THE AUTOPSYFORENSIC PATHOLOGY
MEDICAL EXAMINER or CORONERCoroner- elected position, most not medical professionals, undertakers, politicians, required qualifications- US citizen, over 21 yo. Medical examiner- physicians, most not trained in forensic pathology
The AutopsyAn autopsy is an examination of the body after deathInternal and external examsPurpose is to document any disease or injury that may have contributed to the deathOverall purpose is to create an opinion regarding the cause and manner of death
When Forensic Pathology is Appliedviolent deathshomicide accidents suicides suspicious sudden and unexpected child or infant deathsprisonerspersons under institutional caredrugs or alcohol deaths in close proximity to surgerysuspicion of public health threat
The AutopsyUSES:-establish COD, MOD TOD-weapon used-find identity of deceased-determining the effect of trauma or pre-existing conditions
Manners of DeathNatural- dies of cancerHomicide- gunshot woundSuicide- gunshot woundAccident- fallen off an icy ladderUndetermined
Causes of Death/Mechanism of DeathAsphyxiaStrangulationDrowningSmotheringWoundsBulletStabBlunt ForceRapePoisoningBurnTraffic Fatalities
The AutopsyAverage a couple hoursPerformed in an M.E. or coroners officePerformed normally 8am-4pm, or 24hrs a day, 7 days a week, 365 days a year.Autopsies may cost from several hundred to several thousand dollars depending on purpose and types of tests run.
External ExamEvidenceMeasurementsPhotographsOdor- cyanide (almond), alcoholWounds, bruises, needle marks, petechia TattoosRigidity, Lividity
TOD- Stages of DecompositionRigor Mortis- stiffening of muscles and body parts in position at death Due to loss of ATP in muscle cellsBegins 1-2 hours after deathStarts at top of body and proceeds downwardComplete within 8-12 hrsMuscles will relax as break down occurs, 24-36hrEnvironment affects rate
TOD- Stages of DecompositionLivor Mortis- blood settling down towards areas closest to the groundDetermine position at death (death-12 h)Red Blood Cells settle and break down in tissues (bruising), (1-2 hrs)Fixed then death > 10 hrsNot Fixed then death (skin turns white when pressure applied) < 10 hrs
TOD- Stages of DecompositionAlgor Mortis- body loses heat after death, ~ 1-1.5 F (.4 -.75 C)/hr until environmental temp. reached
Affected by environment, body fat, clothing
TODOcular Fluid (vitreous humor)- after death blood cells in eye break open and release potassium, amt of K present can indicate TODOpen eyes- eyes dry, cloudy film, 2-3 hrs. after deathClosed eyes- ~24 hrs
TODStomach Contents- digestion of last mealFull undigested meal : 2-4 hrsStomach empty, SI full: 4-6 hrsSmall Intestine empty- > 12 hrs
TODInsect Infestation- stage of life cycle of insects on DB is indicative of TODThe blowfly is the first witness to arrive at the crime scene
The pathologist first examines the outside of the body. A great deal can be learned in this way. Many pathologists use scalpels with rulers marked on their blades.
The body is opened using a Y-shaped incision from shoulders to mid-chest and down to the pubic region. If the head is to be opened, the pathologist makes a second incision across the head, joining the bony prominences just below and behind the ears. When this is sewed back up, it will be concealed by the pillow on which the dead person's head rests. The pathologist uses a scalpel for these incisions. There is almost no bleeding, since a dead body has no blood pressure except that produced by gravity.
The incisions are carried down to the skull, the rib cage and breastbone, and the cavity which contains the organs of the abdomen. The scalp and the soft tissues in front of the chest are then reflected back. Again, the pathologist looks around for any abnormalities.
The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative The rest of the team is continuing with the removal of the other organs. They have decided to take the urinary system as one piece, and the digestive system down to the small intestine as another single piece. This will require careful dissection
**Most people fail to realize that almost half the deaths examined by a forensic pathologist are natural deaths occurring in the absence of injury.*Homicide and suicide may require the most work to determine the manner of death because a homicide may be set up to look like a suicide when in reality it is a homicide.**Performed in off hours in cases of mass disasters or high profile media attention.*