7/26/2019 Autopsy, Causes
1/58
AUTOPSY
7/26/2019 Autopsy, Causes
2/58
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.
7/26/2019 Autopsy, Causes
3/58
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.
7/26/2019 Autopsy, Causes
4/58
Kinds of Autopsies
Hospital or non-official autopsy
Medico-legal or official autopsy
7/26/2019 Autopsy, Causes
5/58
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.
7/26/2019 Autopsy, Causes
6/58
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.
7/26/2019 Autopsy, Causes
7/58
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.
7/26/2019 Autopsy, Causes
8/58
Persons authorized to conduct autopsies:
Medical health officers
Medical officers of law enforcement
agenciesMembers of the medical staff ofaccredited hospital
7/26/2019 Autopsy, Causes
9/58
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.
7/26/2019 Autopsy, Causes
10/58
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
7/26/2019 Autopsy, Causes
11/58
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
7/26/2019 Autopsy, Causes
12/58
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
7/26/2019 Autopsy, Causes
13/58
7/26/2019 Autopsy, Causes
14/58
7/26/2019 Autopsy, Causes
15/58
7/26/2019 Autopsy, Causes
16/58
7/26/2019 Autopsy, Causes
17/58
7/26/2019 Autopsy, Causes
18/58
7/26/2019 Autopsy, Causes
19/58
7/26/2019 Autopsy, Causes
20/58
7/26/2019 Autopsy, Causes
21/58
7/26/2019 Autopsy, Causes
22/58
7/26/2019 Autopsy, Causes
23/58
7/26/2019 Autopsy, Causes
24/58
7/26/2019 Autopsy, Causes
25/58
7/26/2019 Autopsy, Causes
26/58
7/26/2019 Autopsy, Causes
27/58
7/26/2019 Autopsy, Causes
28/58
7/26/2019 Autopsy, Causes
29/58
7/26/2019 Autopsy, Causes
30/58
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.
7/26/2019 Autopsy, Causes
31/58
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?
7/26/2019 Autopsy, Causes
32/58
CAUSES OF DEATH
7/26/2019 Autopsy, Causes
33/58
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.
7/26/2019 Autopsy, Causes
34/58
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.
7/26/2019 Autopsy, Causes
35/58
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.
7/26/2019 Autopsy, Causes
36/58
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.
7/26/2019 Autopsy, Causes
37/58
Medico-legal Masquerade
Violent deaths maybe accompanied byminimal or no external evidence of
injury or natural death maybeaccompanied by signs of violence.
7/26/2019 Autopsy, Causes
38/58
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)
7/26/2019 Autopsy, Causes
39/58
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.
7/26/2019 Autopsy, Causes
40/58
Medico-legal Classification:
Natural death
Violent death
Accidental death Negligent death Infanticidal death Parricidal death Murder Homicidal death
7/26/2019 Autopsy, Causes
41/58
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
7/26/2019 Autopsy, Causes
42/58
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.
7/26/2019 Autopsy, Causes
43/58
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.
7/26/2019 Autopsy, Causes
44/58
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.
7/26/2019 Autopsy, Causes
45/58
Classification of trauma or injuries:
Physical injury
Thermal injury
Electrical injuryAtmospheric injury
Chemical injury
Radiation injury
Infection
7/26/2019 Autopsy, Causes
46/58
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.
7/26/2019 Autopsy, Causes
47/58
Death under special circumstances:
Death caused in a tumultuous array
Death or physical injuries inflicted under
exceptional circumstances.
7/26/2019 Autopsy, Causes
48/58
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.
7/26/2019 Autopsy, Causes
49/58
Special Deaths
Judicial death
Euthanasia
SuicideDeath from starvation
7/26/2019 Autopsy, Causes
50/58
Judicial Death
Death by electrocutionDeath by lethal injectionDeath by hanging
Death by musketryDeath by gas chamberOthers Beheading Crucifixion Stoning Smothering
7/26/2019 Autopsy, Causes
51/58
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.
7/26/2019 Autopsy, Causes
52/58
Who may perform euthanasia
The patient himself.
The physician, with or without the
knowledge and consent of the patient.(R., v. Adams,)
Karen Quilan
7/26/2019 Autopsy, Causes
53/58
Suicide:
It is an unfortunate consequence ofmental illness and social
disorganization.Rare in children, common in adults andelederly.
Male > femaleUsually occurs at home.
7/26/2019 Autopsy, Causes
54/58
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)
7/26/2019 Autopsy, Causes
55/58
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.
7/26/2019 Autopsy, Causes
56/58
Death from starvation:
Types: Acute starvation
Chronic starvationCauses: Suicidal
Homicidal Accidental
7/26/2019 Autopsy, Causes
57/58
"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?"
7/26/2019 Autopsy, Causes
58/58
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?