Autopsy, Causes

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    AUTOPSY

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    Autopsy

    It is a comprehensive study of a dead body,performed by a trained physician employing

    recognized dissection procedure andtechniques. Tissues maybe removed forfurther examination and preservation.

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    Autopsy vs Post-mortem Examination

    Post-mortem examination- externalexamination of a dead body without

    incision being made. Blood and bodyfluids maybe collected for examination.

    Autopsy- in addition to external

    examination, the body is opened and aninternal examination is conducted.

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    Kinds of Autopsies

    Hospital or non-official autopsy

    Medico-legal or official autopsy

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    Hospital Autopsy

    Purpose: Determine the cause of death

    Provide correlation of clinical diagnosis andclinical symptoms Determine the effectiveness of therapy Study the natural course of disease process

    Educating students and physiciansConsent of the rightful person needed.

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    Medico-legal Autopsy

    Purpose: Determine the cause, mode and time of death.

    Recover, identify and preserve evidentiary material.

    Provide interpretation and correlation of facts andcircumstances related to death

    Provide a factual, objective medical report for lawenforcement, prosecution and defense agencies

    Separating death due to disease from death due toexternal cause for protection of the innocent.

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    When shall an autopsy be performed?

    Whenever required by special laws.

    Upon order of a competent court, a mayor and a provincialor city fiscal.

    Upon written request of police authorities.

    Whenever the Solicitor General, Provincial or City fiscal asauthorized by existing laws, shall deem it necessary todisinter and take possession of the remains forexamination to determine the cause of death

    Whenever the nearest kin shall request in writing the

    authorities concerned in order to ascertain the cause ofdeath.

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    Persons authorized to conduct autopsies:

    Medical health officers

    Medical officers of law enforcement

    agenciesMembers of the medical staff ofaccredited hospital

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    Guidelines in the performance of autopsies:

    It should follow the protocols in conducting autopsies.

    It must be comprehensive.

    Bodies which are mutilated, decomposing or burned arestill suitable for autopsy.

    Autopsies must be performed in a manner which showrespect of the dead body.

    Proper identity of the deceased autopsied must beestablished in non-official autopsy.

    A dead body must not be embalmed before autopsy.

    The body must be autopsied in the same condition when

    found in the crime scene.

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    Stages in the conduct of Autopsy:

    Preliminary examination Examination of the surrounding

    Examination of the clothing Identity of the body

    External examination Examination of the body surfaces

    Determination of the position and approximationtime of death

    Internal examination

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    Mistakes in autopsies:Error or omission in the collection of evidence foridentification. Failure to take photographs, fingerprints

    Error or omission in the collection of evidence required forestablishing the time of death

    Failure to report rectal temperature.Error or omission in the collection of evidence required forother medico-legal examination. Failure to collect nail scrapings, sample of hair,, seminal fluid

    Error or omission result in the production of undesirable

    artifacts or in the destruction of valid evidence. Using hammer and chisel to open skull

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    Negligent autopsy:

    Failure to have an adequate history or factsand circumstances surrounding the death.

    Failure to make a thorough externalexamination.

    Inadequate or improper internal examination.

    Improper histological examination.

    Lack of toxicological or other laboratory aids.

    Pathologist incompetence

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    Jenny entered the library seeking just the right information. The problem wasa tricky one. She watch enough of those TV crime shows to know that. She

    approached the young man behind the information desk. " I wonder, couldyou show me where I can find information on poisons?"

    "What kind of poisons?" he asked her with a nice smile. "Too many bugs onyour ros bushes?"

    "Oh no, I'm a mystery writer and I want to know an untraceable poison in one

    of my books to kill off a bad guy," she told him, using the line she'd rehearsedon front of the mirror.

    Even though Max had one foot in the grave and the other on the banana

    peel, Jenny knew his kids would blame her for his death. Unless he died ofnatural causes, they'd suspect her and demand an autopsy. After all, evenunder the terms of prenuptial agreement, she d get a life estate in the houseand its content, and a pretty substantial sum of money, too. So the poisonhad to be untraceable.

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    It seems that most poisons were traceable. But. There was one that seem to

    fit the bill. She headed home after stopping at the drug store to refill Max s

    medications and pick up a few things for herself.

    She came home, changed into sweats, painted and reprinted her nails and

    finally helped Max with his medications, as usual. She slept restlessly that

    night with Max in the next room. She could hear him wheezing through the

    walls. Max was old, with cardiac problems and asthma. How long could he

    live anyway?

    Max suffered seizure and was brought to the hospital, treated and released.

    Over the next three months, Max condition deteriorated and became

    weaker, more confused and suffered headaches and dizziness. During the

    last visit from his kids, Max died. Jenny jumped for Joy and started packing

    for her Grand Cayman vacation.

    If not for the faint smell of almonds present during autopsy, the medical

    examiner might never have known there was a found play. What had Jenny

    used to kill Max?

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    CAUSES OF DEATH

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    Cause of Death

    It is the injury, disease or thecombination of both responsible for

    initiating the trend or physiologicdisturbance, brief or prolonged, whichproduces the fatal termination.

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    Cause of Death

    Immediate (primary) cause of death: it iswhen trauma or diseases kill quickly thatthere is no opportunity for sequelae orcomplications to develop.

    Proximate (secondary) cause of death:it iswhen the injury or disease was survived for a

    sufficiently prolonged interval whichpermitted to the development of serioussequelae which actually caused the death.

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    Mechanism of death

    It is the physiologic derangement orbiochemical disturbance incompatible

    with life which is initiated by the causeof death. Ex: hemorrhagic shock, sepsis,respiratory depression.

    Cardio-respiratory arrest should neverstand as the cause of death.

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    Manner of Death

    It is the explanation as to how the causeof death came into being or how the

    cause of death arose.Natural: death is caused solely by adisease.

    Violent or unnatural death: death due toinjury of any sort.

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    Medico-legal Masquerade

    Violent deaths maybe accompanied byminimal or no external evidence of

    injury or natural death maybeaccompanied by signs of violence.

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    Degree of certainty to the cause ofdeath:

    When the structural abnormalities established beyonddoubt the identity of the cause of death.

    When there is that degree of probability amounting

    to almost certainty the cause of death.When the cause of death is established primarily byhistorical facts.

    When neither history, laboratory and anatomicfindings is sufficient to determine the cause of deathbut merely speculate as to the cause of death.(probably)

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    Instantaneous physiologic death:

    Sudden death within seconds or minutes after aminor trauma or peripheral stimulation. Circulatoryfailure is caused by vagocardiac stoppage of heart

    and dilatation of blood vessels. (urination, kick in thescrotum)

    Death by inhibition: diagnosis by exclusion

    Diseases with no pathognomic findings: Sudden infant death syndrome Sudden unexplained nocturnal death

    For cases where there is no working diagnosis upondeath, the cause of death should be undetermined.

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    Medico-legal Classification:

    Natural death

    Violent death

    Accidental death Negligent death Infanticidal death Parricidal death Murder Homicidal death

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    Natural death

    Affection of the CNS

    Affection of the circulatory system

    Affection of the respiratory systemAffection of the gastrointestinal tract

    Affection of the genito-urinary tract

    Affection of the glands

    Sudden death in young children

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    If violence was applied on a dead person, the personinflicting the physical injuries cannot be guilty ofmurder, homicide or parricide.

    If the violence inflicted on a person suffering from anatural disease only accelerated the death of thevictim, the offender inflicting such violence isresponsible for the death of the victim.

    If the victim died of a natural cause and the physical

    injuries inflicted is independent of the cause of death,the accused will not be responsible for the death butmerely for the physical injuries he had inflicted.

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    To make the offender liable for the death ofthe victim, it must be proven that the death isthe natural consequence of the physicalinjuries inflicted.

    The physician must determine for the interestof justice with absolute care at autopsy and

    laboratory examination the real cause ofdeath.

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    Violent death

    The following should be established: The the victim at the time the physical

    injuries were inflicted was in normal health. That the death maybe expected from the

    physical injuries infected. That the death ensued within a reasonable

    time.

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    Classification of trauma or injuries:

    Physical injury

    Thermal injury

    Electrical injuryAtmospheric injury

    Chemical injury

    Radiation injury

    Infection

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    Refusal of the victim to submit to a surgicaloperation do not relieve the accused from thenatural and ordinary result of the feloniousact and does not relieve him of his criminalliability.

    The presence of infection on the wounds

    inflicted if not deliberately induced by thevictim makes the offender also responsible forit.

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    Death under special circumstances:

    Death caused in a tumultuous array

    Death or physical injuries inflicted under

    exceptional circumstances.

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    Pathological classification of the causesof death.

    Death from syncope Death from sudden cessation of heart action

    Death from asphyxia Death from low or absent oxygen in the blood andtissues.

    Death from coma

    Death resulting from arrest in the function of thebrain.

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    Special Deaths

    Judicial death

    Euthanasia

    SuicideDeath from starvation

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    Judicial Death

    Death by electrocutionDeath by lethal injectionDeath by hanging

    Death by musketryDeath by gas chamberOthers Beheading Crucifixion Stoning Smothering

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    Euthanasia

    Types of euthanasia Active euthanasia

    Active euthanasia in demand

    Passive euthanasia Orthothanasia when an incurably ill person is allowed to

    die a natural death without the application of any operationor treatment.

    Dysthanasia when there is an attempt to extend the lifespan of a person by the use of extraordinary treatmentwithout which the patient would have died earlier.

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    Who may perform euthanasia

    The patient himself.

    The physician, with or without the

    knowledge and consent of the patient.(R., v. Adams,)

    Karen Quilan

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    Suicide:

    It is an unfortunate consequence ofmental illness and social

    disorganization.Rare in children, common in adults andelederly.

    Male > femaleUsually occurs at home.

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    Suicide

    Psychological classification of suicide: First degree deliberate, planned

    Second degree impulsive, unplanned

    Third degree accidental

    Suicide which suggest lack of capacity for intention.(ex. psychotics)

    Self destruction due to self negligence.(recklessdriving)

    Justifiable suicide (incurable diseases)

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    Evidences that will infer death is suicidal.

    History of depression, mental disease or unresolvedpersonal problem.

    Previous attempt of self destruction.

    In committed by inflection of physical injuries, the

    wounds are located in areas accessible to the hand,vital parts of the body and usually solitary.

    Others: presence of cadaveric spasm in in handholding the gun; bottle of poison;absence of signs ofstruggle.

    Presence of suicide note.Suicide scene in a place not susceptible to public view.

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    Death from starvation:

    Types: Acute starvation

    Chronic starvationCauses: Suicidal

    Homicidal Accidental

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    "My husband has stopped breathing." Irene said to the dispatcher of 911. The

    famous politician was found faced up, his shirt partially opened and his open

    jaw showing the early stages of rigor mortis.

    When the medical examiner arrived at the scene,detective Wilson said, "we're

    thinking this is a drug overdose, Doc. The guy was known heroine user. Even

    the wife admits he liked to "chase the dragon" (inhale the vapors of heroine).

    Detective Wilson continued,"We found 6 balloons of Mexican black tar heroine

    in the bedside table along with the pill bottle of Xanax." Both knew Xanaxcould be used to help a drug user detox after a long drug binge.

    Well, let see what the body tells us,DR Lester said. He pulled on a pair of latex

    gloves and as he observed, he dictated into a small digital recorder his initial

    findings. "A red area over the victim's upper lip". He opened the eyelids one at

    a time. "Petechial hemorrhage s in both eyes."

    "What?"

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    DR. Lester held up his hand in the classic sign for patience andcontinued his observations. "Two small, reddish brown marks on

    the chest." He turned the body over. "Bruises on his back, smallscrapes on both wrists contain the distinctive markings of wristrestraints."

    "You're thinking robbery gone bad?"

    DR. Lester didn't respond. His examination continued for anotherhalf hour. When he finished, detective Wilson asked, "anypreliminary decisions on manner of death.?"

    "I'll need to wait for the tox screen," he said, referring to the blood

    tests that would reveal the level of drugs in the deceased's body.Maybe accidental overdose or suicide. But I'm thinking homicide."

    Why?