A CONCEPT OF THE AUTOPSY

1
A CONCEPT OF THE AUTOPSY

• Newcastle Department of forensic Medicine

2
WARNINGTHIS PRESENTATION DEPICTS PHOTOS
OF DECEASED PEOPLE
3
Giovanni Morgagni 1682-1771

• Those who have dissected or inspected many
  bodies have at least learned to doubt, while
  those who are ignorant of anatomy and do not take
  the trouble to attend to it, are in no doubt at
  all.

4
Latin proverb

• Taceant colloquia. Effugiat risus. Hic locus est
  ubi mors gaudet succurrere vitae.
• Let conversation cease. Let laughter flee. This
  is the place where death delights to help the
  living.

5
WHAT IS AN AUTOPSY?

• A specialist medical procedure.
• Examination of a dead person by a doctor.
• Auto-self-(Latin)
• opsy-to look (Gk)
• Literally, see for onself
• Necropsypost mortemautopsy.
• Hospital v Coronial autopsy
• Different purposes and end points for each

6
The autopsy

• A foundation stone for medical teaching and
  research
• Autopsy rates gt50 in hospitals once!
• Now lt5 at best world-wide.
• Jews, Buddhists, Muslims and others oppose
  autopsies
• Concept of limited autopsy
• eg brain, heart only

7
THE CORONIAL AUTOPSY

• 1-2 ALL DEATHS
• CASE REFERRED TO CORONER
• POLICE INVESTIGATE FOR CORONER
• NO DEATH CERTIFICATE WRITTEN
• NO CONSENT NEEDED FROM RELATIVES
• LEGAL AUTHORITY FOR AUTOPSY FROM CORONER
• RELATIVES CAN OBJECT TO AUTOPSY IN NSW

8
TYPES OF CORONIAL CASES

• Violent, traumatic or unnatural death
• Death under suspicious or unusual circumstances
• Cause of death unknown
• No doctor seen for lt 3 months
• Within 24 hrs of anaesthetic-any type.
• In custody-gaol, police station, institution

9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
THE HOSPITAL AUTOPSY

• Done by pathology trainee in a hospital
• N.O.K. authorised (Consented)
• Cause of death is known
• Death certificate appropriately issued
• Designated officer reviews case
• Not a case referrable to Coroner
• Organs may be retained (with consent).

15
HOSPITAL AUTOPSY

• CORRELATE PATHOLOGICAL FINDINGS WITH CLINICAL
  FINDINGS/DIAGNOSES
• DIAGNOSE OCCULT DISEASES
• ASSESS ADEQUACY OF Rx
• REASONS FOR FAILURE OF Rx
• TEACHING
• RESEARCH
• AUDIT/PEER REVIEW

16
Why the decline of the hospital autopsy?

• Most pathologists and clinicians are not
  interested.
• Time consuming
• Dirty and smelly
• More productive challenges elsewhere.
• OHS poor
• Antiquated morgues-seldom upgraded.
• Poor CPC, peer review to correlate

17
THE AUTOPSY IN DECLINE

• TEACHING HOSPITAL EMPIRES FADING
• PATHOLOGY NO LONGER IMPORTANT FOR UNDERGRADS.
• SOME CLINICIANS HAVE A FEAR OF IT.
• SO BEST NOT TO ASK FOR ONE.
• NEW TESTS REPLACED THE AUTOPSY (?)
• GENERAL COMMUNITY DISLIKE OF THE AUTOPSY
• They suffered enough

18
HOW TO DO AN AUTOPSY

• ENSURE CORRECT PERSON-CHECK I.D.
• ENSURE CONSENT GIVEN
• BRING CAMERA, PEN, DIAGRAMS, DICTAPHONE
• GET A HISTORY
• DO EXTERNAL EXAMINATION
• THEN INTERNAL EXAMINATION
• COLLECT SAMPLES
• FINALISE THE REPORT-WITHIN DAYS IF NO TOXICOLOGY

19
IDENTIFICATION

• VISUAL-MISTAKES HAPPEN
• FINGERPRINTS
• DENTAL EXAMINATION-CORRELATE
• DNA-DEFINITIVE BUT COMPARATIVE
• OTHER-TATTOOS/CLOTHING/PROSTHESES
• eg ARTHROPLASTY, CABG WIRES

20
THE AUTOPSY

• HISTORY-MEDICAL RECORDS, POLICE, RELATIVES
• EXTERNAL EXAMINATION
• Clothing
• Natural disease
• Post mortem changes
• Marks, scars, tattoos
• Medical Rx
• Injuries

21
The autopsy

• Internal examination
• Head and neck
• Chest
• Abdomen
• Special dissection eg spinal cord
• Limbs

22
Special tests

• Histology-all cases even if normal
• Microbiology-virology, bacteriology etc.
• Toxicology-blood, urine, vitreous etc.
• Blood-femoral/iliac
• Urine-bladder
• Vitreous-2.5mL each eye
• Also bile, liver, stomach contents, muscle, hair,
  nails, anything!
• Blood-DNA
• Clothing

23
THE AUTOPSY REPORT

• PAINTS A PICTURE
• HISTORY OF EVENTS
• AUTOPSY FINDINGS
• TOXICOLOGY TESTS RESULTS
• COMMENTS DISCUSSION
• CAUSE OF DEATH
• CORRELATION OF RESULTS WITH HISTORY

24
THE REPORT

• CAUSE OF DEATH
• eg 1a) CARDIAC TAMPONADE due to
• b) RUPTURED LEFT VENTRICLE due to
• C) ACUTE MYOCARDIAL INFARCTION
• 2. DIABETES, HYPERTENSION, OBESITY

25
THE REPORT

• ANY DOCTOR WHO READS THE REPORT SHOULD FOLLOW IT.
• A MEDICAL REPORT BUT MADE UNDERSTANDABLE FOR LAY
  PERSONS
• GLOSSARY AT END
• LITERATURE REFERENCES, IF ANY

26
MY CONCEPT OF THE AUTOPSY

• THE AUTOPSY IS ALIVE-ONLY JUST!
• ANOTHER MEDICAL PROCEDURE
• DONE BY TECHNICALLY COMPETENT STAFF
• UNDER STRICT OHS RULES
• COLLEGE LEVEL STANDARDS OF PERFORMANCE
• SUBJECT TO REVIEW AND DEBATE
• SO TAKE PHOTOS
• DOCUMENT DOCUMENT

27
AND FINALLY

• AQUAINT SELF WITH CASE
• DONT RUSH
• BE CLEAN, TIDY HYGIENIC
• BE THOROUGH
• KEEP LEGIBLE NOTES
• DICTATE WITHIN 24 HRS
• FINALISE WITHIN 6-8 WKS

28
THANK YOU