post mortem

Question 1

3 types of autopsies are:

Answer 1

1. Hospital/Consented Autopsy (Next of KinConsent Required) - 5%
2. Coroners Autopsy (Next of Kin consent not required) - 95%
3. Forensic Autopsy

Question 2

value of hospital autopsy:

Answer 2

• Good audit of hospital service
• 20% of cases will show pathology not suspected even in a well investigated patient
• If next of kin are unhappy with management of patient, the autopsy can provide evidence of how well or badly the patient was managed

Question 3

hospital autopsy:
- done by —- at the request of the —- or the next of —
- Must get —- from next of kin
- consent taken by —-
- Must get —- to retain tissue/organs for diagnosis , teaching , research

Answer 3

pathologist
clinician
kin
written permission
senior clinician
written permission

Question 4

hospital autopsy:
* Must —- to next of kin what autopsy involves and
must be sure they understand what is said to them
* We explain that tissue/organs may be retained and that
after these have been examined the next of kin will be informed
* We explain to them how the tissue/organs might be
disposed of/retained and that their wishes will be carried
out

Answer 4

explain

Question 5

coroners autopsies in hospitals:
- ordered by —
- are all —- cases
- Required when a death cert cannot be signed because the cause
of death is —
- coroners role is:

Answer 5

coroner
legal
not known
cause and place of death

Question 6

indications of coroners autopsys:

Answer 6

• All drownings
• All poisonings
• All suicides
• All road traffic accidents
• All deaths in institutions (prison, long stay nursing homes,
  hospitals etc.)
• All deaths within 24 hours of admission to hospital
• All deaths within 24 hours of an invasive procedure
• All deaths where MRSA, clinical difficile are implicated
• All deaths due to notifiable diseases
• Other cases to be reported to the Coroner are “online” on
  Beaumont Hospital computer system

Question 7

• Do not require permission from the next of kin
• They must not be asked
• Permission to retain organs for diagnosis is not necessary
  from next of kin
• Permission to retain organs for research and teaching is required
  are all under:

Answer 7

coroners autopsies

Question 8

Where next of kin agree only to a partial autopsy
(hospital autopsy) is known as —
* —– is never limited or partial

Answer 8

limited autopsies
coroners autopsies

Question 9

• Where a criminal cause of death is suspected
• Carried out by Forensic Pathologist
  known as:

Answer 9

forensic autopsies

Question 10

before commencing a autopsy :
- gather as much — as possible before starting from hospital staff next of kin or police etc
- Leave drains, IV lines, catheters,
endotracheal tubes in situ for pathologist to
examine

Answer 10

info

Question 11

external examination include:

Answer 11

• Is rigor mortis present?
• Is lividity present?
• Check name band to ensure correct body
• Ethnicity
• Approximate age
• Weight/BMI
• Jaundice?
• External marks/wounds/scars
• Nicotine staining
• Petechiae and around eyes or in skin
• Signs of trauma

Question 12

what is involved in an autopsy:
- — opened
- — removed
- all organs will be —

Answer 12

skull
brain
removed, weighed, dissected and examined

Question 13

• It is essential to —- all organs for microscopy
• Sometimes the cause of death can only be identified at —-

Answer 13

sampled
microscopical assessment

Question 14

• The State Laboratory provides a forensic toxicology service to assist pathologist in identifying a cause of death by confirming presence or absence of:
• —– will be used
• The chemistry is complex, using —-
• A report is given to the —-

Answer 14

 Ethanol
 Legal drugs and medications
 Illegal drugs
 Toxic substances (e.g.: carbon monoxide
- Blood, urine and sometimes vitreous fluid and gastric fluid are used
- mass spectrometry
- Pathologist and the Coroner

Question 15

In case of possible sepsis, sterile techniques must be used for taking samples of blood, urine,
pulmonary secretions this is known as:

Answer 15

microbiology

Question 16

special autopsies:
* Forensic Autopsies are performed by —-
* Sudden infant death autopsies are performed by
—-

Answer 16

Forensic Pathologists
Paediatric Pathologists

Question 17

in road traffic accidents:
important to —- injuries as they help identify vehicle involved
* Important to exclude/confirm any —– of death for an accident

Answer 17

photograph
natural cause

Question 18

• After autopsy the Pathologist provides a complete — with the interpretation of the— of death
• An —- may be held following an autopsy

Answer 18

report
cause
inquest

Question 19

inquest are held if:

Answer 19

• The cause of death is not clear after the autopsy
• If there are any unanswered questions from next
  of kin
• All Road Traffic Accidents and suicides
• This inquest is a legal
  hearing
• Coroner presides
• Jury may be present
• Witness statements are
  read
• Witnesses are examined
• Clinicians and
• Pathologists attend
  Coroner Gives
  Verdict:
  Natural Causes
  Accidental death
  Suicide
  Death by
  misadventure

Question 20

what can go wrong in autopsy work:

Answer 20

Body is sent incorrectly for burial despite the next of
kin having requested an autopsy
- Cause - poor communication
* Clinicians have not informed the Coroner of a death
and a body has been incorrectly sent for burial
* In a Coroner’s case, Clinician has asked for
permission for an autopsy from next of kin but next of
kin refuse
* Very upsetting for next of kin to be told even though
they were asked for permission and they refused
permission, an autopsy will be performed anyway

Question 21

-In the event that the deceased is not a “Coroner’s Case”, the Team may ask the next of kin for consent to a —-
-The Team MUST be in a position to produce a —- before considering asking the Family for consent for a Consented Post Mortem! (no cause of death! Coroner’s referral)
- —- MUST be given by the family and they can refuse. The family may also stipulate the limitations of the Post
Mortem.

Answer 21

“Consented Post Mortem”.
death certificate
consent

Question 22

true or false:
- Small samples of tissue are often taken for histology, consent for this is needed in a hospital case
- For an organ to be retained in a hospital case, consent from the family is needed
- For an organ to be retained in a Coroners case, consent from the Coroner is needed
- Disposal of all human tissue is separate from all other
hospital waste and is documented separately. Sometimes
the tissues are given back to the family for burial

Answer 22

all true