Lecture 9: Autopsy Flashcards
Coroners law
> Post mortem examination
Registration
Inquests
Disposal
Human tissue act
> Retention, disposal of human tissue
Consent
Specific legislation
> Common law
Births and deaths Registration Act 1953
Registration of Births and Deaths Regulations 1987
Coroners Act 1988
Coroners and justice Act 2009
Coroners Rules 1984
Human Tissue Act 2004
Death certificate
> Medical certificate of cause of death
-States the official cause of
death
»_space; 1(a), 1(b), 1(c ), 2
format
Death certificate
-A certified copy of the
entry in the death register
Green form
-Certificate for burial or
cremation
»_space;Proof of next of
kin/who is conducting
the funeral
»_space;Proof death has been
registered
Cremation
-Addition forms are needed
Roles
> The coroner
Pathologist
Coroners officer
APT
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 changes
Concludes manner of death
Pathologist
> Laboratory/office/mortuary based
Medically qualified
Perform post mortems
Dissections/evisceration
can specialise in forensics
Establishes cause of death
Employed by the hospital/coroner
Also performs diagnostic histology duties
Coroners officer
> Can attend to scenes of death/PMs/inquests
Information gathering
Acts on behalf of the coroner e.g. sends PM requests, releases etc
Liaises closes with family
APT
> 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 deceased
Improve the quality of death certification
Improve the quality of mortality data
When is a post-mortem needed
Reportable deaths to the coroner:
> Sudden/unexpected
> Unknown cause
> 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
> Result of neglect
> Regulated to employment/industrial disease
> Cases of specific interest/concern for the coroner e.g. Paediatric, DOLs
Not all deaths reported to the coroner will result in a post mortem
Why is it needed?
> Cause of death
Reconstruction of events
Insurance
Mortality records
Inform health statistics and identity trends
Make legislative changes
Public interest
Post mortem examination- 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
Coroner’s jurisdiction
No consent required unless hospital post-mortem
Discussion can be made with pathologists, family and attending doctors
Considerations
> Can cause of death be determined without autopsy?
Is the autopsy likely to provide any additional information ‘balance of probability’
Obvious trauma
Potentially undetermined- old age?
Other means- Non-invasive/tox only
Religion
Types of post mortem
Paediatric
* Specialised
High risk
* Infectious disease
* Intravenous drug users
Independent
* Possible disagreement
with treatment
* Second opinion
Start stop
* Possible suspicious
* Police in attendance to
observe
Toxicology only
* Obvious COD
* Contributing factors
Non invasive
* Suspected COD
* MRI scanning
* Religious considerations-
community funded
* Cost and space
* Living Vs dead usage
* Interpretation by
specialist
-May need invasive anyway
Post mortem procedure
–>Confirmation of identity
–>External examination
–>Evisceration
–>Toxicology
–>Weighing organs
–>Dissection
–>Histology
–>Reconstruction
–>Cleaning down
–>Storage
–>Viewing?
–>Release?
Post mortems- external examinations
> Wounds, abrasions, fractures
Growths
Tattoos
Piercings
Condition of skin
-Discolouration e.g. jaundice, cyanosis
-Rashers, patches, petechia, haemorrhages
-Skin slippage
Oedema
Surgical scars
Evidence of medical intervention
-Lines
-CPR
-Stoma, catheters
Ligatures
-Circumference
-Type e.g. material
-Point of suspension
Asymmetry- legs
Height/weight
Post mortems- Evisceration
Incisions
* ‘Y’
* ‘I’ or straight
* Modified ‘Y’
* Head- Mastoid to mastoid
Organ removal
> En Masse of Letuille
-All viscera together
En Bloc method of Ghon
-Blocks or ‘plucks’ of
systems
Virchow
-Organ by organ 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 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’
APT reconstructs and cleans down
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
Post mortems- 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
