Autopsy (Postmortem Examination) Flashcards
(46 cards)
-Gold standard for confirmation of a medical disease
-Wherever scientific medicine of high quality is practiced, postmortem exams are performed
-Whenever a conscientious physician knows why he lost his patient, a postmortem exam has been performed
-Whenever criminal law is enforced
-Whenever a death certificate shows accurately the causes of death & confirmed medical diagnosis for the assembling of vital statistics, a postmortem has been performed
-Whenever there is medical research on the causes & nature of diseases such as cancer, heart diseases & stroke, the investigative method is the postmortem exam
-An informed society requires a postmortem exam in human death for the good of medical science, for the public’s health & for the future care of the living patient
Autopsy
Types of autopsy
- Complete autopsy
- Partial autopsy
- Selective autopsy
Type of autopsy
- Requires consent
- Complete examination of all organs, including the brain
Complete autopsy
Type of autopsy
- Part of the anatomy
Partial autopsy
Type of autopsy
- Restricted to at least a single organ (Ex. MI – heart)
Selective autopsy
- Written consent from the next kin-abide by the extent or restrictions allowed
- Relative: oriented by the attending physician, not the pathologist - Death certificate (Old: Blue form | New: Blue border/frame)
- Signed by:
a. Physician
b. Pathologist (back): will sign when PME has been performed - Medical abstract or clinical data
- Medico-legal clearance
- Suspicious evidence of foul play
- Ex. physical injury
Preliminaries for PME
Other Uses of Death Certificate
Burial & cremation purposes
Transport of body from hospital funeral cemetery
Medical insurance claiming
- If suicide: (-) insurance
- Acts of God (lightning, flood): (-) insurance
- Civil war: (-) insurance
PME is permitted w/o consent in the following circumstances
- When it is ordered by the police or coroner (NBI)
- When it is necessary to complete the death certificate
- When the deceased himself has given consent before he died (advanced directive)
- Stipulate that in the event you will die, you will be giving out a consent for autopsy
- Donate your organs for medical purposes or for transplantations - Deceased military personnel who dies in active services/training duty or military services
If pathologist is not available
The medico-legal examiner or the coroner has jurisdiction in medico-legal cases & may authorize the pathologist to proceed w/ an autopsy
The coroner has authority in the following cases: (Give atleast 3)
- All natural deaths occurring in the hospital w/in 24 hrs of admission, unless the case was attended by a private physician w/in 36 hrs of death
- Newborns in the 1st 24 hrs of life
- All injury cases, old or recent
- All deaths due to unknown cases
- All deaths due to suspicious cases
- All abortion, whether self-induced or otherwise
- All violent deaths
- All accidental deaths
- All sudden deaths
- All cases w/o medical attendance w/in 36 hrs prior to the hour of death
- All deaths due to drowning, hanging or strangulation (asphyxia)
- All deaths due to shooting, stab wounds, burns, electricity, lightning, tetanus, etc.
- Homicides
- All suicides
- All poisoning
- Stillborn = omission
- Premature death
Death of an organism
Cessation of circulation & respiration (1960’s)
Somatic death
T/F:
Clinically dead & dead are the same.
T
cessation of heartbeat & respiration but the brain is still alive but injured
Clinical death
Criteria for the pronouncement of death
- Advanced resuscitation techniques that are capable of reviving effectively cases of clinical death
- Advance life-sustaining equipment capable of maintaining cardiovascular & respiratory functions despite severe brain injury
- Redefinition from cessation to irreversible cessation of cardiorespiratory functions after resuscitation attempts
- Brain death: cannot be revived anymore [National institute of neurological diseases & stroke in the US (1977)]
perpetual state of deep sleep
Brain death
Criteria for brain death
a. Coma (patient will not respond) & cerebral unresponsiveness
b. Apnea
c. Absent cephalic (brainstem) reflexes
d. Electrocerebral silence
criteria should be present for 30 mins at least 6 hrs after onset of coma & apnea
American Bar association & National Conference of Commission of Uniform State Laws Legislative Definition of Death (1980)
- irreversible cessation of circulation & respiratory functions
- Irreversible cessation of all functions of the entire brain, including the brainstem is dead
Death:
1. Coma
2. Absence of the following:
- Motor response
- Pupillary response to light & pupils at mid-position
- Corneal reflexes
- Caloric responses
- Gag reflexes
- Coughing in response to tracheal suctioning
- Sucking & rooting reflexes
Death according to American academy of Neurology
- 1st demonstrable change after death is cooling of the body
- At room temp: 2’-2.5’F/hr (1st hr)
- 1.5-2’F/hr (next 12 hrs)
- 1’F/hr (next 12-18 hrs)
- As a rule, the body cools at 1.5’F/hr (50% of cases)
- Not a reliable indicator as to the time of death
Algor mortis
- Rigidity of the body due to hardening of the skeletal muscles caused by a series of physiochemical events after death
- (–chemical bodies between actin & myosin
- This interlocking is fixed & produces rigor mortis w/o shortening of the muscles
- Sets w/in 2 hrs after death (head & neck)
- Complete w/ 12 hrs
- Persists about 3-4 days
Rigor mortis
- Blood supply gravitates to the skin vessels w/c becomes toneless & dilate after circulation ceases
- Becomes evident as early as 20 mins after death
- Fully evident w/in 4-8 hrs
- Tardien spots: petechiae
Livor mortis (postmortem lividity/hypostasis)
- Abdomen: green
- Formation of sulfur gases (bacteria)
Discoloration of tissue
Enumerate the postmortem changes.
- Algor mortis
- Rigor mortis
- Livor mortis (postmortem lividity/hypostasis)
- Postmortem clotting of blood
- Discoloration of tissue
- Putrefaction
- Dessication (mummification)
Organs removed & dissected individually in the body
Most widely used metohd
Technique of Rokitansky
