Syntax Literate: Jurnal Ilmiah Indonesia p�ISSN: 2541-0849

e-ISSN: 2548-1398

Vol. 7, No. 9, September 2022

 

STAB WOUND ON CHEST THROUGH THE LUNGS

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Agustinus Sitepu

Specialist Doctor Education Program Forensic Medical Science and Medicolegal Department Studies Usu Faculty of Medicine/H. Adam Malik Hospital Medan, Indonesia

Email: [email protected]

 

Abstract

Sharp trauma is one part of mechanical trauma. It is often found in the field.���� Sharp trauma consists of several parts, namely cuts, stab wounds, iris wounds. In this case, the victim suffered a stab wound to the left chest through the sixth intercostal space and seven, through the lower left lung to penetrate the envelope heart to the left heart muscle. A stab wound is an injury to the body caused by stabbing objects that have sharp edges on the body. If measurements are taken, the stab wounds have a longer depth of wound than the length of the wound. On the other hand, in iris wounds, the injuries can occur on the chest, abdomen, spine, neck, head and extremities. Stab wounds to the head and neck are rare. The most dangerous stab wound is on the left chest. Someone will tend to pierce the left chest. Moreover, if someone who intends to kill, then that person will stab at the left chest. This is because most of the heart is located on the left side of the chest so people thought the victim would die sooner.

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Keywords: Sharp Trauma, Stab Wound

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Introduction

An injury can be defined as the damage to body tissue that caused by a trauma. There are various causes of injury, namely: caused by gunshots, electric currents, contact with blunt objects, objects sharps, chemicals, and so on. Criminal acts accompanied by sharp weapons often occur. This is often related to the ease of obtaining sharp weapons everywhere. By having sharp weapons murder, suicide, and accidents can happen.1

�Determining the way of how one's death is a challenge. It is one of the most difficult tasks for a forensic expert and medical personnel in determining whether the death��� is because of killing self, accident, or homicide as included in the early stages of the investigation death. The difference between homicide, suicide and accidental injury is a central issue in forensic pathology. In addition, the cause of death due to sharps injuries are common and cause the loss of a person's life. Seen from the nature of violence, the hardness of sharp objects is carried out using sharp objects such as knives, axes, razors and etc. Wounds caused by sharp objects can be in the form of stab wounds, cuts and iris. Viewed from a medico-legal aspect, the checking of people who suffer violence due to sharp objects, doctors are essentially required to provide clarity of problems such as the type of injury, the type of violence that causes injury and qualification of injury.2

 

Definition

�Traumatology is a branch of medicine that studies trauma or injuries and their association with various types of violence (forced weapons) with abnormalities in the body due to tissue discontinuities that leaves a trace.3

�Sharp trauma is one type of trauma which is a division from mechanical trauma. Sharp trauma is an abnormality in the body caused by the contact of an object with surface capable of slicing so that continuity network disappears. It is usually caused by swords, scissors, razors, axes and etc. Injuries caused by sharp trauma can cause cuts, stab wounds and stab wounds.�

The general characteristics of a sharp object wound are1,4:

a.      The outline of the wound is usually regular, the edges are even, and the angle is sharp.

b.     If connected, they will be tight because these things are only separates, and it does not destroy the network and forms a straight line from a slight bend.

c.      No network bridge.

d.     There is no bruising in the area around the wound line.

�One of the most common is a stab wound. A stab wound is an injury on the body caused by stabbing objects that have sharp edges on the body. Stab wounds can be distinguished from iris wounds based on their length and size wound depth. When measured, the puncture wound has the depth of the wound which is longer than the length. On the other hand, in iris wounds, the angle of the wound can indicate an approximate object cause, whether it is a one-edged or double-edged knife. If one corner of the wound is acute and the other is blunt, meaning that the object causing it is a one-edged sharp object. When Both angles of the wound are sharp, the wound can be caused by a sharp-edged object two5.�

� Injuries can occur on the chest, abdomen, spine, neck, head and neck extremity. Stab wounds to the head and neck are rare. Stab wounds to the neck can cause rapid death because bleeding, air embolism or asphyxia caused by bleeding great soft tissue with compression pressure on the trachea and blood vessels neck. The victim can die from severing the carotid artery, jugular vein, pharynx and trachea 6.

�The most dangerous stab wound is on the left chest. Someone will tend to pierce the left chest. Moreover, if someone who intends to kill, then that person will stab at the left chest, this is because most of the heart is located in the left chest so that the person think the victim will die faster. The stab wound to the chest will result in serious, life-threatening heart injury. stab wound on the right chest usually injure the right ventricle, aorta, or right atrium. And on the left chest usually injure the right ventricle. In stab wounds, damage atria can be more serious than ventricular damage due to muscle ventricles can still contract, which can slow or end bleeding.

�Puncture wounds to the spine are rare. Like a stab wound head, the knife used can break and bone fragments are found behind. Injury to the spinal cord can cause paralysis. Stab wounds to the abdomen can cause damage to the liver, spleen, stomach, pancreas, kidneys, urinary bladder, intestines so that it can cause quite a lot of bleeding. Death does not occur directly on the wound stab in the abdomen. The fact is that it's only been a few days or even weeks of injury stab can cause death. 6

�Stab wounds to the extremities can lead to death as well. Prick can extremity vessels such as the femoral artery. In almost these cases, the victim was stabbed while consuming alcohol and didn't realize that is suffering from a stab wound.

Wound Characteristics

a.     Length and depth of wound

�In stab wounds, the length of the wound on the skin can be the same, smaller or larger compared to the width of the blade. Most stab wounds will open not because of the nature of the things that enter but as a result elasticity of the skin. In certain parts of the body, where there is a base In the form of bone or muscle fibers, the wound may appear as a curve. The length of the wound is important to measure by closing the two edges of the wound, because that's why will represent the width of the tool. The length of the wound on the surface of the skin looks smaller of the width of the tool, especially if the wound is transverse to the muscle. When the wound enters and out through the same groove then the width of the wound is equal to the width of the tool. It frequently happens that the width of the wound exceeds the width of the tool due to sideways pulling piercing time and pulling time.

Likewise, it happens if the incoming tool enters the network with a tilted position7.

b.     Wound Shape

�The shape of the wound on a stab wound can be affected by the shape and size of the weapon used, direction of thrust, movement of the weapon on the wound, movement of the victim punctured, and the state of skin elasticity. The wound margin area can provide information on the sharpness of the weapon used. A blunt weapon for example will experience abrasion. The edges of the wound can show sharp parts (an acute angle) and an obtuse (obtuse angle) of a single-sided sharp-edged knife.

�A knife with both sharp edges will produce a cut with sharp edges. There are several factors that affect the shape of a stab wound, one of which is: is the victim's reaction when stabbed or when the knife comes out, it can be causing the wound to be less characteristic. Or manipulation done at the time of stabbing also affects. Some of the wound patterns that can be found that is 8 :

1.     Stab in which is then partially ejected, and then reinserted through a different channel.���

In that situation, the wound does not match the usual picture and more than one channel. It can be found in deeper tissues and organs.

2.     The puncture is then removed by directing it to one of the angle, so that the wound that is formed is wider and gives a wound to the surface of the skin like a tail.

3.     The stab goes in then while it is still inside and it is stabbed in the other direction, so that the wound channel becomes wider. Visible external wounds are also more area compared to the width of the weapon used.

4.     Puncture in which it is then removed by using the dot deepest as an anvil, so that the wound channel is narrow at the deepest point and widest superficially. So that the external wound is bigger compared to the width of the weapon used.

5.     The stitch rotates on in, out, or both. Wound angle is large and irregular in shape.

Puncture Wound Examination

�On examination of the wound, there are two types of wounds due to sharp instruments that need to be carefully considered and have recognizable characteristics from the action victims, namely signs of trials and wounds of resistance. Both have the form location and medicolegal. The test mark is a shallow incision. A stab wound is made before fatal injuries by individuals contemplating suicide. Trial wound is often parallel and located close to the wound in the area of wrist or neck. Other forms of superficial stab wounds near deep and deadly stab wounds. Another form of injury due to an instrument that sharp is a �resistance wound�. This type of wound can be found on the fingers, hands, and forearms of the victim as he tries to protect himself from swing of a weapon, for example by grasping the blade of a sharp instrument.

�In examination, the interpretation of the wound should be based on findings and findings should not be influenced by patient or family information. Inspection intended to determine:

a.      Number of wounds

b.     Wound location

c.      wound direction

d.     Wound size (length, width and depth)

e.      Estimating injuries as the cause of the victim's death or not

f.      Estimating the way in which injuries occur, whether homicide, suicide, or accident.� The location of the wound is described by connecting the affected areas adjacent to the anatomical line of the body and the position of certain tissues, for example the line in the middle of the body, the catia, the nipple, the center, the joints and others.

Causes of Death

�In stab wounds, the cause of death is divided into two, namely direct and indirect cause. In immediate death, bleeding usually occurs and damage to important organs (heart, liver, large blood vessels, etc.), and air embolism. In cases of indirect cause, the death usually occurs due to sepsis or infection. The most common cause of death in murder caused by a stab wound is heavy bleeding in the large blood vessels. Arterial bleeding from large blood vessels can result in serious death relatively fast. Loss of more than 1 liter of blood from large vessels is fatal.

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Method

Chronology

�A case was reported. A corpse known by the initials BS which� based on the visum request letter dated September 08, 2020, No. K/04/IX/2020/Reskrim on behalf of Binjai Resort Police. On September 08 2020 at 21.00 Western Indonesia Time at the Forensic Room of the Djoelham Hospital, carried out external examination of the corpse and continued internal examination on �September� 8, 2020 at 22.05 Western� Indonesian Time.

Examination Result

General Checking

Body Label�

:�� Not found

Body Wrapping

:�� Not found

Body Cover

:�� Not found

Body clothes

:�� Not found

Funeral jewelry�

:�� Not found

Objects beside the corpse ��:�� Not found

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General identification: found the body of a male, aged 45 years old, Indonesian nationality, brown skin color, body length one hundred sixty eight centimeters.

Specific identification: Nothing

External Checking:

Head

:� no signs of violence

Eyes

:� no signs of violence

Mouth

:� no signs of violence

Teeth

:� totaling thirty.

From the nostrils, mouth opening, right ear, left ear, pubic and release: nothing came out.

Injuries:

On the right hand, there was an open wound with a size of 1.5 cm x 1 cm and a depth of 2.5 cm.

Internal Checking Chest:

Chest skin opening

: Chest fat thickness 0.5 cm

Opening of the chest muscles

: Penetrating stab wounds found in the fourth five intercostal space.

Breastbone opening

:� Found a red liquid as much as 200 cc

 

 

 

Heart

Found a heart weight of 300 grams.

On examination of the lungs : The right lung was found a penetrating open wound on the right lung area. Lung is pale

On abdominal examination ������������� :� No signs of violence were found

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Examination Summary:

External Checking:

1. It is found an open wound on the right arm

Internal Checking:

1.     It is found an open wound on the chest between the fourth and fifth ribs

2.     It is found a red fluid in the chest cavity as much as 200 cc

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Result and Discussion

�Based on the literature review, case reports above and based on the results of the investigation at the scene of the case, it is found that the victim found dead. From these results, there is an alleged action violence against the victim, therefore the investigator through a visum letter request sent to the Djoelham Binjai Hospital at the Forensic Installation of the Djoelham Binjai Hospital. The examination of the victim was carried out by a forensic doctor who was on duty at the Djoelham Binjai Hospital on the same day, and from the results of the examination, it is found:

-        An open wound on the right arm indicates trauma. In this case, there is an open wound where the wound edges are flat, the upper corner of the wound is blunt, the angle of the wound is sharp which indicates a traumatic injury sharp.

-        The presence of red fluid found in the chest cavity as much as 200 cc. This indicates the result of a lot of bleeding because sharp object, so that with this condition the victim experiences heavy bleeding severe which causes a lack of blood supply throughout the body which cause circulatory failure and tissue damage.

Medicolegal Aspect

In conducting examinations of living or dead victims who suffer injuries due to violence, in essence doctors are required to provide clarity regarding the type of injury that occurred, the type of violence/ weapon or object causing the wound and the degree of injury. In this case, the suspect is not yet known, but there are several articles from criminal law that may be imposed on the suspect/perpetrator as:

Article 338 of the Criminal Code, Whoever deliberately takes the life of another person, threatened with murder with a maximum imprisonment of fifteen years.

Article 339 of the Criminal Code, Murder which is followed, accompanied or preceded by a criminal act, which is committed with the intent to prepare or facilitate its implementation, or to disengage oneself or other participants from criminal if caught red-handed, or to ensure possession of the goods obtained illegally, is threatened with life imprisonment, or imprisonment for a certain period of twenty years old.

Article 340 of the Criminal Code, Whoever intentionally and with prior plans used to take other people's lives, was threatened with murder with plan, with the death penalty or imprisonment for life or for certain period, a maximum of twenty years.

�Conclusion

Based on the literature review, case reports and discussion above, it can be concluded as follows: 1). Estimated time of death is between 12 hours - 24 hours before external checking is done. 2). The victim died in an unnatural way. 3). The cause of death was a stab wound to the chest that pierced the heart in lower left and the heart sac, causing excessive bleeding due to sharp trauma.


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Agustinus Sitepu (2022)

 

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