CSIM 1.87: Death and the Post Mortem

Question 1

What is the difference between a cause and a mechanism of death?

Answer 1

Cause = the medical explanation for death in terms of pathological processes as expressed on a death certificate.
(e.g. vitamin deficiency)

Mechanism = the physiological derangement leading to death
(e.g. heart failure - has many causes)

Question 2

How is confirmation of death dealt with when the cause is known and when the cause is unknown?

Answer 2

Known - death certificate by doctor (must be natural and not suspicious)
Unknown - sent to coroner

Question 3

What is the correct format for filling out a death certificate ?

Answer 3

I (a) Disease or condition directly leading to death
(b) Other disease or condition, If any, leading to 1(a)
(c) Other disease or condition, if any, leading to 1(b)
II Other significant conditions CONTRIBUTING TO THE DEATH but not related to the disease or condition causing it

E.G.:

The main cause of death was
Ia.	Bronchopneumonia
lb.	Congestive cardiac failure
Ic.	Coronary artery atheroma and COPD
Contributing conditions were
II.	Chronic renal failure due to prostatic hypertrophy

Question 4

Which deaths must be reported to the coroner?

Answer 4

• Not attended by a doctor during final illness
  
  • Not seen by a doctor 14 days prior to death
  • Unknown cause of death
  • Unnatural cause of death (criminal, suicide, accidents, industrial diseases, any iatrogenesis, neglect [hypothermia, pressure sores], ACUTE alcohol/drugs)
  • In custody
  • War pension

(IMG 181)

Question 5

What is the 24 hour rule?

Answer 5

If someone dies within 24 hours of entering hospital, coroner must be notified

Question 6

Describe the process of an autopsy

Answer 6

Clinical History
External examination
Evisceration
Organ dissection
Further tests
  •  Histology
  •  Microbiology / Virology
  •  Biochemistry / Toxicology
  •  Organ retention
Report (communication)

Question 7

In what two ways can an autopsy be authorised?

Answer 7

• INFORMED consent given by next of kin in a hospital

* Medico-legal authorisation - Coroner’s forensics