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Autopsy
BMT Forensic Unit
What is an Autopsy?
 It
is a specialized examination of a corpse
to determine how and why someone
died and to investigate any disease or
injury
 It is a medical procedure performed
respectfully and carefully to objectively
Two classifications of Autopsy

Clinical: done in attempt to better
understand disease progression, effects of
treatments and to learn how to prevent
deaths.

Forensic:
REQUIRED in cases where criminal
activity is suspected, the body has not been
identified, cases where the cause of death is
not clear and cases involving accidental
death.
Who does the autopsy in NC?


Clinical autopsy can be done by medical
doctor specializing in disease diagnoses or by
medical examiner.
Forensic autopsy is performed by a general
pathologist or a forensic pathologist at the
request of the medical examiner

Forensic autopsy team of specialists can be
involved: anthropologist, archeologist,
geneticist, toxicologist, entomologist,
odontologist, etc.
When is a forensic autopsy
indicated
 Medical
examiner is responsible for
determining the cause and manner of
death in:






All accidents
Unexpected deaths
Unwitnessed deaths
Drug overdoses
Suspected homicides
suicides
NC OCME 2014



The medical examiner can be called upon
when someone does not die of a known
disease at a hospital. His role would be to
determine the true cause of death.
The time and cause of death have legal
implications for insurance, wills and criminal
cases.
If the medical examiner determines that an
autopsy is required, permission from family is
not required.
Autopsy SOP
 Body
must get to the medical examiner’s
office or hospital morgue
 Great effort to preserve evidence
(without contamination):


Hands are bagged (blood could be under
fingernails; gunshot residue)
Body covered and transported in a new
body bag to reduce the possibility of
evidence contamination during transport.
Autopsy external inspection



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Once in morgue, the pathologist and
assistants put on gowns, gloves, and face
shields.
Photos are taken during each step
Xray is taken of the body (this preserves
evidence of fractures and any bullets)
First examination is performed with the
clothing on. Evidence (gun shot residue,
fibers, hair samples) is collected and
preserved.



Signs of petechial hemorrhage is assessed
(dots of blood under the eyelids); this would
indicate the person may have suffocated.
One external inspection is complete, the
body is cleaned, weighed, measured and all
identifying features (sex, race, eye color, hair
type, color, apparent age, scars, tattoos and
birthmarks) are noted.
Blood, oral fluid and tissue samples may now
be taken for toxicological analysis.
Autopsy internal inspection
Y
shaped incision made that exposes the
rib cage and abdomen
 Pathologist
removes and weighs internal
organs and checks for injuries and
abnormalities.


May also collect tissue samples for
microscopic study, culturing disease
organisms or toxicology analysis
If brain must be examined, it is placed in
formalin for several weeks so that it can be
sliced.
 Once
internal inspection is complete,
organs are put back into the body and
skin sewn up discretely so that the family
can view the body and the mortuary can
prepare for the funeral.
 The medical examiner (Coroner) must
complete the Report of the Investigation
and sign the Death Certificate both of
which should specify the CAUSE and
MANNER of DEATH
Time of Death
 In
forensic cases the time since death
(post mortem interval) is important
 The body decomposes in predictable
ways after death.
Time of Death indicators
•
Potassium levels in ocular fluid
(vitreous humor of the eye)
Algor mortis indicator
•
Algor mortis: Body cools at a predictable rate
(approximately one degree/hour until it
reaches ambient temperature). Obesity and
warm climates slow the process.
Liver mortis indicator
•
Liver Mortis: Blood settles to the lowest parts of
the body resulting in discoloration of the
tissue. This helps determine the position of the
body at death.
Rigor mortis indicator
•
Rigor mortis: stiffening of the body muscles
after death occur due to chemical changes
(build up of calcium in muscles causing the
muscles to contract). Rigor mortis begins
between 2-6 hours after death and reaches
maximum stiffness at 12 hours after death.
Thereafter the muscles gradually relax.
Other time of death indicators
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Decomposition starts with growth of bacteria
(this is hastened in warm moist temperatures)
Digestion proceeds at a predictable rate,
contents of stomach and intestines can
provide valuable clues
Insects lay eggs in dead body at a certain
point after death. These eggs mature into
larvae and pupate on a very predictable
timeline
Autopsy as a clinical research
tool

In clinical medicine, it is the BEST way to
confirm certain disease diagnoses


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This is important to policy and public health
decisions
Can act as a quality control measure for
doctors and hospitals and new treatments
Can provide understanding of how
treatments are working and shape
recommendations regarding clinical practice.
Barriers to Autopsy
 Autopsies
in the US have declined sharply
from 19% in 1972 to 8.5% in 2007

It is uncommon for an autopsy to be
performed in a hospital due to disease
 This
is partly because of the cost that
insurance does not cover
 Clinician fear that the autopsy may reveal
sub-standard care was given
 Many believe that modern imaging tools
have reduced the need for autopsies
Autopsy research
 Has
revealed that many patients were
misdiagnosed and might have lived if
proper diagnosis was made
 They can show when the need for
treatment protocols need to be made
Are consents required for
autopsy?
 Forensic
autopsy does not require a
consent from the family member. It is
determined by the medical examiner.
 Clinical autopsy are ordered by the
medical physician and must have family
consent.
Religion and Autopsy
 Most
religions have specific beliefs and practices
related to death and the treatment of bodies


Some encourage immediate burial
Some forbid desecration of the body
 11
states allow a family to express religious
objection that must be taken into consideration by
the medical examiner when deciding to do the
autopsy. The medical examiner makes the final
decision