34 Sudden Death Investigation Flashcards
Appreciate why death investigation is necessary in the province of Alberta
- 20-25% of deaths are 3
Reasons for sudden death investigation:
- Determine ? and ?
- Rule out ?
- Identify ?
- Collect ?
- Determine whether or not the death was ?
- Determine if death was due to ?
- Provide documents and information necessary to ?
Appreciate why death investigation is necessary in the province of Alberta
- 20-25% of deaths are **unexpected, unexplained or violent, or occur when decedent had no attending Physician*
Reasons for sudden death investigation:
- Determine cause and manner
- Rule out foul play
- Identify decedent
- Collect evidence
- Determine whether or not the death was preventable
- Determine if death was due to reportable disease
- Provide documents and information necessary to settle estates/insurance claims
Understand the definition of coroner versus medical examiner (ME)
Coroner systems
* Oldest system (dates back to feudal England)
* Coroner may be a ? ; ? or ?
* Coroner may be a ?, but not necessarily a pathologist or a forensic pathologist
* Coroner may order an ?
* Coroner determines ?
Coroner systems
* Oldest system (dates back to feudal England)
* Coroner may be a lay individual ; appointed or elected
* Coroner may be a physician, but not necessarily a pathologist or a forensic pathologist
* Coroner may order an autopsy (performed by a pathologist)
* Coroner determines cause and manner of death
Medical Examiner System
* Newer system, introduced in the United States in early 1918 in NYC
* Medical examiner is a physician that is specialized in pathology and specifically, forensic pathology
* The medical examiner determines cause and manner of death
Understand the definition of coroner versus medical examiner (ME)
Medical Examiner System
- ? Investigation
- Certifies ?
- Generate ? of findings and opinions
- ? (legal role)
* Medical examiner is a ? that is specialized in ? and specifically, ?
* The medical examiner determines ?
Medical Examiner System
- sudden death Investigation
- Certifies medicolegal documents
- Generate reports of findings and opinions
* Medical examiner is a physician that is specialized in pathology and specifically, forensic pathology
* The medical examiner determines cause and manner of death
Coroner systems
* Oldest system (dates back to feudal England)
* Coroner may be a lay individual ; appointed or elected
* Coroner may be a physician, but not necessarily a pathologist or a forensic pathologist
* Coroner may order an autopsy (performed by a pathologist)
* Coroner determines cause and manner of death
ME vs Coroner
**A Medical Examiner is qualified by training **
- Almost always a ?
- Undergraduate degree (4 years)
- Medical degree (4 years)
- Pathology residency (5 years)
- Forensic pathology fellowship (1 year)
A Coroner may be ? or ? and may have little background training
- ? requirements
- Certify ? and ? but don’t do the dirty work
- ? and ? cases (provinces?)
- ?; often have other job
**A Medical Examiner is qualified by training **
- Almost always a forensic pathologist
- Undergraduate degree (4 years)
- Medical degree (4 years)
- Pathology residency (5 years)
- Forensic pathology fellowship (1 year)
A Coroner may be appointed or elected and may have little background training
- Highly variable requirements (high school diploma vs physician)
- Certify CoD and MoD but don’t do the dirty work
- NWT and Nunavut cases
- Administrative position; often have other job
Difference btwn cause of death, manner of death, and mechanism of death
Cause of Death:
- The ? or ? that initiated the ? that resulted in phyiological derangement that led ? and ? to death, no matter how prolonged or rapid
Should not ?
Examples:
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- - Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
Difference btwn cause of death, manner of death, and mechanism of death
Mechanism of Death:
? that ultimately leads to death
- Examples Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not ? as CoD
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- Examples: Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Difference btwn cause of death, manner of death, and mechanism of death
Manner of Death:
Determined based on the ? surrounding the death
- ? - due solely to natural disease/aging
- ? - unintentional injury/poisoning
- ? - intentional self-inflicted act
- ? - Intention or volitional act of one person against another
- ? - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- ? - Medically assisted death
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- Examples: Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Case examples
43 year old man was found unresponsive on the ground. Autopsy revealed severe blunt trauma to the head. Investigation reveals that he was assaulted
CoD: ?
MoD: ?
43 year old man was found unresponsive on the ground. Autopsy revealed severe blunt trauma to the head. Investigation reveals that he was assaulted
CoD: Blunt trauma of head
MoD: Homocide
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- Examples: Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
Case examples
43 year old man was found unresponsive on the ground. Autopsy revealed severe blunt trauma to the head. Investigation reveals that witnesses saw him leap from a tall building. He left a suicide note.
CoD: ?
MoD: ?
43 year old man was found unresponsive on the ground. Autopsy revealed severe blunt trauma to the head. Investigation reveals that witnesses saw him leap from a tall building. He left a suicide note.
CoD: blunt trauma of head
MoD: suicide
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- Examples: Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
40 year old man with paraplegia dies from urosepsis. A review of medical records and investigation reveals that he was shot in the spine by another individual twenty years ago, after which he became paraplegic and required a urinary catheter.
CoD: ?
MoD: ?
40 year old man with paraplegia dies from urosepsis. A review of medical records and investigation reveals that he was shot in the spine by another individual twenty years ago, after which he became paraplegic and required a urinary catheter.
CoD: Bladder Cx due to Paraplegia due to Gunshot Wound of Back
MoD: Homocide
Cause of Death:
- The Disease or injury that initiated the chain of events that resulted in phyiological derangement that led directly and inevitably to death, no matter how prolonged or rapid
Should not stand alone as cause of death
Examples: Pancreatic cx // Athersclerotic Cardiovascular // Blunt force injury // Gunshot wound of Head
Mechanism of Death:
Physiologic derangement that ultimately leads to death
- Examples: Sepsis, exsanguination, asphyxia, arrythmia, cardiopulmonary arrest
- Should not stand alone as CoD
Manner of Death:
Determined based on the circumstances surrounding the death
- Natural - due solely to natural disease/aging
- Accident - unintentional injury/poisoning
- Suicide - intentional self-inflicted act
- Homicide - Intention or volitional act of one person against another
- Undetermined - insufficient information available to assign a manner of death or distiguish between two+ possible manners
- Unclassified - Medically assisted deaths
Sudden death vs Unexpected death?
Sudden Death - Death occurring within one hour of onset of symptoms (up to 24 hours in some definitions)
Unexpected Death - Death of an individual who was thought to be in good health
Two competing priciples of Cause of Death determination:
Ockhams Razor
Hickam’s Dictum
Ockhams Razor
- With competing conclusions, the one with the fewest assumptions should be selected
Hickam’s Dictum
“patients can have as many diseases as they damn well please”
Forensic vs Hospital Autopsy
Forensic:
- Mandated by law
- Determine CoD
- Does not require consent
Hospital/Academic:
- At request of family/physician
- Requires consent
- Only for natural deaths to provide a more precise diagnosis
- Educational component
All sudden and/or unexplained deaths in alberta are investigated under the authority of the ?
Investigation held to determine:
5
All sudden and/or unexplained deaths in alberta are investigated under the authority of the Fatality Inquiries Act
Investigation held to determine:
- Who died
- Where did they die
- When did they die
- Why did they die
- How did they die
What is Ancillary Testing?
Toxicology
Histology
Biochemistry (electrolytes, ketones, creatinine, Urea)
Microbiology (post mortem bacterial transmigration)
Virology
Genetic Testing (young person with no anatomical or toxicologic CoD)
