ROYAL GENERAL PRACTITIONER group 2008

AUTOPSY
A complete evaluation of an individuals death and the circumstances surrounding that death. Also called as "the ultimate physical examination." The fundamental function of the jurisdictional authority investigating the death is also the basic purpose of the autopsy: to establish the cause and manner of death. (pasal 133, 134 dan 135 KUHAP) An autopsy is done mainly to complete a death certificate and to register the vital statistics. These examination included:

1. 2. 3. 4. 5. 6. 7.

A complete evaluation of the medical history and the events leading to death The collection and documentation of trace evidence on and around the body The photographing and cataloging of injuries A detailed external examination from head to toe An internal examination, including the dissection of organs and tissues A microscopic examination of organs and tissues Laboratory and toxicological examinations of body tissues and fluids 8. A written report detailing the pertinent findings, negative findings, and conclusions, including the cause and manner of death

HOSPITAL AUTOPSY
Might help answer a specific medical question or determine the mechanism of death. Eg questions established in this autopsy: Mechanism of death? Hospital care? Drugs therapy? Performed on inpatients of hospitals, upon the requests of families. Physicians cannot order these autopsies without permits signed by the next of kin. Most hospital autopsies are done in teaching hospitals

MEDICAL-LEGAL AUTOPSY ( FORENSIC AUTOPSY)

To obtain the cause and manner of death Eg questions established in this autopsy: Cause of death (COD)? Manner of death? (How it occurred?) It generates an evidentiary document that forms a basis for opinions rendered in a criminal trial, wrongful death civil suit, medical malpractice, civil suit, or administrative hearing. In most states a board-certified pathologist must perform these autopsies. Because medical-legal autopsies are comprehensive exams. , include a study of the CNS, they exceed hospital autopsies in scope.

CASES THAT USUALLY REQUIRE AN AUTOPSY Homicides and Suicides Accidents that occur on the job or Accidents that occur without a witness Drivers in single-car accidents (could be a suicide) or Deaths of pilots in aircraft crashes or Accidents in which natural disease is a factor Sudden, unexpected deaths of children or of apparently healthy persons (usually younger than 15 years) Natural diseases that might impact the community (e.g., meningitis) or Hospital deaths in which the quality of care is an issue Accidents caused by the negligence or reckless behavior of others Deaths of persons in custody of the State or other agency Deaths in which the manner of death is not readily apparent or Deaths in which litigation is reasonably expected Fire deaths, and All suspicious deaths

ROYAL GENERAL PRACTITIONER group 2008

A comprehensive medical-legal autopsy has three phases: 1. Premorgue analysis involves assessing the facts of the death scene (including environmental conditions), witness statements, and the known circumstances surrounding the death. 2. Morgue analysis includes examination of the body and the associated trace evidence. 3. Postmorgue analysis occurs over the ensuing weeks to months and includes analysis of microscopic slides of tissues sampled during the autopsy procedure. Toxicologic, microbiologic culture, chemical, and other laboratory results are also reviewed in this phase and special forensic tests such as DNA identification are performed.
Requirement tools in autopsy1. Universal precaution, 2. Request letter, 3. Body tag, and 4. Autopsy report, etc.

IDENTIFICATION OF THE BODY

1. 2. 3. 4. 5. 6.

Direct Identification by Family Members (visual) Personal Features Objects in the Body Fingerprints Dental Identification Deoxyribonucleic Acid (DNA)

EXTERNAL EXAMINATION 1. CLOTHING AND VALUABLES The clothing can be quite helpful in a death investigation, since it is intimately associated with the body. 2. TRACE EVIDENCE Trace evidence is best taken at the autopsy suite. One method of preparing the body for transport is to drape a clean sheet over the body and then place it in a clean body bag.

FOUR SIGNS OF DEATH 1. Rigor Mortis- Stiffness of muscles during contraction 2. Algor Mortis- Decreasing of body temperature 3. Livor Mortis- Lebam mayat (post morterm hypostasis/suggilation) 4. Decomposition

ROYAL GENERAL PRACTITIONER group 2008

SPECIFIC INJURY Laceration A laceration is the tearing or splitting of skin by a blunt force object carrying force. Lacerations show at least three characteristics: Undermined margins Tissue bridging Abraded margins Blunt Force Injuries Abrasion Contusion An abrasion is the denuding of skin A contusion, or tissue caused by a blunt or rough commonly known as a object. An abrasion is commonly bruise, is a hemorknown as a "scrape." There are four rhage into skin or major types of abrasions: tissues caused by a 1. A usual abrasion or scrape is blunt force tearing due to an object contacting blood vessels. skin or tissue parallel to its surface 2. A sliding abrasion is more linear than a usual abrasion and is caused when movement or sliding is involved. The abrasion lines show the direction of sliding 3. A pressure abrasion is due to a heavy or forcefully projected blunt object contacting or compressing skin or soft tissue in a perpendicular fashion 4. A pattern abrasion is the combination of usual and pressure-type abrasions, usually forming a pattern reminiscent of the blunt object that forcefully contacted the skin Avulsion An avulsion is the tearing away of skin and/or tissue, usually as a result of blunt force. An avulsion can have characteristics of contusions, lacerations, and even sharp force injuries if the avulsing object has a sharp edge. 1. Sharp Force Injuries Stab Wounds: are generally deeper than they are long Incised Wounds: Are generally longer than they are deep. Defense Wounds (cuts): are special types of incised wounds received when victims attempt to defend themselves from knife attacks Puncture Wounds: Are special sharp force wounds that are much deeper than the wide Chopping Wounds: are caused by objects with a sharp edge and substantial weight, such as an axe or a machete Gunshot Wounds: Are usually produced from four main types of weapons in North America: revolver, pistol, rifle, and shotgun. The revolver, pistol, and rifle produce a single entrance wound under normal circumstances. The shotgun can produce a single entrance wound if a slug is the type of round used or multiple entrance wounds if buckshot is fired

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ROYAL GENERAL PRACTITIONER group 2008

INTERNAL EXAMINATION Capable of finding are completely unexpected. The pathologist must examine all tissues carefully and objectively. Eg internal examination are Heart, including coronary arteries and heart valves Chest cavity and mediastinum Lungs and lung hilum Liver and gallbladder, Spleen Stomach and esophagus Small and large intestines,etc. (whole organ of the body) Organ and Tissue Removal TECHNIQUE OF R. VIRCHOW TECHNIQUE OF C. TECHNIQUE OF A. GHON TECHNIQUE OF M. LETULLE ROKITANSKY Organs are removed one by one. This This technique is characterized Thoracic and cervical organs, Thoracic, cervical, abdominal, and pelvic method has been used most widely, by in situ dissection, in part abdominal organs, and the organs are removed as one organ block (en often with some modifications. combined with the removal of urogenital system are removed as masse removal) and subsequently dissected Originally, the first step was to organ blocks. organs blocks (en bloc removal). into organ blocks. expose the cranial cavity and, from Modifications of this technique are This technique requires more experience than the back, the spinal cord, followed by now widely used. the other methods but has the great the thoracic, cervical, and abdominal advantage that the body can be made organs, in that order. available to the undertaker in less than 30 min without having to rush the dissection. Unfortunately, the organ mass is awkward to handle. Examination of the Head, Skull, Brain, and Spinal Cord All medical-legal examinations require the examination of the head, skull, and brain. This includes careful examination of the scalp, skull, and dura mater, the fibrous membrane that tethers the brain in place. There is no complete examination without assessment of the brain and its coverings. Incising the scalp. The scalp skin, subcutaneous tissue, and galea aponeurotica (thick fibrous layer) are cut down to the bone. The cut is started behind the ear, extended around the vertex (top of the head), and completed behind the other ear. Examination of the dura. The top portion of theskull (calvarium) is examined here. The grey membrane is the dura mater. The dura mater has been partially stripped away from the skull. The tip of the scissors is in the epidural ("above the dura") region The subdural space is the region below the dura. Removing the brain. The brainstem is cut and the brain is removed

ROYAL GENERAL PRACTITIONER group 2008 ADDITIONAL NOTE:

DIFFERENCES BETWEEN HOSPITAL AUTOPSY

The hospital autopsy involves history from the hospital chart and an identified person with known disease processes may deal with drug reactions and seeks a mechanism of death, Is academically oriented and medically confidential, Often relies on histologic assessment, Utilizes clinical pathology correlation in the protocol, .

FORENSIC AUTOPSY
The forensic autopsy involves history from the terminal event and scene, the identification of the person is sometimes not known, and the focus is on trauma with or without concomitant natural disease. Often deals with toxicology issues and seeks a cause and manner of death. Seeks evidentiary and confirmatory value and is for the public interest. Utilizes histology for confirmation. report is objective and without interpretation Forensic pathology aids in helping protect public health and safety, enhance quality assurance, advance research and education in medicine, and help with Jurisprudence and the administration of justice.

The cause of death is any injury or disease that produces a physiological derangement in the body that results in the death of the individual. The mechanism of death is the physiological derangement produced by the cause of death that results in death. Examples of mechanism of death would be hemorrhage, septicemia, and cardiac arrhythmia. The manner of death explains how the cause of death came about. Manners of death can generally be categorized as natural, homicide, suicide, accident, or undetermined