The Real CSI: Forensic Pathology and Death Investigation
coroner’s are not physicians. medical examiners are
reportable deaths ;
violent, sudden, unusual
deceased has not been attended by a physician (in america, limit is for ~20 days)
related by accident or injury, either old or recent
homicide (suspected / known), suicide (suspected / known), accidental
due to criminal acts
poisonings
occupational disease or injury (cuz public interest in knowing)
all death in operating rooms or following surgeries / major medical procedures
all deaths where a patient has not fully recovered from an anaesthetic
all solitary deaths
all deaths in which a patient is comatose
all deaths of unidentified persons
all deaths where the suspected cause of death is sudden infant death syndrome
all deaths in prisons or under control of law enforcement agency
all deaths of patients in state mental hospitals
all deaths where there is no known next of kin
all deaths caused by a known or suspected contagious disease constituting a public health hazard
all deaths including acute alcohol or drug intoxication
for injury and accidental, must be considered whether it was the primary cause or only contributary, or whether the death was caused immediately or after some time
even if there’s a plethora of potential natural causes for death, the case be regarded as natural death
typical death certificated -
has it been reported to medical examiner , yes / no
cause of death (e.g., heart attack)
due to , cause of death (e.g., heart disease)
due to , cause of death (e.g., clogging of arteries)
due to , underlying cause of death
other significant conditions contributing to death but not causing death (e.g., diabetes)
dates of medical / surgical procedures
cause of death - specific etiological disease or injury which starts the lethal sequence of events without sufficient intervening causes
sufficient intervening cause - if someone was shot and dies from that then there is no reason to look at underlying health conditions
cause of death is different to mechanism of death. e.g., u can die of a heart attack but the reason why u have a heart attack can be vastly different
hospital deaths / autopsies can only be natural, but under a coroner it can be many
manner of death -
natural (expected due to disease or aginf)
accident (unforeseeable acts or hostile environemnt)
homicide
suicide (needs a preponderance of the evidence)
pending
cannot be determined
good natural causes of death, deaths that are etiological (due to one thing) -
atherosclerotic cardiovascular disease
myocardial infarct due to atherosclerotic coronary artery disease
hypertensive stroke
ruptured cerebral aneurysm
chronic alcoholism
complications of diabetes mellitus
infectious complications of chronic substance abuse
not good natural causes of death, because they have to be DUE to a debilitation -
cardiorespiratory arrest
cardiac arrhythmia
respiratory failure
end stage liver / kidney disease
pneumonia
multi-organ system failure
sepsis
cerebrovascular accident
e.g., if someone has a stroke due to high blood pressure then it is a natural death, but if its due to a cocaine overdose then its accident or suicide
debilitations -
dementia ; e.g, from alzheimer’s, parkinsons, multi-infarct
stroke ; e.g., from inschemic (ascvd), hemorrhagic (hypertension, drugs like coke or meth)
trauma
chronic disease (e.g., diabetes, alcoholism, copd)
sepsis -
overwhelming infection. characterised by hypotension (low blood pressure), elevated white cell count, and organisms in the blood when cultured
more common debilitation patients
must be due to something - bacterial organism name isn’t enough, as you need to determine the source of the infection
autopsy examinations
basics -
gather most recent medical papers and information such as who found them, where were they found, when was the last time they were seen, what the scene looked, what medications were there, i.e., something to give a sense of why and how they’ve died
external examination
internal examination of organs, by making a y incision across the torso and reflecting back the skin. breastplate removed with pruning sheers. reflect the chest plate. each organ taken out and weighed and specimens sliced for additional testing (for damage or disease). incision made across the top of the scape and skin gets reflected forward and backwards. organs are put into plastic bags and put back in the body without order), then the body is sewed up to take a funeral home
documentation taken throughout - diagrams, photographs, autopsy report
difficult causes of death to identify -
compelling story but no sufficient trauma on the body to account for death
lots of trauma on the body and a story that doesn’t explain why
how to be a good medical examiner
will review all data available before coming to a final determination
will try to meet with different groups associated to the case to get more information when the story does not match up
will keep an open mind and remain objective before deciding on cause of death
different types (lesions) of autopsies (not in any classification but a good way to think abt it)
class I - overwhelming pathological findings (e.g., gunshot wound to head)
class II - presence of disease with lethal potential (e.g., a man found dead in his house with no signs of trauma and autopsy shows evidence of heart disease, therefore safe to assume died from a related heart attack)
class III - marginal pathology combined with a compelling history and the exclusion of other causes (situations where their pathology is not enough to kill usually but is the only explanation of their death)
class IV - lethal pathology is not structurally demonstrable
class V - undetermined
death certificate is different to autopsy report. autopsy report includes all the findings, including what is not the primary cause of death, but only the actual cause of death is what’s put on the certificate