Courtesy of Godoy Medical Forensics
In assault and attempted murder cases, we are often asked to look at the severity of the injury and assist in determining if Great Bodily Injury/Significant Bodily Injury (GBI/SBI) has been met. In murder cases, it is sometimes shocking to discover that a single punch resulted in death. A review of medications and medical history can play a critical role in any case with traumatic injuries. Answering the following questions can shed light on the role both the assailant and the victim played in the injuries sustained:
- Was the punch harder than an “average” punch?
- Did the punch land in a critical spot that caused more damage than if it had been an inch to the left?
- Did the victim’s blood alcohol content influence the outcome?
A biomedical engineer would be needed to estimate the force of the punch, but from a medical perspective it is easy to say the greater the force, the more likely the injury is to be severe. With that being said, each individual’s body reacts differently to trauma and one person may have a bruise where another person may have a fracture from the same amount of force. For this reason, it is critical to assess the underlying medical conditions and overall health status of the victim to determine their susceptibility to injury.
Our skeletal system is designed to support our muscular system—allowing us to sit, stand, walk, and run—but it is also designed to protect our internal organs. Our skull obviously protects our brain. One point of weakness is our facial bones; when they are shattered, it places our brain at risk of damage. Even if there is no fracture, an impact to the head can cause internal damage to the brain as it may shift and impact the skull from inside. Many internal brain hemorrhages are due to “Closed Head Injuries,” where there is no penetrating trauma or skull or facial fractures. Where the impact occurs from the punch is often a deciding factor in how severe the injury is: a high force punch to the skull may cause less damage than a low force punch to the face.
Research shows that alcohol intoxication affects the body’s ability to form blood clots—meaning that a person is going to bleed more if drunk than if sober. That may cause a small bleed in the brain to be a big bleed in the brain; the bigger the bleed, the more likely the victim is to have long-term neurological problems (de Lange, et al., 2006).
de Lange, D. W., Hijmering, M. L., Lorsheyd, A., Scholman, W. L., Akkerman, J.-W. N., & van de Wiel, A. (2006). Rapid Intake of Alcohol (Binge Drinking) Inhibits Platelet Adhesion to Fibrinogen Under Flow. Alcoholism, Clinical & Experimental Research.
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