resistance, breaks down into small droplets called spray. splash stains
differ in multiplicity and smaller sizes, up to point ones.
Splashes form when arterial bleeding, when hitting a bloody body or object, on accumulation of blood or impregnation, when dismembering a corpse, when shaking a bloody object or weapon sharply. With arterial bleeding, spots are formed, located in the form of chains with relatively equal intervals and sizes. If splashes arise from blows to a bloody object, then a fan-shaped arrangement of spots is characteristic.
3) Drips. These are traces of an oblong shape, formed during the runoff
blood on an inclined or vertical surface under the influence of gravity.
When the gravity of the flowing blood is balanced by the force of the surface
tension, the flow stops, forming the so-called club-shaped
thickening. On an uneven surface, the streaks become tortuous.
Leaks help to establish the position of a wounded person after the onset of bleeding, restore the position of surrounding objects, and resolve the issue of the sequence of injuries.
4) Imprints. Formed by static (non-slip) contact
a bloody tear-forming object with a tear-receiving surface
(fingers, palms, feet, shoes, etc.).
5) Blots and smears. Formed by sliding contact with
a bloody object, weapon, hands, etc.
6) Puddles. Formed with significant blood loss on the horizontal
non-absorbent or slightly absorbent surfaces, in the absence of
body movements.
Preliminary tests:
h sample with 3% hydrogen peroxide;
h benzidine reaction (blue color of the solution);
h reaction with Voskoboinikov's reagent (powdered benzidine reagent, more convenient for storage and transportation);
h test with luminol.
All preliminary blood tests are non-specific, negative result preliminary samples does not give the right to refuse the subsequent examination of suspicious blood stains in the laboratory.
Open or penetrating wounds of the abdominal cavity are most often caused by firearms or cutting and stabbing objects.
In the practice of surgeons from penetrating wounds of the abdomen, gunshot and stab wounds are most common. In such patients, the examination of the abdomen is carried out immediately after the restoration of airway patency, adequate breathing and circulation. Indications for laparotomy are set on the basis of signs of damage to internal organs that require surgical treatment. Patients in a state of shock and with signs of peritonitis, patients in whom blood is secreted through a nasogastric tube or from the rectum, patients in whom free gas is found in the abdominal cavity or in the retroperitoneal space, patients in whom internal organs are visible, as well as those who are taken to the hospital with a knife sticking out of their stomachs. In such cases, intravenous urography (IVP) is urgently performed, which can quickly detect the presence of two functioning kidneys. Intravenous urography is performed not so much to detect damage to the urinary system, but to make sure that the kidney on the undamaged side is functioning well (extremely important information in cases where a nephrectomy is considered during surgery).
Diagnosis in patients with gunshot wounds is fairly straightforward. On the contrary, the penetrating nature of stab wounds is more difficult to establish. These two types of penetrating abdominal wounds will be described next.
Gunshot wounds, in which a wounding projectile penetrates the human body at the level from the chest to the hips, can cause damage to the abdominal organs. Of all penetrating gunshot wounds to the abdomen, 98% cause damage to internal organs, which require immediate surgical intervention. However, in some cases, the nature of the gunshot wound may cause doubt among doctors. This situation occurs mainly with tangential gunshot wounds of the abdomen. In such cases, laparocentesis is performed, and if the examination of the fluid obtained from the abdominal cavity during peritoneal lavage reveals more than 10.0 × 1012/l of erythrocytes, the wound is penetrating and an urgent laparotomy is required. Gunshot wounds of the thoracoabdominal region, back, lateral parts of the abdomen and pelvic region, which cause doctors to doubt their penetrating nature, are quite rare. In such cases, the diagnostic tactics should be the same as for stab wounds of the abdomen.
With stab wounds of the anterior abdominal wall, the tactics of doctors may be different. At the same time, it is always important to remember that only 50% of all stab wounds of the abdomen penetrate the abdominal cavity, and only 50% of them cause damage to internal organs that require urgent surgical intervention. In our opinion, the main task of examining such patients is to identify victims who have indications for urgent surgical intervention. Such patients need to be quickly prepared for surgery. Patients who are conscious and hemodynamically stable can be examined several times in dynamics in order not to miss a penetrating wound. If they show signs of developing peritonitis or shock, it is necessary to perform surgery. All other patients can be discharged from the hospital in 24-48 hours. Examples when there are doubts about the diagnosis during dynamic observation and examination are quite rare. In these cases, many authors recommend using all possible diagnostic techniques, including laparocentesis and peritoneal lavage, local wound examination (surgical debridement and revision), exploratory laparoscopy, and finally exploratory laparotomy. Of all these methods, in our opinion, laparocentesis and peritoneal lavage are the most informative for diagnosing a penetrating wound of the abdomen and setting indications for urgent surgical intervention. There are three types of abdominal stab wounds that present significant diagnostic difficulties. These are thoracoabdominal wounds, wounds of the back and lateral sections of the abdomen. With thoracoabdominal wounds, the wound channel may enter into chest and penetrate through the diaphragm into the abdominal cavity. In this case, the organs of the abdomen can often be damaged. The presence in such patients of signs of penetration of the wound into the abdominal cavity is an indication for emergency surgery. When examining these cases, we used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l was evidence of the penetrating nature of the injury. In such cases, drainage of the pleural cavity and laparotomy were performed, during which the defect in the diaphragm was sutured, and then an adequate surgical intervention, depending on the injuries found in the abdominal cavity. Stab wounds of the back and lateral parts of the abdomen can cause both damage to the organs of the retroperitoneal space and the abdominal cavity. Especially dangerous are injuries of the retroperitoneal part of the duodenum and colon. In these patients, we also used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l indicates the penetrating nature of the injury. In such cases, an emergency laparotomy was performed to eliminate damage to the organs of the abdominal cavity and retroperitoneal space. If the content of erythrocytes in the fluid obtained from the abdominal cavity during peritoneal lavage was less than 10.0 × 1012/l, we performed computed tomography of the abdomen with the introduction of a contrast agent intravenously, into the duodenum and into the large intestine. With such a technique computed tomography with "triple" contrasting, the accuracy of the method in diagnosing damage to the organs of the retroperitoneal space is more than 95%. Pelvic stab wounds can cause organ damage gastrointestinal tract, organs of the urinary system, as well as internal genital organs in women. We also used laparocentesis and peritoneal lavage to identify the penetrating nature of the wound. In addition, all patients with stab wounds of the pelvic region underwent rigid proctosigmoidoscopy (rectoromanoscopy), cystourethrography, and women, in addition, underwent vaginal examination in the mirrors. At the same time, if the content of erythrocytes in the fluid obtained from the abdominal cavity exceeded 10.0 × 1012/l, or during other studies, signs of damage to internal organs were detected, an emergency operation was performed. All other patients were followed up dynamically.
Most often, with penetrating stab wounds of the abdomen from parenchymal organs, the liver is damaged (in 37% of cases), the spleen (7%) and kidneys (5%). However, in general, hollow organs with stab-cut penetrating wounds of the abdomen are most often damaged. Their hollow organs are most often damaged small intestine (in 26% of cases), stomach (19%) and large intestine (16.5%).
According to our data, anterior abdominal wall injury, not penetrating into, are found in 13.2-15.3% of all abdominal injuries. In a part of the patients we observed, the wounds with both knives and firearms were clearly demonstrative in nature, like a “cry for help”, like a desperate attempt to attract the attention of others. Such wounds are often incised and, although outwardly dramatic, do not pose a threat to life, with rare exceptions when the lower epigastric artery is damaged.
Substantial part lumbar region injuries, without penetrating into the abdominal cavity, leads to damage to the organs of the retroperitoneal space. The most commonly observed damage to the kidneys, ascending and descending colon, somewhat less often - the duodenum and pancreas, aorta and inferior vena cava.
Wounds of the anterior abdominal wall and lumbar region, inflicted by firearms at low speed, do not present big problems for surgical treatment. When using high-velocity projectiles, the effect of a combat strike is so severe that it leads to a life-threatening condition.
Non-penetrating wounds can be through (tangential), when the wound channel passes from right to left (or vice versa) in the thickness of the muscles of the back and in the retroperitoneal space, accompanied by the formation of hemorrhages of various sizes, with damage to the vertebrae and spinal cord.
Penetrating wounds of the abdominal wall
Near 20-25% wounds with melee weapons penetrating into the abdominal cavity, are not accompanied by damage to internal organs, even with a deep immersion of a sharp object. Most often this happens when a knife strikes with little force and speed, when the movable loops of the small and large intestine, due to elasticity, manage to slip away from the blade.
It should be noted that the presence postoperative scars and adhesive process in the abdominal cavity, limiting the mobility of organs, sharply increases the possibility of their damage with penetrating stab wounds.
Stab wounds inflict bayonet, a narrow stylet, sharpened files and screwdrivers, an awl, a dinner fork and other sharp objects. Such wounds are characterized by small size, but significant depth of the wound channel.
At extensive cut wounds penetrating into the abdominal cavity, there is a prolapse of the abdominal organs, most often the greater omentum and loops small intestine. In the literature, there are observations of prolapse of the spleen, the tail of the pancreas, and the left lobe of the liver from wounds.
In this case, the fallen organs are exposed to massive infection and can be infringed.
An artistic description of a cut wound in the abdomen can be found in Hans Evers (collection of short stories Horror. Grenada): “... delivered a terrible blow to his opponent from below upwards in the stomach and pulled the blade back from the side. A disgusting mass of intestines literally flowed from a long wound. It was the section of the liver that had fallen into the wound of the abdominal wall that was successfully removed in the 12th century, followed by cauterization of the Hildanus parenchyma with a red-hot iron, initiating liver resections.
In car accidents and work-related injuries, there are injured caused by secondary projectiles. Such wounds are similar in character to torn-bruised ones.
Skin wounds in most cases, they are localized on the anterior abdominal wall. In second place in frequency are wounds of the lower chest with the spread of the wound channel through the diaphragm into the abdominal cavity or retroperitoneal space. From the wound of the abdominal wall, blood, bile, liquid intestinal contents, urine can flow. Much less often, wounds are localized in the lumbar, sacral or gluteal regions.
In observations F. Henao et al. in case of penetrating wounds of the lumbar region, the wound channel penetrated into the abdominal cavity in 60%, into the pleural cavity in 31%, and in 9% the wound had a thoracoabdominal character.
In a detailed post J. J. Peck, T.V. Berne emphasized that most often such wounds are located to the left of the spine, in 22% they have a stab character with a narrow and long wound channel, the course of which in the muscle mass can be displaced. Information about the frequency of damage to the organs of the abdominal cavity and retroperitoneal space is contradictory: in the literature it is often from 5.8 to 75%.
Concerning gunshot wounds, then the morphological features of damage to parenchymal organs are due to their homogeneous structure and abundant blood supply. Therefore, usually the wound channel in these organs has a direct direction, is filled with detritus and blood clots. Cracks of various depths extend from it in different directions.
Morphological features damage to hollow organs due to the fact that these organs differ sharply in the content of liquid and gases. It is precisely due to the displacement of liquid and gases during injuries of hollow organs that a temporary pulsating cavity of large dimensions arises, which leads to extensive ruptures and delamination of the organ walls at a great distance from the wound channel. In this case, hollow organs filled with liquid contents and gas are damaged much more strongly than hollow organs without contents. This fact was well known even during the First World War, when the soldiers were given only sugar before the attack, forbidding the intake of rich food and limiting the intake of fluids.
Determined that the presence of dense stools in the colon to some extent reduces the degree of hydraulic side impact and, therefore, reduces the likelihood of extensive ruptures. At the same time, the places of natural bends of the intestine and the places of its fixation, making it difficult for the shock wave to pass along the intestinal tube, are typical places of ruptures, which should be paid attention to when examining the abdominal organs.
Depending on the kinetic energy of the projectile, it can pass through both walls of a hollow organ or stop in its lumen. In the latter case, the stopping effect of the wall of a hollow organ may be accompanied by its bruising, followed by necrosis. Bruises of hollow organs from the outside lead to the formation of subserous hematomas, which can also subsequently lead to necrosis of the deep layers of the intestine.
In addition, a feature gunshot wounds to the abdomen is the so-called transformation of the external contours of the abdominal cavity [Aleksandrov L. N. et al.], which consists in the fact that the transverse dimensions of the abdomen at the time of injury change dramatically in the direction of increase and decrease. These fluctuations are repeated several times and, in case of penetrating wounds, are accompanied by an intermittent ejection of the contents of the damaged hollow organs from the outlet, often ending with the loss of intestinal loops or a strand of the greater omentum from this hole.
