3: Postmortem Examination Part 2

necropsy

other term for autopsy

College of American Pathologists

proponent organization of the very specific, complicated criteria for autopsy

attending physician

**College of American Pathologists Criteria**

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Deaths in which autopsy may help to explain unknown and unanticipated medical complications to the (?)

reasonable certainty on clinical grounds

**College of American Pathologists Criteria**

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All deaths in which the cause of death or a major diagnosis is not known with (?)

family and/or public

**College of American Pathologists Criteria**

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Cases in which autopsy may help to allay concerns of the (?) regarding the death, and to provide reassurance to them regarding the same

reassurance

**College of American Pathologists Criteria**

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Cases in which autopsy may help to allay concerns of the family and/or the public regarding the death, and to provide (?) to them regarding the same

Unexpected or unexplained

**College of American Pathologists Criteria**

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(?) deaths occurring during or following any dental, medical or surgical diagnostic procedures and/or therapies

institutional review boards

**College of American Pathologists Criteria**

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Deaths of patients who have participated in clinical trials (protocols) approved by (?)

does NOT necessitate autopsy

**College of American Pathologists Criteria**

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Unexpected or unexplained deaths which are apparently natural and not subject to a forensic medical jurisdiction

1. DOA
2. w/in 24 hrs of admission
3. sustained an injury while hospitalized

**College of American Pathologists Criteria**

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Natural deaths which are subject to, but waived by, a forensic medical jurisdiction such as:

1\.

2\.

3\.

high-risk infectious and contagious

**College of American Pathologists Criteria**

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Deaths resulting from (?) diseases

obstetric (*panganganak*)

**College of American Pathologists Criteria**

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All (?) deaths

perinatal: not yet born

pediatric: ‘til 17 yrs of age

**College of American Pathologists Criteria**

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All perinatal and pediatric deaths:

*Differentiate perinatal and pediatric*

transplant organs

**College of American Pathologists Criteria**

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Deaths at any age in which it is believed that autopsy would disclose a known or suspected illness which also may have a bearing on survivors or recipients of (?)

environmental or occupational

**College of American Pathologists Criteria**

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Deaths known or suspected to have resulted from (?) hazards

medicolegal examiner or the coroner

who has jurisdiction in medicolegal cases, and may authorize the pathologist to proceed with an autopsy

coroner

* public official
* appointed/elected in a geographical jurisdiction
* inquires into death
* may NOT be MD

authorize a pathologist to perform autopsy

if the coroner is not an MD, what is his/her alternative primary responsibility?

attended by a private physician within 36 hours of death

**More Simplified Criteria**

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All natural deaths occurring in the hospital within 24 hrs of admission, unless the case was (?)

first 24 hrs

**More Simplified Criteria**

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Newborns in the (?) of life

injury

**More Simplified Criteria**

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All (?) cases, old or recent

* unknown


* suspicious

**More Simplified Criteria**

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All deaths due to (?) cases

abortion

**More Simplified Criteria**

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All (?) cases, whether self induced or otherwise

* violent
* accidental
* sudden

**More Simplified Criteria**

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All (?) deaths

within 36 hours

**More Simplified Criteria**

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All cases without medical attendance (?) prior to the hour of death

strangulation

**More Simplified Criteria**

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All deaths due to drowning, hanging or (?)

tetanus

**More Simplified Criteria**

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All deaths due to shooting, stab wounds, burns, electricity, lightning, (?), etc.

false

**More Simplified Criteria**

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homicides are NOT included in the criteria

true

**More Simplified Criteria**

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suicides are included in the criteria

poisoning

**More Simplified Criteria**

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All cases in which there is suspicion of (?)

born dead

**More Simplified Criteria**

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Stillborns

born >3 weeks earlier than their due date

**More Simplified Criteria**

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Prematures

false

The Philippines require autopsy

medicolegal purposes

the bulk of autopsy cases in the Philippines are for (?) purposes

Clinical or Medical death

* death of an organism
* 1960s: Cessation of circulation and respiration
* Criteria for the pronouncement of death

cessation to irreversible cessation

the 1960s definition of clinical or medical death was revised to?

resuscitation techniques

* can survive na lang under life support (brain dead)

**Criteria for Pronouncement of Death**

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Advances in (?) that are capable of reviving effectively cases of clinical death

cardiovascular and respiratory

**Criteria for Pronouncement of Death**

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Advanced life- sustaining equipment capable of maintaining (?) functions despite severe brain injury

irreversible cessation

**Criteria for Pronouncement of Death**

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Redefinition from cessation to (?) of cardiorespiratory functions after resuscitation attempts

National Institute of Neurological Diseases and Stroke in the United States (1977)

**Criteria for Pronouncement of Death:** Brain Death Criteria

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Criteria for Brain Death was developed by?

1. Coma and Cerebral unresponsiveness
2. Apnea
3. Absent cephalic (brainstem) reflexes
4. Electrocerebral silence

**Criteria for Pronouncement of Death:** Brain Death Criteria

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4 criterias for brain death

false

**Criteria for Pronouncement of Death:** Brain Death Criteria

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the Criteria for Brain Death by the National Institute of Neurological Diseases and Stroke in the United States (1977) is not anymore used today

apnea

**Criteria for Pronouncement of Death:** Brain Death Criteria

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* cessation of breathing or air flow
* 2 mins: severe to irreversible damage

1. 2 EEG recordings
* separated by 1 4-hr observation period

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2. Cerebral angiography exam

**Criteria for Pronouncement of Death:** Brain Death Criteria

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In France, the law has either of the 2 requirements to declare electrocerebral silence

1\.

2\.

* 30-min good quality EEG
* complete ECS

**Criteria for Pronouncement of Death:** Brain Death Criteria

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In France, what are the indications of a confirmed ECI?

electrocerebral silence

**Criteria for Pronouncement of Death:** Brain Death Criteria

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* no cerebral activity >2uV
* ruled out possble influence of sedative drugs, metabolic diseases, hypothermia

CT brain angiography

**Criteria for Pronouncement of Death:** Brain Death Criteria

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gold standard for ruling out possible influence of sedative drugs

proceed w/ caution as ECI is observed kahit walang cerebral death

**Criteria for Pronouncement of Death:** Brain Death Criteria

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newborn considerations for declaring brain death in France

30 minutes at least 6 hour

**Criteria for Pronouncement of Death:** Brain Death Criteria

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Criteria should be present for (?) after onset of coma and apnea

1980

* American Bar Association
* National Conference of Commissioners of Uniform State Laws

**Legislative Definition of Death:** Somatic Death

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organizations that provided the legislative definition for ‘death’

2

**Legislative Definition of Death:** Somatic Death

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how many criteria

1. Irreversible cessation of circulatory and respiratory functions
* di na kaya pag walang life support
2. Irreversible cessation of all functions of the entire brain, including the brainstem is dead
* may ECS

**Legislative Definition of Death:** Somatic Death

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what are the 2 criteria under legislative definition

deep unconsciousness for a prolongued/indefinite period of time due to severe injury or illness

medical definition for ‘coma’

American Academy of Neurology

what organization medically defined ‘coma’

1. Motor response
2. Pupillary response to light and pupils at mid-position
3. Corneal reflexes
4. Caloric response
5. Gag reflex
6. Coughing in response to tracheal suctioning
7. Sucking and Rooting reflexes

enumerate the absence of response/reflex indicative of coma (7)

Corneal reflexes

dilation of cornea

caloric response

hearing

Sucking and Rooting reflexes

reflexes in babies

Rooting reflexes

a basic survival reflex of babies (hinahanap yung dede ng mom)

Republic Act 7170 or Organ Donation Act of 1991

proclaimed that organ and tissue donations from donors who have been declared brain dead has been allowed

1. consent of relative
2. physician authority/approval

2 grounds of RA 7170

**Medical Certificate of Death**

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indicates how death is/was documented and certified

1. immediate
2. antecedent
3. underlying

**Medical Certificate of Death**

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3 causes of death

immediate cod

**Medical Certificate of Death**

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* readily identified w/ clinical evidence

antecedent cod

**Medical Certificate of Death**

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* any disease that led to morbidity then mortality

underlying cod

**Medical Certificate of Death**

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* (WHO) disease that initiated the train of events leading directly to death, OR
* circumstances which produced the fatal injury

immediate cod

**Medical Certificate of Death**

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* the final disease, injury, or complication directly causing death
* a consequence of an underlying cause

antecedent cod

**Medical Certificate of Death**

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__Immediate:__

In the case of ***sudden or traumatic death***, the violent act or accident is the (?) to an injury entered, although these two events are often almost simultaneous.

antecedent cod

**Medical Certificate of Death**

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* condition(s) that led to or precipitated the immediate cause of death
* other intervening cause
* occurring between the underlying and immediate

* proximate
* root cause

**Medical Certificate of Death**

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underlying cod is AKA

underlying cod

**Medical Certificate of Death**

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most important entry in the certificate

underlying cod

**Medical Certificate of Death**

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Without this, the death would not have happened

underlying cod

**Medical Certificate of Death**

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basis of mortality statistics

* causes of death (8 days and over)
* maternal condition (f, 15-49)
* death by external causes
* attendant details
* if autopsy was performed
* duration of autopsy (mmddyy)
* certificate of death

**Medical Certificate of Death**

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give examples of possible contents in a medical certificate of death

Natural

**Categories of Death**

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* from disease
* old age

Accidental

**Categories of Death**

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* environmental influence
* occupational hazard

Suicide

**Categories of Death**

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* intentionally self-inflicted

Homicide

**Categories of Death**

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* deliberate action of another person

Indeterminate or Undetermined

**Categories of Death**

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* unknown cause
* bigla lang namatay

clinical depression

**Categories of Death**

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very common POSSIBLE cause of indeterminate or undetermined cause of death