autopsy: Flashcards
legal aspect:
coroners law- post mortem examination, registration, inquests, disposal.
human tissue act: retention, disposal of human tissue, consent.
death certificate:
medical certificate of cause of death- states the official cause of death.
a certified copy of the entry in the death register.
green form- certificate for burial or cremation, proof of next of kin, proof death has been registered.
additional forms are required for cremation
roles: the coroner:
independent judicial officer.
office/court based.
usually legal/medical background.
decides whether a post mortem should be performed.
resides over inquests.
can influence legal changed.
concludes manner of death.
roles: pathologist
lab/office/mortuary based.
medically qualified,
performs post mortems.
dissection/evisceration.
can specialise in forensics.
establishes cause of death.
employed by hospital/coroner.
also performs diagnostic histology duties.
roles: coroners officer
can attend scenes of death/Pms/inquest.
information gathering.
acts on behalf of the coroner- sends PM request.
leases closely with family.
roles: ATP.
mortuary based.
employed by the hospital.
assists the pathologist.
evisceration.
diploma qualified.
mortuary maintenance.
custodian of the deceased.
medical examiner:
senior doctor.
medical examiner office.
provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths.
ensure the appropriate direction of deaths to the coroner.
provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased.
improve the quality of death certification. improve the quality of mortality data.
autopsy
when a post mortem is needed:
sudden/unexpected, unknown causes, unnatural, suspicious, death in custody, has not seen a doctor during their last illness or within 2 weeks, death as a result of a medical procedure or before full recovery, results of neglect, related to employment/industrial disease, cases of specific interest/concern for the coroner.
consent:
there is no property in the body- common law.
the coroner has the right to take possession of the body for post mortem examination. coroners jurisdiction.
no consent required unless hospital post mortem.
discussion can be made with pathologists, family, and attending doctors.
types of post mortem:
coroners- consent not required, ATP completes evisceration, pathologist determines COD.
forensic- consent not required, suspicious deaths, cause of death, pathologist also completes evisceration, evidence collection, reconstruction of events.
hospital- consented by the family- requested, COD is known, death is registered, information gathering, can be limited (not whole body).
subtypes/specialised post mortems:
paediatric- specialised.
high risk- infectious disease. intravenous drug users.
independent- possible disagreement with treatment, second opinion.
start stop- possibly suspicious. police attend to observe.
toxicology only- obvious COD. contributing factors.
non invasive- suspected COD, MRI scanning, religious considerations- community funded, cost and space.
procedure:
confirmation of identity- external identity- evisceration- toxicology- weighing organs- dissection- histology- reconstruction- cleaning down- storage- viewing- release.
organ removal: incision, reflection, sternum removal, bowel removal, drop the tongue, blocks.
organ removal:
en masse of letuille- all viscera together.
en bloc method of ghon- blocks or plucks of systems.
virchow- organ by retrieval.
rokinansky (often confused with en bloc)- in situ examination, removal of select organs.
combination of blunt and sharp dissection.
adaption required.
every mortuary/pathologist is different.
forensic post mortem:
forensic pathologist- additional training. performs evisceration and dissection- adaption of technique may be required.
documentation is extensive.
crime scene examiners present for evidence collection and photography.
samples collection for ID.
police in attendance.
out of hours.
ATP reconstructs and cleans down.
post mortem- additional samples:
histology- the study of tissues, small pieces of each organ, preserved in formalin, processed in the histology department, microscopic examination, COD is not found macroscopically, support findings, rule out possibilities.
toxicology/other tests- blood, urine, cerebrospinal fluid, vitreous humour, stomach contents, bone marrow
reconstruction:
removal of excess fluid.
packing- prevents leakage, reconstructs body shape.
suturing- main incisions, closing up injuries. cleaning.
washing the hair.
shrouds, plastic, sheet, body bag.
makes viewings possible.
maintains dignity and respect.
