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