1. PROCEDURE
1.1. 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)
1.1.1. EXTERNAL EXAMINATION
1.1.2. INTERNAL EXAMINATION
1.1.2.1. 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
1.1.2.2. TECHNIQUE
1.1.2.3. EVISCERATION
1.1.2.3.1. INTIAL CUTS
2. DEATH CERTIFICATE
2.1. Death certification
2.1.1. EVERY DEATH MUST BE CERTIFIED
2.1.2. PHYSICIANS OR PUBLIC OFFICERS (IN CERTAIN CATEGORIES OF DEAH)
2.2. CAUSE OF DEATH CERTIFICATE
2.2.1. Example
2.2.2. mechanisms of death
2.2.2.1. rules in including mechanism
2.2.2.1.1. Examples
2.2.3. f
3. FINAL AUTOPSY RAPORT
3.1. 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
4. THE CONCEPT OF DEATH
4.1. MANNER
4.1.1. Circumstances surrounding death (SHAUN): SUICIDE HOMICIDE ACCIDENT UNDETERMINED NATURAL
4.2. CAUSE
4.2.1. 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
4.3. MECHANISM
4.3.1. The process (ANATOMICAL or PHYSIOLOGICAL DERANGEMENT) initiated by the cause of death resulting in disruption of function ex: exsanguination (bleeding to death) is the mechanism of death in many scenarios: gunshot knife wound ruptured aortic aneurysm
4.4. Death - cessation of all life functions and vital phenomena; moment in dying process Dying - process of moving from the state of being alive to the state of being death
4.4.1. CLINICAL - cessation of signs of life (respiration, circulation, consciousness REVERSIBLE upon applying resuscitation menouvers
4.4.2. SOMATIC/SYSTEMIC - permanent, irrevesible desintegration of the organism AS A WHOLE (not whole organism) Evolution of the definition [circulation->whole brain -> brain stem]
4.4.2.1. PRONOUCEMENT OF DEATH
4.4.2.1.1. PRACTICAL: Lack of respiration, pulse, heart sounds (observation for 5 min; lack of electrical activity if monitoring available) + stiff pupils, lack of reaction to pain, lack of corneal reflexes + !!!!drugs/alcohol excluded; may confound exam!!!
4.4.2.1.2. BRAIN STEM DEATH
4.4.2.1.3. ERLIEST DEFINITE SIGN OF DEATH - segmentation of blood columns in retinal vesels (after minutes,last for 1 hour); high specificity but low sensitivity
4.4.2.1.4. DEFINITE SIGNS OF DEATH
4.5. AUTOPSY
5. 1
5.1. estimation of the hight of the diaphragm
5.1.1. 3
5.1.1.1. opening pericardial sac
5.1.1.1.1. clamping the duodenum
6. 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)
6.1. ESTABLISH THE CIRCUMSTANCES OF A CRIME
7. Reasons for decline in autopsy rate
7.1. !!Expensive !!!New Technology - self -confidence Litigation Extra work for clinicians Hazardous Time consuming for pathologis
7.2. Objection of the family
7.2.1. "Deceased suffered enough" Fear of disfigurement Delay in funeral arrangement
8. Significance
8.1. discovery of new diseases
8.2. medical statistics
8.3. value for family members
8.3.1. inherited diseases
8.3.2. litigation/insurance benefits
8.3.2.1. occupation related
8.3.2.2. verification of diagnosis and treatment
8.4. quality control (20% should be autopsied)
8.5. education and research
9. TYPES
9.1. HOSPITAL/CLINICAL
9.1.1. CLINICAL QUESTIONS TO ANSWER &...
9.2. FORENSIC/MEDICOLEGAL
9.2.1. Pathology is one of the forensic disciplines
9.2.1.1. 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
9.3. Differences
9.3.1. DIAGNOSIS VS MANNER OF DEATH