Autopsy Serve

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    Autopsy is a special type of scientific examination

    of a dead body carried out under the laws of state

    to 1) determine the cause of death whether

    natural or unnatural 2)to determine identity of the person

    3)to determine time since death

    4)in new born infants to determine the question

    of live birth and viability

    5)in case of mutilated bodies to find whether they

    are human and if human the probable cause of

    death.

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    types of post mortems

    Medico legal

    Pathological

    In a hospital attached to government /bmc

    teaching institutions(medical college)

    medico-legal post mortems are done by doctors

    from Forensic medicine and toxicology dept and

    Pathological post-mortems are done by

    pathologists

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    Medico-legal post mortem is done in following cases

    deaths due to unknown poisoning,

    drowning,

    accidents-vehicular railway hanging

    asphyxia due to unknown cause

    brought dead pts in casualty,

    Death due o fire arms injury Electric shock

    pts who dies in hospital within 24 hrs of admissionwhere doctors are not in the position to state causeof death .

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    Essential requirements for medico legal pm

    Authorisation : in earlier days it was given by

    coroner but now days it is given by inspector or

    sub inspector of police stationA dead body challan and inquest report should be

    handed over by investigating police officer to

    medical officer for performing autopsy.

    Identification of dead body should be done byconstable to avoid p m on wrong dead body

    Visit the scene of crime if needed

    Examination of dead body internal and external.

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    Criteria for pathological post mortems

    Any pt died in hospital after 24hrs of admission andstill if treating doctor is not in a position to commentthe cause of death due to non conclusive reports ,ifpts has not responded to treatment

    For research studies like to find out cause formetabolic disorder, genetic abnormalities.

    No invasive procedure like central line ;any operation

    shouldn't have been carried out on pt.panchnama/inquest report is not required.

    Only a request letter in the name of pathologist bytreating doctor is essential and superintendent andhospital administrators are informed.

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    Benefits of autopsiesBenifits to families

    Psychologically, the autopsy provides closure byidentifying or confirming the cause of death. Theautopsy can demonstrate to the family that the careprovided was appropriate, thereby alleviating guiltamong family members and offering reassuranceregarding the quality of medical care

    Benefits for the clinician and hospital:

    The procedure can confirm the accuracy of the clinicaldiagnoses and the appropriateness of medical care.

    The autopsy findings can be utilized to educatephysicians, nurses, residents, and students, therebycontributing to an improved quality of care.

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    According to Government Rule 2005.

    Post mortem can be carried out for 24 hrs i e

    during night time also:

    where there is light source of 8 tube lights. Andthe walls and floorings are covered with white

    coloured tiles/ marble.

    If the doctor finds any suspicious cause after

    external examination and reading inquest report

    He can postpone the Post mortem till next

    morning.

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    Post mortem to be done by 2 medical

    officers.

    Any female who dies with in 7 years of married life, p m should be done by 2 medical officers of

    which 1 should be preferably female if available.

    Any complicative post mortem like suspected

    rape ,fire arms (gun shot) ,death due to assault.

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    If it is not possible to comment cause of death theviscera has to be send to forensic medicine lab atkalina santacruz Mumbai for chemical analysis,

    And for histopathology at J J group of hospital.

    Method for collection and storage of viscera

    All the desired organs like pieces of liver,lungs,spleen,kidney ,pancreas,adrenals,brain are cutand washed under running tap water to clear blood

    and stored in plastic bottle containing 10% formalinand send for histopathology.

    Stomach and small intestine with contents are storedin plastic jar containing common salt and sent forchemical analysis.

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    Other items that can be sent for chemical analysisare

    Blood

    HairNail clippings

    Vaginal and anal swab

    Every bottle labelled and sealed properly.

    Name-Age/sexP m no.

    ADR no.

    Viscera for HP/ CA

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    Final cause of death should be given after obtaininghistopathology report chemical analysis report andassessment of medical records.

    After writing every cause of death it should always bestated whether it is due to natural cause or unnatural.

    Eg.

    Death duet to bilateral extensive pulmonarykochs(Natural).

    Death due to drowning under water (Unnatural).Evidence of ligature mark around neck however finaldiagnosis after HP and CA report. And assessment ofmedical records.

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    If the body is decomposed and can not be moved

    from that place then post mortem has to be done

    on the spot where the body is found on request

    of police which is called spot post mortem.

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    Post mortem centres in Mumbai

    Facilities for p m is available at every govt/ bmcteaching institution

    J J group of hospitals K E M SION AND NAIRhospitals

    And also at 1)cooper p m center,

    2)rajawadi p m center

    3) bhagawati p m center.All these p m centres are under direct control of

    home ministry. And police surgeon is the in chargeof all post mortem centres .

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    Format for p m report

    Cause of death certi. For identified bodies and

    Unknown /unidentified bodies ( pink colour.)Death certificate for in hospital pts

    Histopathology forms

    Chemical analysis form

    Post mortem notes should be filled immediatelyby doctor within 3 to 7 days in two copies , onecopy is kept as a medical record and other copyshould be collected by concern police station.

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    After post mortem a separate certificate is issued

    by concern police station for transporting the

    body to the desired place for cremation.

    In metropolitan cities it is rule that no bodyshould be cremated without a cause of death

    certificate.

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    EMOLUMENT PAID TO DOCTORS

    To encourage doctors for doing pos mortems

    Government has started paying doctors in following

    way

    Doctor Rs.60/- per p m

    Asist. Doctor Rs.30/- ---------

    Attendant Rs. 20/-Cutter Rs 15/-

    Upto maximum of 30 post mortems per month

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    MORTURY

    After Death of pt in hospital and after post mortem the bodyis sent to place called mortuary for temporary storage.. Itis preserved in a proper condition below 4 c until it isdisposed off.

    LOCATION :

    Ground Floor is the best location for a Mortuary andpostmortem room. It should have suitable separate exitand area should be protected from the view of patientsand public.

    Size of the department depends upon whether it is teachingor non-teaching hospital

    . It has been estimated that in hospital, there is one deathper bed per year and the size of mortuary should be basedon this estimate.

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    cold storage room

    with multiple compartments for storage of dead

    bodies at the temp of below 4c.

    post mortem room

    There should be three to four separate tables with

    large sinks and abundant water supply.

    Source of light should be adequate.

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    Viscera Preservation Room :

    All viscera required to send to

    histopathology and chemical analysis should be

    preserved in proper container and stored insteel cupboards.

    Medical Officers Room :

    It should be provided with a table, two-three

    chairs for patients relatives. A resting area formedical officer should be provided with a

    toilet, bathroom, and basin and facilities for

    communication .

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    Record Room :

    To keep records of post-mortems notes,

    inquest reports, letters received from concern

    police stations, stock register of equipments and supplies.

    Separate register has to be maintained for

    medico legal p m s and in hospital deaths.

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    Store room

    for storing instruments ,gloves aprons, chemicals,

    stationeries.

    A room for morgue attendants with toilet and

    bathroom.

    A waiting room for relatives.

    A room for police-equipped with telephone.

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    Staff required

    Head of department professor ,associate

    professor ,lecture in forensic medicine and

    toxicology

    Medical officer

    Mortuary