Download pdf - Autopsy Serve

8/8/2019 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 attendant for receiving dead bodies,

reports.inquest panchanama, for maintain record

Cutter for performing post mortem

Sweeper for cleaning p m room and premises