Transcript PERI- AND POSTMORTEM EXAMINATION

Subsection C1
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1. Resuscitative artifacts
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2. Autolysis / decomposition
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3. Rough Handling During Exhumation
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4. Transport and Autopsy
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5. Body Changes Secondary to Exposure to
Natural Elements, Animals / Insects
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injuries observed on the patient’s body
during the initial scene investigation.
includes any and all resuscitative efforts by
trained and untrained personnel, which may
have caused injury to the body.
“IATROGENIC COMPLICATIONS”
◦ Laryngeal
abrasions from
traumatic
intubation
◦ Skin & soft tissue
lesions, rib &
sternum fractures
from chest
decompression
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Surgical stab wounds for insertion of tubes & drains
Laparotomy, tracheostomy, & thoracotomy incisions
Incisions for peritoneal lavage
Cutdowns of wrists, antecubital fossa, & ankles
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May be misinterpreted!
Therapeutic tubing (i.e. IV lining, respiratory
tubes, catheters, tracheostomies) should
never be removed prior to sending a body to
the coroner
Chart should be reviewed prior to autopsy
Treating physicians should be consulted
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Physicians, Fire Personnel, and Law Enforcement
◦ resuscitative treatments often cause external or internal
injuries to patients – documentation necessary
◦ resuscitative artifacts and any associated equipment
visible on the body should be documented in the
investigative report and photographed.
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agency and contact name and number of the
individual who attempted resuscitation should
also be documented in the report for follow-up as
necessary.
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Relatives, Neighbors, Good Samaritans
the investigator needs to document
resuscitative efforts by photographing any
artifacts or injury visible on the patient.
include the name and contact information of
the individual who attempted resuscitation
and their relationship to the patient.
Trauma
• Any visible trauma to the patient should be
documented by the investigator and photographed
for the pre-autopsy report to the pathologist.
Poisoning or Intoxication
• Any suspected blockage of the patient’s respiratory
tract from poisoning or intoxication should be
investigated, collected, documented, and reported
to the pathologist before autopsy. Any suspected
poison or toxicant, including medication bottles with
pills, cleaning agent bottles should be collected.
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AUTOLYSIS
◦ the breakdown of cells and organs through an
aseptic chemical process caused by intracellular
changes
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PUTREFACTION
◦ post- mortem destruction of soft tissues of body due
to action of bacteria & endogenous enzymes
Autolysis
Putrefaction
Black putrefaction
Butyric fermentation
Skeletonization/Dry decay
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first few days after death
no physical signs of decomposition yet, but
homeostasis has stopped  cellular and soft
tissue changes
body enters algor mortis  reduction in body
temperature following death
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When the body’s cells reach the final stage of
autolysis, an anaerobic environment is
created allowing the body’s normal bacteria
to break down the remaining carbohydrates,
proteins, and lipids. The products from the
breakdown create acids, gases, and other
products which cause volatile organic
compounds and putrefactive effects.
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Odor, color changes, and bloating of the body.
BACTERIA’S ROLE
◦ Activity in the cecum turn the lower part of the abdomen
green
◦ break down hemoglobin into sulfhemoglobin which
causes the green color change.
◦ enter the venous system causing blood to hemolyze
(formation of red streaks in the vein)
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formation of gases
◦ enters the abdomen which forces liquids and feces out of
the body
◦ enter the neck and face, causing swelling of the mouth,
lips, and tongue.
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skin also fragile, leading to skin slippage,
making it difficult to move a body. Body hair
comes off easily.
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discoloration from green to brown 
transition of the early stage of putrefaction to
the advanced decompositional stages.
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the body cavity ruptures, the abdominal gases
escape and the body darkens from its
greenish color.
◦ These activities allow for a greater invasion of
scavengers, and insect activity increases greatly.
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ends as the bones become apparent, which
can take anywhere from 10 to 20 days after
death depending on region and temperature.
dependent on the degree to which the body is
exposed.
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body begins to dry out
human carcass is first mummified, and then
goes through adipocere formation
◦ Adipocere (grave wax) formation  loss of body
odor and the formation of a cheesy appearance on
the cadaver.
◦ Mummification post-active stage because there is
less definite distinction between changes and they
are indicated by reduced skin, cartilage, and bone. It
is also indicated when all of the internal organs are
lost due to insect activity.
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Occurs when the last of the soft-tissue has
been removed from the body
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more highly dependent on soil type and pH,
along with presence of groundwater.
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Greenish discoloration of the lower
quadrants of the abdomen
Greenish discoloration of the head, neck, &
shoulders
Swelling of the face due to bacterial gas
formation; “marbling”
Bloating
Purge fluid
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Hemolysed blood leaks out into the tissues
Tissues and organs soften and degenerate
into a mass of unrecognizable tissue
Adipocere
◦ firm greyish-white to brown wax-like material
composed of oleic, palmitic and stearic acids
ROUGH HANDLING
DURING
EXHUMATION
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The uncovering or exposure through erosion
of a former surface, landscape, or feature
that had been buried by subsequent
deposition.
authorized digging out the coffin of a dead
person from his grave, in order to establish
his cause of death, or to decide upon some
other relevant fact
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Becomes necessary when;
◦ At the time of death, there were no suspicions and
the body was buried without a post-mortem. Later
on fresh facts may come to light, showing some foul
play.
◦ when the first post-mortem was inadequate.
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Identification
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Determine cause of death
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Recovery of foreign bodies (e.g. bullets)
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Recovery of organs or tissues
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Transfer to other burial sites
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Time: usually done in broad daylight
Who should be present:
◦ basic exhumation team would consist;
a. diggers,
b. pathologist
c. investigating officer
d. photographer (serve in documentation)
e. transport coordinator.
Identification of the grave: with help of the relatives and
officer in charge of the graveyard
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If there are too many curious spectators, the
area should be screened off.
Professional diggers are then requested to
remove soil from the grave
When the coffin becomes visible, strong
ropes are passed beneath the coffin, and it is
lifted up
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Soil from above, below, and from all four sides of
the coffin should be collected and preserved in
separate glass jars, with identification tags.
In addition, at least two samples
must be taken from some distance
(25 to 30 yards) from the grave.
This is very necessary in
some poisoning cases.
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It is customary to open the lid of the coffin
once it is brought out of the grave.
Allows foul gases to escape in open air
(rather than be released in the mortuary later)
Enables the pathologist to make a quick
examination of the remains
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Care must be taken in handling exhumed
bodies
Fractures or mechanical trauma due to rough
handling during the process of exhumation
may be mistaken for pre-mortem injuries
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Examination in-situ is important to determine
later on if changes were caused by
exhumation or not. (quick examination of the
body to identify the cadaver, taking
photographs for documentation)
TRANSPORT
AND
AUTOPSY
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Means “see for yourself”
also known as a post-mortem examination,
obduction, autopsia cadaverum
A special surgical operation on a dead body
performed by specially-trained physicians
called the forensic pathologists or other
persons authorized by law.
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Determine or confirm the cause of death
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Improve the diagnosis of specific disease
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Advance medical and scientific knowledge
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Aid in the evaluation of new techniques, procedures
or medications
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Aid in medical education
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May absolve guilt and remove concern about possible
genetic defects
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FORENSIC
◦ This is done for medical-legal purposes and is the one
that is normally seen on television or in the news.
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CLINICAL
◦ This is usually performed in hospitals to determine a
cause of death for research and study purposes.
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CORONER’S
◦ cases where no medical cause of death is readily
available.
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The manner of death is classified as
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Natural
Accident
Homicide
Suicide
Undetermined
Following an in-depth examination of all the
evidence, a medical examiner or coroner will
assign a cause of death as one of the five
listed above.
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Body is received in a body bag or evidence
sheet.
A brand new body bag is used for each body
to ensure that only evidence from that body
is contained within the bag.
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an alternate way to transport the body.
a sterile sheet that the body is covered in
when it is moved.
If it is believed there may be any significant
residue on the hands, for instance
gunpowder, a separate paper sack is put
around each hand and taped shut around the
wrist.
1.EXTERNAL EXAMINATION
2. INTERNAL EXAMINATION
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Ultraviolet light may also be used to search
body surfaces for any evidence not easily
visible to the naked eye.
Samples of hair, nails and the
like are taken and the body
may also be X-rayed.
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The body is removed from the bag,
undressed and any wounds
present are examined.
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A large and deep Y-shaped incision is made
from shoulder to shoulder meeting at the
breastbone extending all the way down to
the pubic bone and will make a slight
deviation to the side to avoid the navel.
If the body is that of a woman, the incisions
are made to go around the breasts so that
the arms of the "Y" have a slightly curved
appearance.
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A scalpel is utilized to remove any soft tissue
that is still attached to the posterior side of
the chest plate.
Now the lungs and the heart
are exposed.
The chest plate is set aside
and will be eventually replaced
at the end of the autopsy.
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The various organs are examined, weighed
and tissue samples in the form of slices are
taken.
Even major blood vessels are cut open and
inspected at this stage.
To examine the brain, a cut is made from
behind one ear, across the forehead, to the
other ear and around.
 These incisions are made
on the back of the head so that
when the autopsy is completed,
the incision can be neatly
sewn up
and is not noticed
when the head is resting on a pillow in funeral
where it is open casket
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The scalp is pulled away from the skull in two
flaps with the front flap going over the face
and the rear flap over the back of the neck.
The skull is then cut with an electric saw to
create a "cap" that can be pulled off,
exposing the brain. The dura remains
attached to the "cap".
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The brain's connection to the spinal cord is
severed, and the brain can then be easily
lifted out of the skull for examination. If the
brain needs to be preserved before being
inspected, it is contained in a jar of formalin
for at least two
BODY CHANGES
SECONDARY TO
EXPOSURE TO
NATURAL ELEMENTS,
ANIMALS/INSECTS
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Algor Mortis (Body Cooling)
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Rigor Mortis
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Livor Mortis (Hypostasis, Post Mortem Lividity,
Post Mortem Suggillations)
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Putrefaction (Decomposition)
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Adipocere
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Mummification
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Defined as reduction in body temperature
following death.
“most useful single indicator of the time of
death during the first 24 hours postmortem”
by Pounder
However, use of body temperature
estimations to assess time of death applies
only to cool and temperate climates.
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Air movement accelerates cooling
-cooling is more rapid in humid air (better
conduction)
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Immersion in water
-cools more rapidly (twice as fast)
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Clothing and coverings
-insulate the body; slows cooling
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caused by a chemical change in the muscles
after death, causing the limbs of the corpse
to become stiff (Latin word:rigor means stiff)
and difficult to move or manipulate.
When the body is found in a certain position,
it cannot be assumed that the deceased
necessarily died in that position.
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Aka post mortem lividity which means a
purple discoloration of the skin resulting
from the gravitational pooling of blood in the
veins and the capillary beds of the dependent
part of the body following cessation of
circulation.
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Post mortem destruction of the soft tissues of
the body by the action of bacteria and
enzymes (both bacterial and endogenous)
Main changes: change in color, evolution of
gas and liquefaction
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Air
◦ hasten decomposition
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Moderate Moisture
◦ accelerate decomposition
◦ elaborate the growth and multiplication of bacteria
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Condition of the air
◦ if contains septic bacteria--> hasten
decomposition
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Earth
◦ Moist soil accelerates decomposition
◦ Dry soil retards decomposition
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Water
◦ Decomposition faster in running and bacteria-laden
water
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Clothing
◦ initially hastens, later delays
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Temperature of the air
◦ optimum temp for is 70 F-100F
◦ Decomposition does not occur below 32F or above
212F
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Light
◦ faster in the absence of light
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Aka saponification; modification of
putrefaction characterized by the
transformation of fatty tissues into a
yellowish-white, greasy, (but friable when
dry), wax like substance with a sweetish
rancid odor.
Ordinarily, it will remain unchanged for years.
Causes:
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hydrolysis of fat with the release of fatty acids
Putrefactive organisms, of which Clostridium welchii is most
active, are important, and adipocere formation is facilitated
by post mortem invasion of the tissues by endogenous
bacteria
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warm, moist, anaerobic environment thus favours adipocere
formation
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air-prolongs formation
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clothes- adipocere formation is found under body clothings,
especially if tight
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Modification of putrefaction characterised by
dehydration or dessication of tissues.
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Body shrivels and is converted to a leathery or
parchment-like mass of skin and tendons
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Skin shrinkage may produce large artefactual
splits mimmicking injuries
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Importance: preservation of tissues which aids
in personal identification and the recognition of
injuries
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Hastens in conditions of dry heat
usually occur in warm countries-->early
evaporation of body fluid takes place earlier
and faster than decomposition
New born infants more prone to
mummification because of being small and
sterile
dry soil-accelerates
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Flies
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Reptiles
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Rodents
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Fish and crabs
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Molds
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Common house flies
◦ LC larval-->pupal-->adult
◦ usual time the egg to be hatched into larva is 24
hrs
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live fleas in the cloths of drowning cases
◦ A flea can survive for approx. 24 hrs submerged in
water.