quiz 1 autopsy

quiz is 8/29. study hard and the world is yours.

who orders an autopsy?

the coroner/medical examiner

who performs an autopsy?

the forensic pathologist

what are the four kinds of autopsies?

medicolegal (forensic) autopsy, medical (hospital) autopsy, partial autopsy, complete autopsy

under what circumstances are autopsies done?

sudden deaths not caused by recognizable disease, all deaths in suspicious circumstances, all violent deaths, fetal deaths, stillborns, babies, all operative and peri-operative deaths, unidentifiable individuals, any uncertain death

what are some autopsy considerations?

sharp bone edges, having to continuously aspirate chest cavity, avoiding high pressure when embalming, remember to clamp leaking vessels

what is different about embalming analysis for an autopsy?

perform usual analysis on a body, but consider what vessels are still intact, if it was a complete autopsy there will be no internal organs/they will have been removed, split embalming into sections, clamp off vessels, may have to change injection pressure depending on section

do you need a higher or lower index when embalming autopsy cases?

higher index

what is common in refrigerated bodies that you should consider while working with them?

artificial firmness

what should you consider about embalming pressure on an autopsied body?

pressure will be different on different parts of body, but when embalming head pressure should be low

what should you consider about embalming flow rate on an autopsied body?

solution flow rate should be slower to reduce swelling and create better distribution and diffusion

when embalming an autopsy, what should you remember about drainage?

almost no blood is left in the body, so don’t worry too much about drainage - autopsy is automatically open drainage

what should your technique be for abdominal cavity drainage in an autopsy case?

place cavity aspirator inside cavity and continuously drain while embalming to avoid build up of fluid

what is a complete autopsy?

most cavities are removed, including cranial cavity, eye enucleation, neck organs, thoracic/abdominal organs, pelvic organs, and sometimes spinal cord

what is a partial autopsy?

only one body cavity is open to examine that specific organ, either cranial, thoracic or abdominal cavity, used when death is known or permission is limited in autopsy

what kind of incision is typically used for an autopsy?

Y shaped incision from shoulder to shoulder down to pelvic bone

what is a dorsal postmortem approach incision?

autopsy is facedown, incision opened from back

what does a cranial incision look like?

runs from top of ear to the other top of ear posteriorly

what are some of the first steps after receiving an autopsied body?

remove body from bag, spray with disinfectant, with gloves, wash body, remove all temporary sutures, begin embalming analysis (see what vessels are viable)

what do you do with a viscera bag during an autopsy embalming?

remove viscera bag, empty viscera to place in large bucket with lid to saturate in cavity fluid

if you set the features on the face, you should also…

…position any broken limbs in appropriate positions before embalming

When embalming an autopsy, you work from…

… lower limbs to upper limbs to head

when injecting the lower extremities, where should you inject if possible?

use terminal end of abdominal aorta - if not that, locate common iliac arteries - if all else fails, locate external iliac arteries

if you are needing to focus on injecting the deeper buttocks and upper thigh region, you should inject the…

internal iliac arteries

what is the general rule for liquid solution to leg ratio when embalming?

about ½ gallon per leg is sufficient, but definitely make your own consideration

what are some factors that may effect leg injection?

pathological conditions, sclerosis, leakage, postmortem conditions

where should you inject the upper extremities through?

arch of aorta is ideal, using aortic branches - if not possible, raise axillary arteries and do arms each separately, can use subclavian for arms and clamp off section that goes

when injecting the head, what should you inject through?

the common carotid arteries, y canula can be used to inject both sides

when injecting the head, you should start on the…

left side

when injecting the head and a cranial autopsy was performed, what do you do?

clamp all leaking vessels using small spring clamps (internal carotids and vertebral arteries)

after the limbs and head have been injected, we must…

…embalm skin folds and superficial tissues using hypovalve trocar or hypodermic syringe in any areas lacking distribution

what do you do with the internal cavities of an autopsy case?

paint inside of cavities with embalming autopsy gel

after the viscera has been soaked in cavity fluid, you’ve got two options - what are they?

can place back in bag and place into body, or can layer viscera with drying powder, cotton, or towels inside of body without bag

if viscera is not returned to the body when autopsy is delivered, what can you use in stead?

stuff cavity with old sheeting, plastic, or other appropriate material

if placing viscera bag back inside of autopsy case, what must you be aware of?

leakage from bag

what can you do to restore natural appearance to the throat?

pack the throat with material

how do you suture a Y incision?

begin suture by pulling skin fold together and tie at xiephoid process of sternum, proceed with suture up one side toward shoulder, tie skin fold together at lower point of incision, continue suture up mid line, follow suture to other shoulder

what sort of suture should be used to close up a cranial cavity?

baseball

how do you suture a cranial cavity?

using baseball stitch, use tight and unseen stitches with strong waxed ligature or dental floss, starting on right side of the head

describe the steps of closing up a cranial autopsy

• aspirate all drainage out of cavity

• paint inside with autopsy gel

• tie off open vessels

• pack orifices that could leak

• pack cranial cavity with cotton saturated in drying powder

• paint cranial cap with autopsy gel

• if calvarium was not placed in viscera bag, place in different bag and saturate with cavity fluid to dry

• return calvarium to skull used notched edge as guide

how do you secure the calvarium to the rest of the skull?

calvarium clamps, brad and wire, plaster of Paris, other commercial clamps

what should be placed over the frontal bone where calvarium was cut?

mortuary putty or cotton when replacing scalp

what are the final steps of embalming an autopsy case?

• wash body well (front and back)

• remove dry powder from sutures

• dry body (front and back)

• collect hair and bone fragments

• seal Y incision with thick gel sealant, cover with cotton to smooth suture line

• recheck facial features, reset if needed

• complete prep as normal, skipping cavity embalming (since soaking viscera and painting cavity did that already)