Untitled Flashcards Set

What is pathology?

• The study of disease

• Divided into anatomic pathology and clinical pathology

  • Anatomic pathology: cytology, histology, autopsy

  • Clinical pathology: lab administration, blood bank, chemistry, hematology, molecular pathology, microbiology, urinalysis

Who are pathologists?

• Physicians trained in anatomic and/or clinical pathology

• We supervise medical laboratories and all lab tests performed in a hospital or clinic

• We diagnose diseases looking at tissue under microscope

• We proform hospital autopsies when requested by family members

Forensic pathology:

• The medicolegal investigation of sudden, unexplained deaths, violent deaths, and suspicious deaths

• Forensic pathologists are anatomic pathologists additionally trained in special autopsy procedures, collection of evidence, toxicology, injury patterns, wound ballistics, forensic serology and DNA

• Forensic pathologists testify as expert witnesses in courts of law

What does it take to be a forensic pathologist:

• Bachelor degree (4 years)

• Medical degree (4 years)

• Anatomic pathology or anatomic and clinical pathology residency (3-4 years)

• Forensic pathology fellowship (1-2 years)

• All forensic pathologists are required to be board certified in anatomic pathology and forensic pathology at a minimum

Why investigate death?

• Identify the decedent

• To determine the cause and manner of death

• To identify diseases or injuries pertinent to public health

• To provide closure to families

• To determine if a crime has been committed, documentation of injuries, and collection of evidence

Coroner systems:

• An elected public official whose duty is to determine cause and manner of death

• Usually not physicians and have no medical training

• Ver minimal training if any

• If autopsy is determined to be necessary, a physician or forensic pathologist will perform (non-physician coroners cannot perform autopsies)

• May have a conflict of interests if funeral director, prosecutor, or enforcement offical

• No accreditation or standardization between jurisdictions

Medical examiner systems:

• Usually state wide

• Employ physicians (usually board certified forensic pathologists) to investigate deaths and perform autopsies

• May be accredited by the National Association of Medical Examiners

• Usually work independently of law enforcement to prevent bias

• Many offices are critically understaffed in 2022

What is an autopsy:

• Comes from the greek work autopsia which means “seen by oneself”

• Involves and external examination of a deceased individual, sometimes followed by an internal examination of the organs

• There are different types

  • Hospital autopsy versus forensic autopsy

  • External exam versus partial autopsy vs virtopsy versus full autopsy

Hospital Autopsy:

• Performed by a general pathologist

• Required written permission from next of kin

• Is and educational tool

• Minimal external examination; focus on internal examination and correlation of findings with clinical records

• Almost never involves examination of neck organs; no collection of evidence or toxicology

• Usually can only sign out manner of death as “natural”

Top 10 causes of death in the US (2021)

• Heart disease, #1

• Cancer, #2

• Covide-19

• Stroke

• Chronic lower respiratory diseases

• Diabetes

• Unintentional injuries, #3 for men

• Suicide

Drug overdose has been a main cause of unintentional death, passed motor vehicle death in 2011, number one drug that causes death is fentanyl

Death Certificates:

• There is no standard death certificate, each state has their own version

• However, most have the general appearance

• Death certificate is very important

  • The source for state and national mortality statistics

  • Is often required before burial or cremation

  • Required for insurance payouts

Medical Certifier required fields:

• Date and time of death

• Cause of death

• Manner of death

• Was the case referred to ME?

• Was an autopsy performed?

• Did tobacco use contribute to death?

• Pregnancy status of females

• Injury section if applicable

• Certifier section with signature

Cause of Death:

• Any injury or disease that produces a physiologic derangement in the body that results in the death of the individual

• Examples:

  • Gunshot wound to head

  • Heart attack

  • Blunt force injury

  • Heroin overdose

  • Hanging

Undetermined Cause of Death:

• Rarely, after complete investigation, autopsy, histology, and toxicology, the cause of death can not be determined

• The presumed mechanism in these deaths is a physiologic process, such as a cardiac arrhythmia, that leaves no evidence at autopsy

  • Genetic testing is becoming more commonplace to assist in these deaths but is not standard at this time

Mechanism of Death:

• The physiologic derangement produced by the cause of death that results in death

• Many causes of death have similar mechanisms of death

• Should not be used on a death certificate

• Examples:

  • Hemorrhage

  • Cardiac arrhythmia

Manner of death:

• Explains how the cause of death came about

• This is determined by investigation, not the autopsy

• Manner of death represents a medical opinion, not a legal term

• Five options:

  • Natural

  • Accident

  • Suicide

  • Homicide

  • Undetermined

Natural: death due solely or nearly totally to disease and/or the aging process

Accident: there is no evidence that the injury occurred with intent to harm or cause death

Suicide: an intential, self-inflicted act committed to do self-harm or cause death to oneself

Homicide: occurs when the death results from an injury from a volitional act committed by another person to cause fear, harm or death, doesn’t mean someone will be charged with a crime

Undetermined: used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death when all information is considered, law enforcement cannot close a case with and “undetermined” manner

Pending: is not an appropriate final manner of death but can be used when filling out the inital death certificate if the pathologist is waiting for further investigation

Basic Rules in Determining Manner:

• The time interval between the injury and death is of little relevance

• In delayed deaths, it is important to consider what previous disease process or injury led to an individual’s demise

• When death involves a combination of natural processes and external factor such as injury, preference is given to the non-natural manner of death

Special Cases:

Deaths due to the acute toxic effects of a drug or poison are typically classified as an “accident”

Russian Roulette is typically classified as “suicide” because the act of placing a loaded firearm to the head and pulling the trigger is inherently dangerous

Motor vehicle fatalities are usually classified as “accident” even if the driver was impaired

• Vehicular homicide is a legal term and not used by forensic pathologists

Deaths due to toxic envenomation such as spider bites, snake bite, and anaphylactic reactions to bee stings are usually classified as “accident”

Deaths due to positional restraint or chokehold by law enforcement personnel are classified as “homicide”