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AUTOPSY by Mind Map: AUTOPSY
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AUTOPSY

FORENSICS - investigation of situations after the fact to establish what occured (usually carried out in relation to criminal or civil law, but also in other fields)

ESTABLISH THE FACTS OF A CRIME

Reasons for decline in autopsy rate

Hazardous !!Expensive Litigation Extra work for clinicians !!!New Technology Time consuming

Objection of the family

"Deceased suffered enough" Fear of disfigurement Delay in funeral arrangement

Significance

discovery of new diseases

medical statistics

value for family members

inherited diseases

litigation/insurance benefits, occupation related, verification of diagnosis and treatment

quality control (20% should be autopsied)

education and research

TYPES

HOSPITAL/CLINICAL

CLINICAL QUESTIONS TO ANSWER &...

FORENSIC/MEDICOLEGAL

Pathology is one of the forensic disciplines, Autopsy is only a part of investigation 1. Background investigation: historical events, police or medical reports, scene inspection, photographs and diagrams. 2. Examination of Clothing 3. Detailed External Examination: Scars, tattoos, injuries. 4. Complete Autopsy 5. Special Studies: toxicology, radiographs, photos

Differences

DIAGNOSIS VS MANNER OF DEATH

NATIONAL REGULATIONS

PROCEDURE

1. External examination 2. Taking blood, vitreous, urine samples 3. Internal examination 4. Preliminary report (48 hours) 5. Microscopic examination 6. Special stains and procedures 7. The final report (2 months)

EXTERNAL EXAMINATION

INTERNAL EXAMINATION, Proximal =cut trachea above epiglottis (w/wo tongue) Distal = Rectum, urethra, prostate/vagina, common iliac vessels Diaphragm Deep retroperitoneal tissue (R&L) Trachea/esophagus to end>cut away from vertebra, TECHNIQUE, EVISCERATION, INTIAL CUTS, ABOMINAL, THORACIC, CRANIAL, ORGAN BLOCKS, VISCERA, BRAIN

DEATH CERTIFICATE

Death certification

EVERY DEATH MUST BE CERTIFIED

PHYSICIANS OR PUBLIC OFFICERS (IN CERTAIN CATEGORIES OF DEAH)

CAUSE OF DEATH CERTIFICATE

Example

mechanisms of death, rules in including mechanism, Examples

f

FINAL AUTOPSY RAPORT

1. Cause of death 2. List of major findings in order of importance 3. Microscopic findings 4. Summary and discussion with clinical and pathological correlation

CONCEPT OF DEATH

MANNER

Circumstances surrounding death (SHAUN) suicide homicide accident undetermined natural

CAUSE

Disease or injury that starts physiological set of events that eventually lead to cerebral/cardiac death alzheimers --> aspiration pneumonia breast cancer --> pulmonary thromboembolism gunshot wound --> gangrene

MECHANISM

The process initiated by the cause of death resulting in disruption of function (physiological or biochemical disturbance) ex: exsanguination (bleeding to death) is the mechanism of death in many scenarios: gunshot knife wound ruptured aortic aneurysm

Death - cessation of all life functions and vital phenomena

CLINICAL -cessation of signs of life (respiration, circulation, consciousness REVERSIBLE upon applying resuscitation menouvers

SOMATIC/SYSTEMIC - permamnet, irrevesible desintegration of the organism AS A WHOLE (not whole organism) Evolution of the definition [circulation->brain -> brain stem], PRONOUCEMENT OF DEATH, PRACTICAL: Lack of respiration, pulse, heart sounds, stiff pupils (observation for 5 min; lack of electrical activity)drugs/alcohol may confound exam, BRAIN STEM DEATH, ERLIEST SIGN OF DEATH - segmentation of blood columns in retinal vesels (afterminutes,lat for 1 hour), but low sensitivity, DEFINITE SIGNS OF DEATH

AUTOPSY

CLINICO-PATHOLOGIC DISCREPANCIES

Goldman classification of discrepancies: Class 1: a discrepant diagnosis with a potential impact on survival Class 2: a discrepant major diagnosis but with equivocal or no impact on survival Class 3: a discrepant minor diagnosis that could have been diagnosed before death Class 4: a discrepant minor diagnosis that could not have been made before death

MAJOR DISCREAPNCIES: unsuspected or incorrect directly related to death

MAJOR ADDITIONAL FINDINGS: Iimpact on treatment or hospital course

PATHOLOGY

1

estimation of the hight of the diaphragm

3, opening pericardial sac, clamping the duodenum, dissection of the ascending colon, removal of the neck and thoracic cavity organ block, removal of the abdominal cavity organ block, removal of the pelvic cavity organ block, 10, 11, 13, 12