1. Postmortem Examination Flashcards
Definition of postmortem examination/autopsy/necropsy
Examination of dead body with a view to search primarily for the cause of death
2 types of autopsy
- Clinical/academic autopsy
- Medicolegal/forensic autopsy
What is clinical/academic autopsy
Performed with consent from relatives to find the diagnosis in which dx cannot be reached during tx or to confirmed dx when doubtful
What is medicolegal/ forensic autopsy
Performed on instruction of legal authority relating to suspicious, sudden, obscure or criminal death and body belongs to State for protection of public interest
What is ‘Locards exchange principle’
Suspect will bring smthg to crime scene and leave with smthg from it ‘every contact leaves trace’
Preliminaries (preparation) to medicolegal autopsy
- carried out at the request of appropriate legal authority
- request/order may move from police officer (sergeant and above rank) or from magistrate or from Coroner under whose jurisdiction the incidence/event leading to death occurred
- a copy of Inquest or ‘Preliminary investigation report’ prepared by investigating police officer at scene of death/dead body challan/hospital record necessary to enable dr to concentrate on organ or part pf body most suspected
- medicolegal autopsy can be performed ONLY at authorised centre and done by person experience
- all registered medical practitioners in government service r authorized to conduct medicolegal autopsy
- need proper place and adequate equipment
- before begin autopsy, need formal identification
- avoid delay
- no unauthorised person can permit mortuary
- all details should be noted
- if dr feel incompetent, can suggest more skilled and experienced doctors
Identification can be divided into
- Primary characteristic
- age, sex, stature - Secondary characteristics
-features, personal artifacts (pocket contents, clothes included mark, defect, stitch, jewellery), hair, scar, tatoos, race, religion, nationality - Comparative data/technique for identification
-dental patterns, finger, superimposition technique, neutron activation analysis, anthropometry
Examination of body
external examination
- Age, sex, race, height, weight, tatoos, birth marks, mole, scars, cloth, hair
- Degree of rigor mortis
- Photograph body and take fingerprints
- Note wound and trauma
internal examination
- Any of the following incisions; standard midline incision (str8 from below chin to pubis),V shaped (from mastoids to suprasternal notch then str8 to pubis), shoulders to manubrium sterni and str8 to pubis
- opening of skull and brain examination
- neck dissection
- intrathoracic organs dissection
- intraabdominal organs dissection
Ancillary (secondary/supplementation) ix
- HPE
- microbiological samples
- biochemical investigations
- chemical department test - toxicological analysis, DNA analysis
Definition of Artefacts and types
- any changed caused or feature introduce in the natural state of body that is likely to be misinterpreted at autopsy
- therapeutic artefacts, agonal artefacts, postmortem artefacts
- therapeutic: incl medical equipment attached to, or accompanying the body such as urinary catheter, et tube, airways, iv lines, ext fixation of fracture, vigorous cpr that cause # of ribs and sternum, injection marks/ring like bruising are cardiac region from defibrillator
-agonal: spillage of gastric content into resp passage - post mortem artefacts: artefacts induced by transportation/storage/handling, embalming/decomposition, predators/mutilation by criminals, improper autopsy procedures
Definitin of exhumation
-Lawful digging out buried body from grave
- no time limit in malaysia
- followed by first autopsy or reautopsy following new information and NOT to confuse with clandestine burial (scene of crime sbb suspect hide the victim body)
Mx of death depend on
- circumstances of death
- where occur
- whether or not it was anticipated
- whether or not there is any suspicion of foul play
Certification of death issued by
- doctor who provided care during the last illness
- doctor who has seen deceased within 14d of death or after death. The dr must confident abt cause of death
- if not able to certify death, death must be reported to coroner/procurator. Death cert given to next of kin then deliver to Registrar of Births, Deaths and Marriages within 7d
- If absence of next of kin, Birth and death registration Act 1953 specifies who else can do:
Any relative present at the death or attendance during his last illness, other relative residing or being in sub-district where death occured, any person present at death, occupier of house if he knew of the happening of death, inmate of house, person causing the disposal of body
