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Autopsy by Dr Yaseen Mohammad for 3rd year students MBBS

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This is a forensic topic from my book FME ,I am working on it for the last two years.

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Autopsy by Dr Yaseen Mohammad for 3rd year students MBBS

  1. 1. recent Exhumation of a Mummified body in Chakaisar opal shangla (after a period of 10 months )lapsetime)
  2. 2. Autopsy All un-natural & sudden deaths must be investigated except where the dead person has been under the care of a physician or the medical history suggests natural death. If the physician suspects foul play he should refuse to issue death certificate.
  3. 3. MEDICOLEGAL AUTOPSY        AUTOPSY; autos-means self ,opis -view literally means to see for oneself. Inspection &dissection of body after death Autopsy means detailed scrutiny(study , exam) of both ext surface &internal contents of the body after opening its cavities, including exams such as histology , biochemistry , toxicology of collected material. Medical autopsy; is the one conducted for medical reasons to confirm or establish diagnosis, in cases where clinical investigations remained futile (unsuccessful) in establishing it. Medico legal autopsy means an autopsy performed by a qualified &Registered medical officer specifically to meet certain requirements of law.-----
  4. 4. MLA        MLA autopsy is performed in the pursuance of law to establish the cause &manner of death & also to establish or rule out foul play. Pm exam ; is the exam of external surfaces of the corpse by inspection e out giving incision for systemic exam ,however specimens like blood &bile, urine may be collected. Psycholollgical autopsy ;is undertaken for alleged(suspected ,so-called) case of suicide to know about the mental status of the deceased at the time of death. The pm exam should be meticulous(careful ,scrupulous) complete &routinely recoded all +tive findings
  5. 5. Autopsy VIRTOPSY  A procedure to record forensic pathological findings applying radiological & digital imaging methods i.e. X-rays, Ultrasonography, CT Scan, MRI and MSCT (multi slice computed tomography), photogrammetry & 3D optical measuring techniques (photographic measurements ) and replacing the standard autopsy procedures.
  6. 6. Objectives of a ml autopsy         1-To determine the identity of a person. 2-To determine the cause of death.(disease , trauma or intoxication) 3- Manner of death; natural or un natural, if unnatural –suicidal, homicide or accidental. 4-In homicide any trace evidence left by the accused on the victim. 5-To determine the time since death 6-In case of newly born infants ,determine the question of viability of the child. & live birth or still birth An autopsy performed by forensic pathologist/RMP.
  7. 7. MEDICOLEGAL AUTOPSY PROTOCOL  Valid Written Authority – from Police or Court  Examination of relevant papers including; FIR/ POLICE INQUEST REPORT) Naqsha-e-Zarar DEAD BODY CHALLAN(REQUISITION TO A MEDICAL OFFICER) IDENTITY BY POLICE & RELATIVES
  8. 8. Precautions for MLA           1-permission or authorisation; it is carried out at the permission of legal authority. 1-in a routine case(suicidal/accidental)-police ASI. Homicide ;-SHO(station house officer) EXUMATIONMagistrate or circle inspector (IG) DEATH in prison ,police custody ,or by police firing authority is Executive Magistrate class1
  9. 9. Precautions MLA 2-DEAD BODY CHALLAN;  it is a requisition submitted by investigating police officer to a medical man while handing over the body for performing autopsy.  It contains the name ,age, sex,religion,of the deceased,as well as  suspected cause of death&the purpose for which the body is sent. 
  10. 10. It also gives the place  ,the distance from where the body has come ,the name of person accompanying the body for protection & identification ,the details of articles &clothing e it.  The MLO should fill up the columns indicating the time of arrival of the body in Mortuary &the time of post mortem exam 
  11. 11. Precautions of a MLA         3-Inquest Report it is a report in which the available hx of the case &the circumstances under which the body was found or recovered are recorded. it also contain the recoded opinion of the witnesses & the police officer ,regarding the injuries, manner of their causation, the cause of death ,the indication of suspected foulplay,if any.
  12. 12. Precautions of a MLA         4-Identification;the body of the deceased should be identified by the police constable who brought it . It should also identified by two relatives wd names&address of persons ,signed or finger pr In unknown body note all points of identification ; race ,religion,sex,age,height&wt dental status, the finger prints if asked by police. police should take photograph of unknown bodies Finger prints if required from terminal phalanx dissect the entire thickness of the skin of each finger ,preserved in10%formalin &labell it.
  13. 13. Protocol for Performing A Forensic Autopsy? The corpse is brought to the medical examiner’s office  The body is then placed on the cadaver dissection table. 
  14. 14. Autopsy STANDARD AUTOPSY SUITE:  Autopsy room  Storage area ◦ Dead body freezers / Chemicals / Instruments / Linen  Change room / sterilization room  Record room  Waiting area for relatives  Offices  Toilets – staff & public  Entry & exits better if separate
  15. 15. Autopsy Autopsy Room  Walls – ice blue tiles  Natural sunlight / daylight lamp / ice blue fluorescent electric tube lights  Running water  Exhausts (03 at floor level)
  16. 16. Autopsy EQUIPMENTS  Mortuary Refrigeration Units – 02, 04, 06 body units with hydraulic lift trolley (custom built freezer room)  Autopsy tables  X-Ray machine + Mobile X-Ray unit  Suction unit  Dissection / Autopsy instruments
  17. 17. Autopsy AUTOPSY INSTRUMENTS Probes (general operators and straight)  Scissors (large blunt-ended, small pointed-ended, medium blunt and pointed-ended and a pair with one blade having a hook extension for opening of the gut)  Forceps (blunt end 4 , 6 )  Knives ◦ Fixed blade 5 ◦ Knife handles for detachable blades ◦ Operating amputating, cartilage cutting, and long knives (from 12 to 24 blade for cutting of brain) 
  18. 18. Autopsy  Urethral sound (curved and van burin)  Proctoscope (different sizes)  Saw electric and manual  Shears, different types (to cut ribs etc)  Hand and band saws  Chisels (small and large)  Hammers (small and large)  Post mortem needles (half curved and cutting edged)  Sutures (different types)
  19. 19. Autopsy EQUIPMENTS  Mortuary Refrigeration Units – 02, 04, 06 body units with hydraulic lift trolley (custom built freezer room)  Autopsy tables  X-Ray machine + Mobile X-Ray unit  Suction unit  Dissection / Autopsy instruments
  20. 20. Autopsy AUTOPSY INSTRUMENTS Probes (general operators and straight)  Scissors (large blunt-ended, small pointed-ended, medium blunt and pointed-ended and a pair with one blade having a hook extension for opening of the gut)  Forceps (blunt end 4 , 6 )  Knives ◦ Fixed blade 5 ◦ Knife handles for detachable blades ◦ Operating amputating, cartilage cutting, and long knives (from 12 to 24 blade for cutting of brain) 
  21. 21. Autopsy  Urethral sound (curved and van burin)  Proctoscope (different sizes)  Saw electric and manual  Shears, different types (to cut ribs etc)  Hand and band saws  Chisels (small and large)  Hammers (small and large)  Post mortem needles (half curved and cutting edged)  Sutures (different types)
  22. 22. External Examination Steps of an external examination. 1. Photographed. 2. Physical evidence collected off body. 3. Samples of hair, nails, etc. are collected. 4. Undressed, examined for wounds. 1. Lacerations, abrasions, bruises. 5. Measured, weighed, cleaned.
  23. 23. Removal and Dissection of the Organs  One organ at a time  All body organs at once - ”Rokitansky Method”  Upon removal each organ is: ◦ Weighed & measured ◦ Examined ◦ Sliced in cross sections ◦ Sampled for microscopic & chemical analysis bsapp.com
  24. 24. Signs of death algor mortis ;Cooling of the body  Liver mortis ;color of death  Rigor mortis; stiffness of death  Pallor mortis; pallor of death
  25. 25. MLA Time after death t b/w death &pm exam is called pm interval  death is immediate or instantaneous, or hospitalized  A diagrammatic representation o f all imp injuries is sketched,  e autopsy #  .date ,place,  signed by MLO. 
  26. 26. Columns of General Register  Entry in the daily and autopsy register  Serial number  Date and time of receipt of corpse  Name and identity of deceased  Name and number of the constable and his police station  Date and time of delivery of corpse  Yearly number  Autopsy number  Date and time of autopsy  Details about specimens collected and laboratory where sent  Provisional / final conclusions regarding cause of death The trained mortician fills all theses columns, except the last three entries that are made by the medical examiner personally Contd.
  27. 27. Autopsy  Personal identity of the corpse to be verified by two relatives with their names and relation  In absence of relatives subjective identification – may include photography and finger prints
  28. 28. 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
  29. 29. 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 – shot charge, glass pieces, hair, foreign fibers -not matching the clothes of the deceased
  30. 30. Physical examination of body surfaces - 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 / natal cleft
  31. 31. Autopsy  Palpation of the body surface ◦ 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
  32. 32. Autopsy  Opening of body cavities ◦ All the three cavities to be opened ◦ Abdomen and thorax opened together  Autopsy incisions ◦ Straight incision extending from chin to pubis avoiding the umbilicus ◦ Y – shaped incision – extending from the base of each ear to meet in the midline at suprasternal notch and continued as straight incision (better exposure of neck structures – may be modified) ◦ Incisions for cranial cavity opening
  33. 33. Autopsy  Exposure of the thorax ◦ Reflect skin along with muscles from chest wall ◦ Cut costal cartilages medial to costo-chondral junction with large cartilage knife ◦ Cut the first rib with rib shear ◦ Dissect to free the diaphragm from the last rib ◦ Remove the sternum – exposes heart, superior media sternum and pleural cavities ◦ Test for presence of air in the plural / pericardial cavities ◦ Examine the pleural cavities for presence or absence of any fluid / adhesions ◦ Examine the pericardial cavity & note the amount of fluid and condition of surface and adhesions if any ◦ Haemo pericardium if any be collected and measured ◦ Locate the source of bleed
  34. 34. Autopsy PERICARDIAL CAVITY  Open with care  Note amount of fluid  Condition of surfaces  Presence or absence of adhesions  Hemo-pericardium – amount of blood – source of bleed
  35. 35. Autopsy  Heart may be removed unopened or right side opened before removal – make incision in the right atrium continue through tricuspid valve along the inferior part of right ventricle then through interior wall of right ventricle close to septum and into the pulmonary artery  Scrutinize atrium, ventricle, pulmonary artery for thrombus / embolism.
  36. 36. Autopsy  Exposure of the Neck Structures ◦ Elevation of skin and subcutaneous tissues as far as the arch of the mandible – layer wise dissection of neck muscles
  37. 37. Autopsy  Examination of the abdominal cavity ◦ Peritoneum incised using two fingers of left hand to elevate to avoid injury to internal viscera ◦ Inspect all the organs and the blood vessels including those in the pelvis
  38. 38. Autopsy OPENING OF CRANIAL CAVITY  Neck extended by a wooden block under the neck and upper chest  Incision – intermastoid extending on the vertex  Reflect the scalp anteriorly (1.5 cm above supra orbital ridge) and posteriorly  Clean and examine the skull  Give circular saw cut 4 cm above the supra orbital margin anteriorly and over the occipital bone posteriorly
  39. 39. Autopsy Examination of Vertebral Column and Spinal Cord  Anterior approach ◦ Removing all the structures of thorax and abdomen and vertebral column exposed and spinal cord exposed by cutting the vertebral bodies
  40. 40. Autopsy  Posterior approach ◦ Midline incision from base of head to the sacrum, tissues on each side separated, examine the vertebrae. cut through the lemina, spinus processes and laminae removed and spinal dura exposed. ◦ To examine the spinal cord- separate dura from the anterior surface of vertebral bodies ◦ incise the dura along posterior and anterior
  41. 41. Autopsy ADOPT SPECIAL PROCEDURES FOR  Pneumothorax  Pulmonary embolism  Location of thrombus in atrium / ventricle
  42. 42. Autopsy Collection of Samples 1. For chemistry – blood, urine, CSF 2. For toxicological examination – organs, fluids 3. Histological examination
  43. 43. Autopsy Specimens for a suspected case of poisoning (for toxicological analysis) Specimen / Organ Quantity Hair 10 gm Brain 500 gm Liver 500 gm Kidney One whole / ½ of each Lung One whole Stomach Whole with contents Small intestine Initial two feet with contents Blood 50 – 100 cc Urine All available
  44. 44. Autopsy Choice of Specimens Nature of Poison Specimen Alcohol, chloroform, ether, alkaloids, barbiturate, benzene Brain Metals, barbiturates, fluoride, oxalate Liver Heavy metal especially mercury Kidney Lead, arsenic, radium (chronic poisoning) Bone All gaseous poisons Blood Barbiturate, sulfonal, heavy metals Urine
  45. 45. Autopsy Preservatives  Toxicology: ◦ Saturated solution of sodium chloride 33% ◦ Rectified spirit – not to be used in alcohol, phosphorus, acetic acid, carbolic acid ◦ For gaseous poisoning – no preservative (blood, urine in test tube with a layer of liquid paraffin, refrigerate and examine quickly)
  46. 46. Autopsy Preservatives  Histology: ◦ 10% formalin in normal saline ◦ Ethyl alcohol – 90%
  47. 47. Autopsy Reconstruction and Disposal of dead body:  Replace organs in their places  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
  48. 48. 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 – post mortem artifacts lack vital reactions Causes:  Post mortem phenomenon  Physical handling  Interference by scavengers / insects / animals
  49. 49. Autopsy Hazards  Mechanical  Biological  chemical  Electrical  Radiological
  50. 50. Autopsy / Hazards Mechanical  Injuries to limbs ◦ Fractures of lower limbs by fall on wet slippery floor  Injuries to hands ◦ Cut by sharp instruments during dissection ◦ Needle prick during closure of dead body ◦ Burns from boiling water and hot instruments  Injuries to back ◦ Muscles sprains from carrying of heavy corpse  Injuries to eyes ◦ Corneal ulcers by bone dust from sawing of bone
  51. 51. Autopsy Hazards  Biological hazards ◦ Bacterial ◦ Viral ◦ fungal
  52. 52. Autopsy / Hazards Biological  Bacterial infections ◦ From septicemic and pyemic dead body ◦ From purulent fluids in cavity, abscess or from pus from organs and viscera ◦ From specific infections  Typhoid and paratyphoid  Tuberculosis  Leprosy  Anthrax
  53. 53. Autopsy / Hazards  Viral infections ◦ Hepatitis ◦ HIV / AIDS  Fungal
  54. 54. Autopsy / Hazards Chemical  Antiseptics and disinfectants ◦ Iodine ◦ Phenols fluid ◦ Dettol  Fixatives ◦ Formalin
  55. 55. Autopsy / Hazards Electrical  Electric burns due to faulty appliances, metallic autopsy table and wet floors Radiation  Electromagnetic radiation  Ionizing radiation from therapeutic radioactive isotopes
  56. 56. Autopsy Hazards  Measures to prevent hazards : ◦ ◦ ◦ ◦ ◦ ◦ Autopsy protective dress including shoes Thick rubber gloves ( kitchen gloves) Protective eye glasses Keep surfaces dry Insulate all electrical appliances In case of needle pricks---remove gloves – allow to bleed wash thoroughly and apply antiseptic dressing ◦ Get all the workers vaccinated against infectious diseases
  57. 57. Exhumation  It is lawful digging out of the dead body from the grave for postmortem examination or reexamination.  Objectives of Exhumation: a- When suspicion of foul play has been raised after burial. b- When cause of death is disputed and further medical evidence is required. c- When identity of the dead body is to be established.  Authorization: In Pakistan............... By Session Judge.(Magistrate) Time Limit: In Pakistan............... No time limit.
  58. 58. Procedure of Exhumation  : a- Necessary preparations with the help of graveyard authorities b- Identification of the grave by: Care taker of graveyard Grave digger. Relatives or friends present at the time of burial. c- Removal of the dead body from the grave. d- Collection of the samples of the earth in cases of suspected poisoning from : Above the dead body Below the dead body On the sides of the body Control sample from distant place
  59. 59.  Autopsy Examination: No difference in the procedure of Autopsy between a fresh body and body buried in a grave. a- Identification b- External examination c- Internal examination: Special attention to any bony injury. d- Collection of viscera for chemical examination, If not available------- shapeless, homogenous mass of different organs in abdominal & thoracic cavities. Hair, nail, teeth, skin if present.
  60. 60. Autopsy / Exhumation Exhumation  Removal (interment) of corpse from the grave to determine the cause of death Procedure of Exhumation:  Exhumation order by District Magistrate  Nomination of a magistrate by District Magistrate  Team consist of duty magistrate, investigating officer with police and medical examiner  The team reaches the graveyard in the early morning hours  Area cordoned by the police
  61. 61. Autopsy / Exhumation  Grave identified by relatives  Interment of body ordered  Autopsy performed – if feasible body may be shifted to mortuary  Skeleton may reveal useful information  Specimens from the sites of organs may be collected for toxicological analysis if required  The investigating officer must consult the medical officer about the usefulness of the procedure especially if more than 3 weeks have passed since burial
  62. 62.              First Information Report (FIR) is a written document prepared by the police when they receive information about the commission of a cognizable offence. It is a report of information that reaches the police first in point of time and that is why it is called the First Information Report. It is generally a complaint lodged with the police by the victim of a cognizable offence or by someone -on his/her behalf. Anyone can report the commission of a cognizable offence either orally or in writing to the police. Even a telephonic message can be treated as an FIR.
  63. 63. Cognizable Offence         A cognizable offence is one in which the police may arrest a person without warrant. They are authorized to start investigation into a cognizable case on their own and do not require any orders from the court to do so. Non-cognizable Offence A non-cognizable offence is an offence in which a police officer has no authority to arrest without warrant. The police cannot investigate such an offence without the court's permission.
  64. 64. An FIR is a very important               document as it sets the process of criminal justice in motion. It is only after the FIR is registered in the police station that the police takes up investigation of the case. Who can lodge an FIR? Anyone who knows about the commission of a cognizable offence can file an FIR. It is not necessary that only the victim of the crime should file an FIR. A police officer who comes to know about a cognizable offence can file an FIR himself/herself.
  65. 65. The police may not investigate a complaint even if you file , a when:  FIR (i) The case is not serious in nature; (ii) The police feel that there is not enough ground to  investigate.  However, the police must record  the reasons for not conducting an  investigation and in the latter  case must also inform you.  —[Section 157, Criminal Procedure  Code, 1973]  
  66. 66. filing an FIR?             The procedure of filing an FIR is prescribed in Section 154 of the Criminal Procedure Code, 1973. * When information about the commission of a cognizable offence is given orally, the police must write it down. * It is your right as a person giving information or making a complaint to demand that the information recorded by the police is read over to you. * Once the information has been recorded by the police, it must be signed by the person giving the information.
  67. 67.         You should sign the report only after verifying that the information recorded by the police is as per the details given by you. * People who cannot read or write must put their left thumb impression on the document after being satisfied that it is a correct record. * Always ask for a copy of the FIR, if the police do not give it to you. It is your right to get it free of cost.
  68. 68. What should you mention in the FIR? * Your name and address;  * Date, time and location of the  incident you are reporting;  * The true facts of the incident as  they occurred;  * Names and descriptions of the  persons involved in the incident; 
  69. 69. Things you should NOT do:           * Never file a false complaint or give wrong information to the police. You can be prosecuted under law for giving wrong information or for misleading the police. —[Section 203, Penal Code 1860] * Never exaggerate or distort facts. * Never make vague or unclear statements.
  70. 70. What can you do if your FIR is not registered?            * You can meet the S u p e r i n -tendent of Police or other higher officers like Deputy Inspector General ofPolice & Inspector General of Police and bring your complaint to their notice. * You can send your complaint in writing and by post to the Superintendent of Police concerned. If the Superintendent of Police is satisfied with your complaint, he shall either investigate the case himself or order an investigation to be made.

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