unit 1.1: postmortem examination

Autopsy

Considered the ultimate medical audit

• natural

• accident

• homicide

• suicide

• undetermined

five different rulings for manner of death

in a case where suspicious circumstances surround the death

when can a medical examiner or coroner order an autopsy without consent from next of kin

Antistius examines Julius Caesar’s body after his assassination

first recorded autopsy

one wound to the chest that ruptured Caesar’s aorta

which stab wound was fatal?

“Hsi Yüan Lu, or The Washing Away of Wrongs”

• Song Ci

• an instruction manual on how to conduct medico-legal investigations, examine corpses, and determine the time and cause of death

• forward-thinking forensic issues

  • poisoning, decomposition, wounds from various weapons, strangulation, and fake wounds

Bartolomeo da Varignana: medico-legal autopsy

first-known legal autopsy where the death was investigated explicitly to determine if there was fault

lay dissector

Anatomy teachers and students in medical schools did not perform dissections themselves. They would congregate in an operating theater and watch as a cadaver was opened by a ___

Rudolf Ludwig Karl Virchow

• The father of modern pathology

• Realized the importance of the microscope when conducting pathological research to uncover minute details

• characterized a case of leukemia; one of the earliest formal reports on this cancer

high quality

Why Perform PME?

Wherever Scientific medicine of ___ is practiced, postmortem examinations are performed

Autopsy Service

performs autopsies on patients who die at Massachusetts General Hospital and patients who die outside of the hospital who have had some Mass General care

350 cases per year

The Autopsy service performs approximately ___

Mass General

#1 Research Hospital in America and the only hospital to be recognized in all 16 specialties assessed by U.S. News & World Report.

he “lost” his patient

Why Perform PME?

Wherever a conscientious physician knows why ___, a post mortem examination has been performed

criminal law

Why Perform PME?

Whenever ___ is enforced.

causes of death and confirmed medical diagnosis

Why Perform PME?

Whenever a death certificate shows accurately the ___ for the assembling of vital statistics, a postmortem has been performed

medical research

Why Perform PME?

Whenever there is ___ on the causes and nature of diseases such as cancer, heart disease, and stroke, infectious diseases, neurodegenerative diseases, and transplantation medicine, the investigative method is postmortem examination

informed society

Why Perform PME?

An ___ requires a postmortem examination in human death for the good of medical science, for the public’s health and for the future care of the living patient

Administrative Preparations

Preparations Before PME

1. obtain and confirm consent for autopsy

2. obtain and review clinical data

3. contact clinical team and staff pathologist

Preparation of Autopsy Room

Preparations Before PME

1. set up dissection instruments and tools

2. lay out swabs, media, etc. for ancillary studies to be performed

3. prepare photographic equipment

4. PPE

Confirmation of decedent identity

Preparations Before PME

1. most important step in autopsy procedure

2. identifiers on the body must be confirmed and matched with autopsy consent form

3. confirm any limitations or restrictions to autopsy at this time

• Written consent from the next of kin-abide by the extent or restrictions allowed

• Death certificate (blue/pink white forms)

• Medical abstract / Clinical data

• Medicolegal clearance

PME Preliminaries

1. Spouse

2. Adult children

3. Adult grandchildren

4. Parent

5. Brother/Sister

6. Nephew

7. Grandparent

8. Uncle/Aunt

9. Cousin

10. Stepchildren

Consent for Autopsy

presence of a witness

Consent form should be signed in the ___

Complete

in which all body cavities are examined (including the head / brain)

Limited (Partial)

which may exclude the head / brain

Selective

where specific organs only are examined

police or coroner

When is an autopsy allowed?

When it is ordered by the ___

death certificate

When is an autopsy allowed?

When it is necessary to complete ___

advanced directive

When is an autopsy allowed?

When the deceased himself has given consent before he died

Deceased military personnel

When is an autopsy allowed?

___ who dies in active duty/training in the military service

48 hours

Autopsy Facts

An autopsy is usually carried out within ___ after the death

Coronial autopsies

Autopsy Facts

ordered by the state coroner

Hospital based autopsies

Autopsy Facts

performed at the request of the family of the deceased

Medico-legal

Autopsy Facts

forensic

Death Certificate

Autopsy Facts

gross findings

Final Diagnosis

Autopsy Facts

gross and microscopic findings