Autopsy Serve
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Transcript of 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