Who is the coroner?
An independent judicial officer who investigates the cause of death.
What are the 11 cases that must be reported to the coroner?
1) Cause of death is unknown
2) Person not seen by doctor after death or within 14 days before death
3) Violent, unnatural or suspicious
4) Accident 0 related no matter when it occurred
5) May be due to neglect
6) Industrial disease or due to employment
7) Death due to an abortion
8) Death during surgery or before recovering from anaesthetics
9) Suicide
10) Death during/shortly after detention or prison custody
11) Poisoning
What is the role of the coroner?
Coroner finds cause of death only and once that is done they must stop with the search.
What is a hospital autopsy - when is it done?
Allows thorough examination of disease when there has been a discrepancy between actual COD and the COD stated by coroner.
Is consent required for hospital/coroner’s autopsy?
Hospital- yes
Coroner - no
Why is a hospital autopsy conducted?
- Thorough examination of the deceased, the extent of their disease, their treatment and its effects
- Useful for audit
- Monitoring effectiveness of new treatments
- Teaching
- Research
- Discrepency between stated and actual COD
What is the death certificate data used for?
- Epidemiologu
- Helps divide funds more appropriately
Hence important to be accurate
Compare hospital and coroner’s autopsy
Hospital:
- consent must be obtained from next of kin
- with consent any material can be taken
Coroner’s:
- no consent needed
- material only taken if needed to establish COD
How is an autopsy done?
- incision made from neck to top of pelvis
- organs removed and looked at systematically
What is a death certificate?
- Filled in for any death
- Taken to Registrar (registers births, marriages and deaths) by the family
- Must be correct before registration of death is possible
What is the layout of the death certificate?
1a) immediate cause of death (necessary) e.g. haemopericardium
1b) Predisposing factor e.g. MI
1c) Predisposing factor e.g. Ischaemic heart disease
2) other contributing fcators not directly linked to death e.g. hypertension
What are the three main causes of death in young people?
1) Congenital disease - poorly controlled asthma, diabetes, CF
2) Trauma
3) Drugs and alcohol
What are the main natural causes of sudden unexpected deaths?
1) Cardiovascular disease - usually cardiac arrhythmia, commonly severe CA atherosclerosis, may find MI scarring or CA thrombosis
2) Hypertensive heart disease - accompanied by CA atherosclerosis, cardiac arrhythmia usual case. Cardiomegaly - left ventricular hypertrophy
3) Other cardiac causes e.g. cardiomyopathy, myocarditis, structural abnormalities, floppy mitral valve, aortic stenosis, conduction abnormalities
4) Vascular system - ruptured aortic aneurysm associated with atherosclerosis and hypertension
5) CNS -
non traumatic subarachnoid haemorrhage e.g. Berry aneurysm (silent till ruptures)
Intracerebral haemorrhage (type of stroke) - causes 10-30% of all strokes. Most common cause is hypertension
Epilepsy
6) Respiratory system - pulmonary embolus, asthma,
7) GI tract e.g. pancreatitis, bleeding ulcers and bleeding esophageal varices
(not usually unexpected)
CHCVCRG
Unnatural causes of sudden unexpected deaths
1) Drugs - 1% of coroner reported deaths
2) Alcohol - 1% of coroner reported deaths, associated with GI problems and trauma
3) Trauma
What is a bruise/contusion?
An extravasated collection of blood which has leaked from damaged small arteries, venules and veins but not capillaries
Occurs more easily where the skin is lax. Fragility of vessels and coagulation state affect bruising. Caused by a blunt trauma injury. Can bruise after death
What is an abrasion?
A graze or scratch. Most superficial of blunt trauma injuries and is confined to the epidermis.
Due to tangential force - may have distal skin tag e.g. friction burn. Can also be due to vertical force - no skin tag e.g. stamp
What is a laceration?
A split to the skin caused by blunt force overstretching skin. Passes through the full thickness of the skin. They are deep and bleed. Margins are ragged with crushing and bruising. Bridging fibres arch across skin.
Where are lacerations common and rare?
Common where skin can be compressed between the force and underlying bone - e.g. scalp, elbow, shin
Rare over fleshy areas e.g. buttocks or breast
What is flaying?
Tangential applied force leading to horizontal laceration
What is the difference between a cut and a stab?
stab - depth of wound>width
cut - length of wound> depth
What causes cuts and stabs?
- a sharp object e.g. a knife or sharp glass shards
What are the features of cuts/stabs?
- edges and margins are clear
- minimal injury to surrounding tissues
- info about weapon type can be deduced
What may cause an abrasion?
Friction burn Car radiator Flooring Whip Stamp
