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العودة   كل الطب أكبر منتديات طبية عربية 6 أعوام من العطاءAllteb 6 Years of Donation > التعليم الطبي الأساسي > الفرقة الرابعة > Fornsic Medicine & Toxicology

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قديم 02-12-2009, 09:01 PM   #1
dr_khalil
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افتراضي مجموعة من ال Reports مغطية المنهج ان شاء الله تعجبكم


مجموعة من ال Reports مغطية المنهج انشاء الله تعجبكم

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Report of toxicology


(Arsenic)
Name : ……………..
Age : 23 years
Colleage student was brought to ED because of complaining of abdominal pain , watery diarrhea , vomiting . on examination : patient was hypotension with bilateral muscle wasting , muscle tenderness , hyperthesia in the overlying skin two weeks prior to admission the student was working in his father's field with frequent contact with insecticides & consume large quantities of vegetables from the field.
ttt
1- prevent further exposure
2-decotaminaton * GL
* AC
* Ferric hydroxide
3- chelating agent
* BAL 5 mg / kg
then 2.5 mg /kg/ 8 : 12 h ----24h
then 2.5 mg /kg /12 : 24 -----10 days
* BAL Penicellamine
25 mg /kg/6 h. for 6 : 8 days
4- supportive ttt : IV fluids - Electrolyte – Vital functions
5- symptomatic ttt








Ethanol))
*Name : ………
*Age : 27 years
*He was brought to poison center , he was comatosed, temperature was 36 , Respiration 12/ min , the reflexes were decreased ,sensations were lost , the pupils were constricted but dilate on pinching skin
Treatment :*
1- Stabilization : ttt of coma with triple therapy
maintain airway ,artificial respiration
2- decontamination : removal by GL
3- elimination : Heamodialysis
4- Antidote : Vit. B6 IM


*Conclusion : A case of ethanol toxicity he is 27 years old with symptoms & signs of acute toxicity








( Potash )


Name: …………………
Age : 3 years
*** : male
Complaint : He was brought by his mother to the hospital and she told that he drank bottle of potash 4 hours ago underneath the sunk .He was suffering from pain in the mouth , oeosophagus and stomach .Vomiting of slimy dark fluid , thirst, dysphagia hoarseness of voice and diarrhea .


Treatment
1- stabilization .......... tracheostomy
.......... Anti shock measures
2 – decontamination (emesis & GL are contraindicated ).
3- supportive ttt * Feeding naso-gstric tube
* Antibiotic…...prevent 2ry infection
* Steroids …….prevent stricture
4-surgical retrograde dilatation , gastrostomy feeding replacement of oesophagus


conclusion : a case of corrosive poisoning ( potash ) in a male child 3 years old who drank from a bottle of potash and was admitted with severe pain , vomiting , diarrhea and escars in the mouth .






Report of burn.
Name: Bahya Mohammed El Shahat. ***:female. Age: 40 y.
Number of burns:a lot allover the ****. Type of burn:dry heat.
Degree of burn: 3rd grade [skin and muscle are completely burn so it is painless].
Extend of burn: more of 50% of **** [dangerous]. Antemortum & accidental.
Antemortum characters: dry heat burn , carbon soots in lungs & air way & signs of vital reactions.
Cause of death: neurogenic shock.
Conclusions:-.
40 y female has dry heat extend to about 50% of **** surface , 3rd degree & she died.



Report of head injury.
Age:40 y. ***: male history: blow by axe.
Acute fracture present in Lt side of frontal bone of the skull. It is 1 blow , the edges are regular straight & sharp with loss of substance & take the shape of causative instrument [trainglar in shape]. Homicidal case caused by axe.
Base indicates position of assailant in front of the victim.
Permanent infirmity , loss of substances.
Cause of death: concusion & compresion with brain laceration.




Report of wound.
Age:40 y. ***:female. No.of wounds:2. type of wound: cut wound.
Site of wounds:in the Lt index.
Di******ion of wounds:-.
2 cut wounds in the Lt index finger 2.5 cm in length & 2 mm in depth the other 1.5 cm in length & 1 mm in depth.
Possible causative instrument: sharp instrument.
Haemorrhage: simple & slight. Accidental.
Conclusions: female with 2 cut wounds in her left index.




Report of wound.
Age:14 y. ***:male. No.of wounds:2 wounds.
Type of wound:lacerated [brush abrasions]. Site of wound: Rt elbow.
De******ion of wound:-.
2 lacerated wounds on Rt elbow. The superior one is 1 cm & the inferior is 3.5 cm.
Small haemorrhage.
Causative instrument: dragging along the ground. Accidental.
Conclusions:-.
14 y male has 2 lacerated wounds on the Rt elbow.







Report of Abortion



A woman alleged that she has been aborted in 3rd month of pregnancy after a quarrel.
ÝÇØãÉ íæÓÝ ÇáÓíÏ1- Age: 28 years old , Name :
2- Consent of the patient & taking history.
3-Diagnosis:
A- Pregnancy signs: Breasts: engorged breasts, enlarged nipples & areola, Montgomery's follicles Abdomen: enlarged dark pigmentation (linea nigra) in midline, white & red small lines (stria gravidarum) on sides
+ve human chrionic gonadotropin hormone in urine 2 weeks after abortion


B- General violence signs: There is bruises & abrasion on the abdomen.


C- Local violence signs:
a-vagina: congestion, laceration or ulceration with blood clots
b-cervix: Lacerated, soft dilated external os with blood clots
c- Uterus: Enlarged, show signs of metritis with bleeding & embryonic tissue may protrude from vagina & cervix.
D- Lab investigation: it is negative (Not spontaneous abortion or induced by abortifacient drugs)
E- Examination products of abortion:
1- It is not menstrual blood
2- +ve precipitin test: human fetus.
3- From fetal characters he is in 3rd intrauterine life: 9 cm long, 30 gm weight, formed placenta. Formed nose & mouth.
4- No rancid odour to exclude macerated fetus


Conclusion: It is a criminal abortion due to the quarrel









Report of fire arms



Young male came with sustained penetrating abdominal injury was brought to the hospital.


ÃÍãÏ ÓáíãÇä ÇáÚáÇ&atilde ;1- Name:
Age: 22 Y.O
2- Type of injury: Inlet of fire arm (Rifled weapon)
Shape: circular regular hole. Size: Nearly small sized. Number of wounds: Only one
Margin: Bruising& there is the bowder marking & tattooing
Edge: Everted as it is present in fatty area
Anatomical site: in the abdomen
3- Powder marking:
There is soiling ring (inlet wound)
No gun powder marking is found (he was shot from along distance)
4- Causative weapon: Long rifled weapon bore: 16 mm (known from the extracted missile)
5- Distance of firing: more than 3 meters.



Conclusion: He was shot by long rifled weapon from a distance more than 3 meters in the abdomen.







Report of Abortion



A woman alleged that she has been aborted in 3rd month of pregnancy after a quarrel.
ÝÇØãÉ ãÍãÏ ÇáÓíÏ1- Age: 28 years old , Name :
2- Consent of the patient & taking history.
3-Diagnosis:
A- Pregnancy signs: Breasts: engorged breasts, enlarged nipples & areola, Montgomery's follicles Abdomen: enlarged dark pigmentation (linea nigra) in midline, white & red small lines (stria gravidarum) on sides
+ve human chrionic gonadotropin hormone in urine 2 weeks after abortion


B- General violence signs: There is bruises & abrasion on the abdomen.


C- Local violence signs: a-vagina: congestion, laceration or ulceration with blood clots
b-cervix: Lacerated, soft dilated external os with blood clots
c- Uterus: Enlarged, show signs of metritis with bleeding & embryonic tissue may protrude from vagina & cervix.
D- Lab investigation: it is negative (Not spontaneous abortion or induced by abortifacient drugs)
E- Examination products of abortion:
1- It is not menstrual blood
2- +ve precipitin test: human fetus.
3- From fetal characters he is in 3rd intrauterine life: 9 cm long, 30 gm weight, formed placenta. Formed nose & mouth.
4- No rancid odour to exclude macerated fetus


Conclusion: It is a criminal abortion due to the quarrel








Report of fire arms



Young male came with sustained penetrating abdominal injury was brought to the hospital.


ÕÇÈÑÃ&Iacute ;&a tilde;Ï Úáí 1- Name:
Age: 22 Y.O
2- Type of injury: Inlet of fire arm (Rifled weapon)
Shape: circular regular hole. Size: Nearly small sized. Number of wounds: Only one
Margin: Bruising& there is the bowder marking & tattooing
Edge: Everted as it is present in fatty area
Anatomical site: in the abdomen
3- Powder marking:
There is soiling ring (inlet wound)
No gun powder marking is found (he was shot from along distance)
4- Causative weapon: Long rifled weapon bore: 16 mm (known from the extracted missile)
5- Distance of firing: more than 3 meters.



Conclusion: He was shot by long rifled weapon from a distance more than 3 meters in the abdomen.







REPORT OF HEAD INJURY
Name: Eman .
Age:19 y. ***: female.
Injury: clear cut wound of the scalp.
Characters: sharp regular edges , the wound is more long than deep , 5 cm in length , sharply cut edge of hair , bleeding. By x-ray there is no fracture of skul , no affection of brain .
Number of wounds: one. Site of wound : Lt temporal part.
Possiple instrument: sharp instrument , it is accident.
Conclusions:-.
Eman has 19 years old came to hospital with bleeding after accident. On exammination bleeding was from wound on scalp.
It is clear cut wound (sharp regular edge , more long than deep. 5 cm in length . sharply cut hair. So that the causetive instrument may be sharp instrument.
The x-ray showed no brain affection , no skull fracture the wound was on Lt temporal part.




REPORT OF HEAD INJURY
Name:Ashraf Mohammed.
Time & date : 27/10/2005 Wednesday 12:30 pm.
***: male. Age: 18 y.
Numberof wounds:2.
Type & site: 1 stab wound-in the chest.
More deep than long [length 3 cm-deep 6 cm].
The edges [ one sharp the other rounded] so the causative instrument has one single blade.
2 head injury-partial cut fracture on scalp sharp regular edge , more long than deep (8 cm in length) sharply cut brain-bleeding- by x-ray ther is no brain affection no skull fracture . so cauative instrument is sharp instrument (knife).
It is homicidal.
Conclusions:-.
Ashraf 18 y came to hospital . on examination there are two wounds . one stap wound in thorax [ more deep than long 3 cm in length 6 cm in deepth). The edges of wound , one sharp the other rounded so causative instrument has single bladed , by x-ray there is no complications.
Other partial cut fracture on scalp has sharp regular edge more long than deep 8 cm in length , sharply cut hair by x-ray there is no skull fracture , no brain affection it is expected to be homicidal.







Report of organo phosphate poisoning.
……………Name:
Age:18 y. ***: female.
Her mother brought her to hospital with nausia , vomting , abdominal pain , diarrhea , excess salivation , myosis , blurred vesion , chest pain , bradicardia and hypotension.
When asked she said that she drunk organo phosphate.
Treatment:-.
(1)emesis , gastric lavage by activated charcoal.
(2)decontamination of skin. (3)suction of oral secretions.
(4)specific antidote [atropine] 5-2 mg untill full atropinization [dry mouse , dilated pupils , pulse rate 100-140 per min] (5)give oxime better than atropine.
To be sure of diagnosis:
RBCs actylcholine estrase level [normal level 100%]. Pseudocholine estrases in plasma and livre [normal 9000-3800 u].




Report of insecticids.
Victim is 15 y,female. Hitory of spraying. Accidintal.
Clinical picture:-.
Sweeting , lacrimation , costricted pupil , vomiting and abdominal pain.
Investigations:-.
Level of pseudocholine estrase is decreased , pulse [60/min] , full conciousness , miosis & sweeting.
Management:-.
(1)Gastric lavage by activated charcol. (2) skin decontamination. (3)atropine 2mg I.V.
Treatment:-.
(1) Sympatomatic treatment. (2)observation. (3)antibiotics (4)diazepam.




Report of kerosin poisoning.
Name: ***: female. Age: one year & 3 months.
Her parents brought her to hospital with sever vomiting & smell of kerosin in the vomitus , eyes upword. Then she entered in a coma grade 2 respond to painful stimuli , respiratory depression.
Treatment:-.
(1)maintain respiration [oxygen inhalation] (2)prevent aspiration of vomitus.
(3)skin decontamination. (4)antidote [hydrocortisone] then put in intensive care.
Investigations:-.
Chest x-ray arterial blood gases ECG monitoring.







REPORT OF WOUND
Name:Ali Mohammed Ali
Time & Date/ 12 am-saterday 1/10/2005
***: male Age: 45
Number of wounds: 2
Type of wound: 1-lacerated 2-deep cut wound
Sites of wounds: 1-in the face 2-dorsum of left foot.
Characters:-.
(1) lacerated wound length 2 cm,dimentions 3*2*5 cm, edges: bleeding
(2) Deep cut wound length 1 cm ,dimentions 2*3 mm edges: clear cut
Possible causetive instrument: lacerated wound by blunt object
Deep cut wound by sharp instrument it is expected to be accidental
Conclusion:-.
Ali (45 years) came to hospital after accident. On examination doctor found two wounds. One lacerated on face [length 2 cm, dimentions 3*2*5 cm]bleeding in touch.
The other deep cut wound in dorsum of lt foot [length 1 cm, dimentions 2*3 mm] with clean cut edges.




REPORT OF WOUND
Name :
Age : 18 years old. *** :female.
Time & date :Wednesday 27/10/2005 2 pm.
Number of wound:superfacial cut wound.s
Site / Rt index from behind.
Characters:-.clean , clear , regular , 2 cm in length
Possible causetive instrument sharp object.
Conclusions:-.
Male (18y) came to hospital. On examination we found superfacial cut wound [clear , clean , regular , 2 cm in length] in his Rt index (from behind).
The man said it was done by sharp instrument used in farm , it was an accident.




REPORT OF BURN
Name:
Time & date / Wednesday 12 am 5/10/2005.
*** : female. Age :35 years old .
Number of burns: one. Type of burn: moist heat.
Degree of burn: grade 1 , red area show vesicles.
Extend of wound:in lower have of thigh in front onlyabove knee jointnot exceed 9% it is accident.
Conclusions:-.
Female has 35 years old came to hospital crying and said that boiling water fall on her thigh . on examinations there is red area on lower half of thigh the front only and show vesicles.
The burn was 1st degree


.
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