All about Autopsy in forensic medicine .pptx

All about Autopsy in forensic medicine.

1. The Forensic Autopsy Dr.M Qadeer Naqvi

2. What is an Autopsy? “See for yourself” A post mortem examination performed to determine the cause of death.

3. Types of Autopsy There are four main types of autopsies: 1. Medico-Legal Autopsy or Forensic  or  coroner's autopsies  seek to find the cause and manner of death and to identify the decedent . They are generally performed, as prescribed by applicable law, in cases of violent, suspicious or sudden deaths , deaths without medical assistance or during surgical procedures . 2. Clinical  or  Pathological autopsies  are performed to diagnose a particular disease or for research purposes . They aim to determine, clarify, or confirm medical diagnoses that remained unknown or unclear prior to the patient's death. 3. Anatomical  or  academic autopsies  are performed by students of anatomy for study purpose only. 4. Virtual  or  medical imaging autopsies  are performed utilizing imaging technology only, primarily magnetic resonance imaging (MRI) and computed tomography

4. Why is a Forensic Autopsy preformed? Cause of death deemed suspicious, or involves criminal action.

5. Objectives of autopsy To determine the identity of a person. To determine the cause of death .(disease , trauma or intoxication) Manne r of death; Natural or unnatural , if unnatural –suicidal, homicide or accidental. In homicide any trace evidence left by the accused on the victim. To determine the time since death In case of new born infants, determine whether it was a live birth and its viability .

6. In a forensic autopsy, a medical examiner or coroner declares the death to be: Natural Accident Homicide Suicide or Unknown

7. Natural Death Caused by a known disease: cancer, heart disease, stroke, genetic disorders, etc. Often just simply “old age”

8. Accidental Death Caused by mistake or freak occurrence . Death not planned , but can be explained by circumstances .

9. Homicidal Death the killing of one person by another. Lots of people… Genocide – the deliberate killing of a large group of people, especially those of a particular nation or ethnic group. Homicide is the most investigated death, therefore the most autopsied.

10. Suicidal Death Killing of self. Often the easiest to identify the cause. Can be elaborated further in the report… Toxic, firearm, blunt force trauma, asphyxiation, etc.

11. Unknown Death Deaths in absentia At sea Badly decayed bodies

12. Protocol for Performing A Forensic Autopsy? Corpse brought to Medical Examiner In a new body bag/clean sheets Avoids cross-transfer of evidence Placed on dissection table

13. Here's how an autopsy is done. -The body needs to be identified first and lawful consent should be obtained. -The procedure is done with respect and seriousness . -The prevailing mood in the autopsy room is curiosity, scientific interest , and pleasure at being able to find the truth and share it. Many autopsy services have a sign, "This is the place where death rejoices to help those who live." Usually it is written in Latin ("Hic locus est ubi mors gaudet succurrere vitae"). Autopsy practice was largely developed in Germany, and an autopsy assistant is traditionally honored with the title "diener", which is German for "helper".

14. STAGES OF AUTOPSY EXAMINATION Physical examination of clothes and collection of evidence in them Physical examination of body surfaces and collection of any evidence Opening of the body cavities Scrutiny of internal contents of cavities and vital systems Collection of specimens Closure of the body / reconstruction Disposal of dead body – relatives/ police /contractor

15. External Examination Steps of an external examination. Photographed. Physical evidence collected off body. Samples of hair, nails, etc. are collected. Undressed, examined for wounds. Lacerations, abrasions, bruises. Measured, weighed, cleaned.

16. Physical examination of the clothes Preliminary inspection Description of holes, cuts, tears Removal of clothes from the body Drying of wet clothes and preservation Collection of any foreign material –glass pieces, hair, foreign fibers -not matching the clothes of the deceased

17. Physical examination of body surfaces Inspection (naked eye and with magnifying glass) and palpation of body surfaces Abnormal coloration of skin Presence of injuries Location and extent of hypostasis Examination of the natural orifices – oral, auricular, nasal, ocular, anal, vulvar / groin / axila etc

18. Poisoning cases Smell of the body and viscera. Postmortem staining and its colour. If froth present,its nature. Colour of sclera, lips and nails. Mouth and surroundings. Injuries. Details of G.I tract examination. Description of stomach and contents.

19. Burns cases Smell from the body,kerosene other inflammable agents. Nature of burns. - Antemortem - Postmortem. Extent and degree of burns. Age of burns. Injuries other than burns.

20. Autopsy Palpation of the body sur face Detection of rigor mortis Detection of lump or foreign body – bullet, pallet Examination of the external injuries Shape, size, site (in relation to fixed anatomical landmark), number and pattern of distribution Correlation of holes, cuts, extent of blood soaking with injuries Defense wounds / hesitational cuts / cadaveric spasm

21. Signs of death Respiratory arrest  (no  breathing ) Cardiac arrest  (no  pulse ) Pallor mortis , paleness which happens in the 15–120 minutes after death Livor mortis , a settling of the blood in the lower (dependent) portion of the body Algor mortis , the reduction in body temperature following death. This is generally a steady decline until matching ambient temperature Rigor mortis , the limbs of the corpse become stiff (Latin  rigor ) and difficult to move or manipulate Decomposition , the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.

22. INTERNAL EXAMINATION It consists of: 1. Incising the body 2. Inspecting the various organs 3. Examining the cavities systematically 4. Weighing and measuring the organs 5. Checking for any pathology 6. Putting all the organs back in and padding 7. Suturing the body

23. SKIN INCISIONS 1. ‘I’ shaped Incision : It is a straight line incision extending from the chin to the symphysis pubis . 2. ‘Y’ Shaped Incision : This type of incision starts near the acromion process and progresses downwards towards the xiphoid process . The incision is then extended till the symphysis pubis. Also, a similar incision is made on the opposite side of the body. 3. Modified ‘Y’ Shaped : A ‘Y’ shaped incision is made from the suprasternal notch to symphysis pubis . It extends from the suprasternal notch over the clavicle to its center on both sides and passes upwards over the neck , behind the ear .

24. Viscera to be collected for Chemical Examination Stomach with contents. Upper part of small intestine. - 30cms with contents. 500gms of liver and half of each kidney. 5-10ml of blood. 30ml of urine.

25. REMOVAL OF ORGANS Virchow’s Technique : In the Virchow technique, the organs are removed one by one and dissected as removed. Head  Thorax  Abdomen Rokitansky’s Technique: This procedure is characterized by in situ dissection, in part combined with en bloc removal Letulle’s Technique : ( Removed en masse and dissected as organ block.) Cervical  Thoracic  Abdominal  Pelvic Organs

26. Virchow’s approach is good for demonstrating pathological change in individual organs, especially in high-risk autopsies or where permission is limited to one organ Letulle method is the best technique for preserving the vascular supply and relationships between organs.

27. ORDER OF EXAMINATION VIRCHOW’S TECHNIQUE  Head Thoracic (Cervical) Abdominal Organs

28. AFTER COMPLETING INTERNAL EXAMINATIONS Body cavities should be cleaned and made free from blood, fluids etc. Organs are placed back in and excess space is packed with cotton/cloth etc. (esp. in the pelvis and the neck regions.) Dissection flaps are closed and sutured . Skull is filled with cotton and absorbent material and the skull cap is placed back in and the scalp is stitched . Body is washed with water, dried , covered with clothes and handed over to the police officials .

29. Autopsy Reconstruct the body – to make it presentable for the relatives Disposal – hand over to relatives through police – if unclaimed keep in refrigerator and arrange to inform the official burial contractor / may be handed over to anatomy department

30. Autopsy Post mortem artifacts Artifact – artificial product or feature which is not real but added to original by processing / handling Artifacts added to dead body during post mortem period Causes: Post mortem phenomenon Physical handling Interference by scavengers / insects / animals

31. Before death Therapeutic artifacts. Surgical artifacts. At the moment of death Agonal artifacts. (Aspiration of gastric contents) Resuscitation artifacts

32. After death Artifacts due to the handling of the body. Artifacts related to rigor mortis. Artifacts related to postmortem lividity. Artifacts due to animal bite. Artifacts due to chemicals. Artifacts due to refrigeration. Embalming artifacts. (preserving effects)

33. Artifacts during autopsy Air in blood vessels. Skull fractures. Visceral damage. Extravasation of blood. Fracture of hyoid bone.

34. Negative Autopsy When gross and microscopic examination and other investigations fail to reveal a cause of death,the autopsy is considered to be negative. - Men. - Material. -Method.

35. Men Lack of experience. Lack of training. Material Inadequate microscopic examination. Insufficient laboratory examination. Lack of toxicological analysis.

36. Method Inadequate history. Lapses in external examination. Inadequate or improper internal examination.

37. Obscure Autopsy Which do not reveal the cause for death in which there are trivial,equivocal or obscure findings or no positive findings. Causes Natural diseases . -Death by emotion or work stress. -Death due to functional failure- epilepsy,paroxysmal fibrillation.

38. Biochemical disturbances Uraemia,diabetes,potassium deficiency. Anoxic anaemia. Endocrine dysfunction Adrenal insufficiency. Thyrotoxicosis or Myxoedema. Concealed trauma Concussion. Blunt injury to heart. Reflex vagal inhibition.

39. Poisoning Narcotic poisoning. Anesthetic over dosage. Neurotoxic or Cytotoxic poisons. Plant poisoning. Miscellaneous Allergy. Drug idiosyncrasy.