2: Postmortem Examination (Part 1)

autopsy

what was referred to as the “ultimate medical audit?”

1. natural
2. accident
3. homicide
4. suicide
5. undetermined

what are the 5 rulings for the manner of death?

false

everyone receives an autopsy upon death

* medical examiner
* coroner

who can order an autpsy without consent from next of kin in a case where suspicious circumstances surround a death?

pathology

Over the last 2,500 years, as medicine moved from mystic art to proper science, so did the field of (?) and the quest to figure out what a person's body can tell us about how they died.

uncertainty

Autopsies can provide answers—but even now, sometimes they find nothing but a cloud of (?).

44BC

when was the first recorded autopsy?

Antistius

The first recorded autopsy occurs when (?) examines Julius Caesar’s body after his assassination.

23

how many stab wounds did Antistius observed from Julius Caesar’s body?

aorta

It was one wound to the chest that ruptured Caesar’s (?).

conspiracy

The assassination of Julius Caesar was the result of a (?) by approximately 60 Roman senators who called themselves Liberators

* Gaius Cassius Longinus
* Marcus Junius Brutus

Led by (?) and (?), they stabbed Julius Caesar to death in a location adjacent to the Theatre of Pompey on the Ides of March (March 15), 44 BC.

La mort de Cèsar or The Death of Julius Caesar

an 1806 painting by Vincenzo Camuccini

Frederick Hervey, 4th Earl of Bristol

the La mort de Cèsar or The Death of Julius Caesar was originally commissioned in 1793 by who?

Hsi Yüan Lu, or The Washing Away of Wrongs”

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

Song Ci (1247)

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

1. poisoning
2. decomposition
3. wounds from various weapons
4. strangulation
5. fake wounds

5 forward-thinking forensic issues illustrated in the “Hsi Yüan Lu, or The Washing Away of Wrongs”

Bartolomeo da Varignana (1302)

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

medico-legal autopsy

what did Bartolomeo da Varignana (1302) specifically perform?

a magistrate in Bologna

who requested the medico-legal autopsy done by Bartolomeo da Varignana (1302)?

human eye and his tools

Before the advent of the microscope, his observations were limited by the power of the (?).

Renaissance

Throughout the (?), anatomy teachers and students in medical schools did not perform dissections themselves.

* congregate in an operating theater
* watch a “lay dissector” open a cadaver

how did medical students dissect during the renaissance?

Leonardo da Vinci and Michelangelo

(?) and (?) performed a number of “autopsies,” dissecting corpses and observing the anatomy unseen by the naked eye.

Rudolf Ludwig Karl Virchow (1870s)

The father of modern pathology

microscope

Rudolf Virchow realized the importance of the (?) when conducting pathological research to uncover minute details.

leukemia

Through Rudolf Ludwig Karl Virchow’s (1870s) examinations, he characterized a case of (?), and his resulting report is one of the earliest formal reports on this cancer

Scientific medicine of high quality

Wherever (?) is practiced, postmortem examinations are performed

Autopsy Service

The (?) performes autopsies on patients who die at Massachusetts General Hospital, patients who die outside of the hospital who have had some Mass General Care, and patients at Cambridge Hospital, etc.

350 cases per year, approx. 13% of hospital deaths

The Autopsy Service performs approximately how many cases per year?

Mass General

\#1 research hospital in America and the only hospital to be recognized in all 16 specialties assessed by US News & World Report

850

The Autopsy Service has more than how many faculty/trainees and employees supporting them?

conscientious physician

Whenever a (?) knows why he “lost” his patient, a post mortem examination has been performed.

**conscientious** 

a moral responsibility to do your work carefully and to be fair to others

competently performed and thoughtfully reported postmortem examination

a vital component of today’s autopsy practice

documenting diseases and injuries that cause death

integral roles of autopsy

decedent

a term used to refer to a person who has died

explaining the cause of a decedent’s symptoms to family members

one of the most rewarding aspects of autopsy practice

false

autopsy is not necessarily performed when a criminal law is enforced

death certificate

what document shows accurately the causes of death and confirmed medical diagnosis for the assembling of vital statistics a postmortem has been performed

postmortem examination

what investigative method is used whenever there is medical research on causes and nature of diseases

* 40% to 60%
* 5%

Before 1970, approximately (?) to (?) of all hospital deaths in the United States ended in autopsy; in more recent years that number has decreased to below (?).

false

Worldwide autopsy rates have increased steadily since the 1950s— and there is no evidence to suggest that the trend will change

43\.6 to 55.4

(1972 to 2007) % of deaths autopsied due to **external causes**

26\.4 to 29.1

(1972 to 2007) % of deaths autopsied due to **ill-defined causes**

19\.3 to 8.5

(1972 to 2007) % of deaths autopsied due to **total causes**

16\.9 to 4.3

(1972 to 2007) % of deaths autopsied due to **diseases**

informed society

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.

1. administrative preps
2. prep of autopsy room
3. confirmation of decedent identity

**Autopsy Procedure**

\
3 preparatory steps before PME

step 1. administrative preps

**Autopsy Procedure**

\
* obtain and confirm consent for autopsy
* obtain and review clinical records
* contact clinical team and staff pathologist

step 2. prep of autopsy room

**Autopsy Procedure**

\
* set up dissection instruments and tools
* lay out swabs, media, etc. for any anciallry studies to be performed
* prepare photographic equipment
* assemble PPE

step 3. confirmation of decedent identity

**Autopsy Procedure**

\
* identifiers on the body must be confirmed and matched with consent form
* confirm limitations or restrictions to the autopsy

step 3. confirmation of decedent identity

**Autopsy Procedure**

\
most important step in the autopsy procedure

1. written consent from the next of kin-abide by the extent or restrictions allowed
2. Death certificate (blue /pink white forms)
3. Medical abstract / Clinical data
4. Medicolegal clearance

**Autopsy Procedure**

\
4 documents necessary for the procedure

1. Spouse
2. Adult children
3. Adult grandchildren
4. Parent
5. Brother/Sister
6. Nephew
7. Grandparent
8. Uncle/Aunt
9. Cousin
10. Stepchildren

**Autopsy Procedure**

\
Enumerate the 10 legal next of kin to consent the autopsy in order of priority (most to least)

if it is not required by law

**Autopsy Procedure**

\
when would you need the permission from the next of kin to be able to perform autopsy?

witness

**Autopsy Procedure**

\
consent form must be signed in the present of a (?)

true

**Autopsy Procedure**

\
in preparing for the autopsy, one should review records and medical history

1. printed name
2. relationship to the deceased
3. name of the deceased
4. name of hospital

**Autopsy Procedure:** Consent form

\
“I, (1), the (2) of the deceased," (3), being entitled by law to control the disposition of the remains, hereby request the pathologist of (4) to perform an autopsy on the body of said deceased.”

complete

**Types of Autopsy**

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

limited / partial

**Types of Autopsy**

\
may exclude the head / brain

selective

**Types of Autopsy**

\
specific organs only are examined

false

a police or coroner has no power to order an autopsy

true

a autopsy is performed when it is necesary to complete the death certificate

true

an individual can give an advanced directive giving consent to do an autopsy on their body after expiration

false

autopsy is not necessary to be performed on a deceased military personnel who dies in active duty/training in the military service

within 48 hours

an autopsy is usually carried out within how many hours after the death of a person?

coronial

an autopsy can be hospital-based/non-coronial or (?)

coronial autopsy

type of autopsy that is ordered by the state coroner

hospital-based autopsy

a type of autopsy that is performed at the request of the family of the deceased

1. selective
2. partial
3. complete

3 extents of autopsy

retention

autopsy is the (?) of organs

forensic

medico legal is for (?)

death certificate

gross findings

final diagnosis

gross and microscopic findings

gross findings

AKA provisional anatomic diagnosis

gross and microscopic findings

AKA final anatomic diagnosis