Thursday, September 15, 2011


The most memorable day of my life when I am felicitated by my students (PGT) for geting the FELLOW of National Foundation of Clinical Forensic Medicine, awarded to me for my incision technique “Fourth Incision: The Cosmetic Autopsy Technique”.
Thank you students, thank you all.

Monday, September 12, 2011

Toxidromes



What is a toxidrome
       It is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others.
The cholinergic toxidrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Cholinergic SLUDGE
      Salivation
      Lacrimation
      Urination
      Diarrhoea
      GI cramps
      Emesis
      Wheezing
      Diaporesis
      Bronchorrhoea
      Bradycardia
      Miosis
      Carbamate
      Organophosphates
      Physostigmine
      Pilocarpine
      Atropine
      Pralidoxime for organophosphates



The anticholinergic toxidrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Anticholinergic
Hot as a hare
Dry as a bone
Red as a beet
Mad as a hatter
Blind as a bat
      Mydriasis
      Blurred vision
      Fever
•      Dry skin
•      Flushing
•      Ileus
•      Urinary retention
•      Tachycardia
•      Hypertension
•      Psychosis
•      Coma
•      Seizures
•      Myoclonus
•      Antihistamines
•      Atropine
•      Baclofen
•      Benztropine
•      Tricyclic
        antidepressants
•      Phenothiazines
•      Propantheline
•      Scopolamine  
• Physostigmine

 (do not use in cyclic antidepressant overdose as will worsen conduction disturbances)



Hallucinogenic Sympathomimetic toxidrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Hallucinogenic
      Disorientation
      Hallucinations
      Hyperactive Bowel
      Panic
      Seizure
      Tachycardia
      Hypertension
      Tachypnoea
      Amphetamine
      Cocaine
      Pseudoephedrine
      Phencyclidine
      Ephedrine  
      Benzodiazepines


Sedative/hypnotic toxidrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Sedative / hypnotic
      Stupor & coma
      Confusion
      Slurred speech
      Apnoea
      Anticonvulsants
      Antipsychotics
      Barbiturates
      Benzodiazepines
      Ethanol
      Meprobamate
      Opiates
      Naloxone
      Flumazenil
      Urinary alkanisation for Phenobarbital


Opiate toxidrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Narcotic
      Altered mental status
      Slow shallow breaths
      Meiosis
      Bradycardia
      Hypotension
      Hypothermia
      Decreased bowel sounds
   Dextromethorphan
   Opiates
   Pentazocine
   Propoxyphene
      Nalaoxone


Serotonergic syndrome
Syndrome
Signs &Symptoms
Poisons
Antidote
Serotonergic
   Irritability
   Hyperreflexia
   Flushing
   Diarrhoea
   Diaphoresis
   Fever
   Trismus
   Tremor
   Myoclonus
      Fluoxetine
      Meperidine
      Paroxetine
      Trazodone
      Clomipramine
      Benzodiazepine


Friday, January 29, 2010

Protocol for Autopsy Examination

Objectives:

* To find out the cause of death

* Mode of death

* Manner of death

* Nature of death

* Time since death

* To note the injuries present on the body

* Weapons used

* Recording the data for identification

* In new born- live birth / still born / dead born

Rules of M.L. Autopsy

* Proper authorisation papers

  1. Command certificate
  2. Forwarding letter
  3. Inquest
  4. Dead body challan

* Should be done in an approved center

* By authorised registered medical practitioner

* Should be done in natural light

* For night autopsy- written order from DC is a must

* Arrangement for proper lighting must be done

* Mention the time of autopsy with the order of the DC in the autopsy report

Note the following before performing autopsy:

* Time of receiving the body

* Time of performing autopsy

* Person identifying the body with signature where of the escorting police is a must.

For identification- allow the person whose name is mentioned in the dead body challan.

External examination

* Length & weight and complexion etc of the body

* Wearing garment

* Any stain / tear on cloth - whether these correspond with injuries on the body

* Body surface - stains / discharge / foreign materials

* All the natural orifices

* Eyes

* Finger nails - Colour Change / Foreign materials – keep nail scraping for foreign material

* Injuries – type, size, shape & position

* Rigor mortis

* Postmortem staining - Colour, distribution

* Decomposition changes

* Temperature

* Any other peculiarities

Internal examination

* All autopsies must be complete

* All the body cavities must be opened and examined

* All the organs must be dissected and examined

Incisions used

* I shaped

* Y shaped

* Modified Y shaped

* 4th Incision: the cosmetic autopsy incision - for details, please go to the link bellow http://drajpatowary.blogspot.com/2007/08/fourth-incision-cosmatic-autopsy.html

* For scalp- mastoid to mastoid incision in coronal plane (through the vertex).

Preservation of viscera in suspected poisoning cases

Viscera & body fluid to be preserved

Stomach with content

Portion of small intestine with content

Portion of liver with gallbladder

Half of each kidney

Viscera should be preserved in saturated solution of sodium chloride. Rectified spirit should be used in cases of poisoning by mineral acids, sodium chloride & vegetable poisons. Never use formalin as preservative.

Blood in sodium fluoride

Urine in thymol

Precautions to be taken in preservation of viscera

* Stomach to be preserved in one container

* Portion of liver and kidney in 2nd container

* Sample of preservative used in 3rd container

* All the containers are to be sealed and labeled

* Sample of the seal to be sent on the forwarding letter

* Blood to be sent in air tight container in death due to alcohol poisoning

* Sample of tissue from injection site to be sent along with similar control tissue in separate container

Precautions to be taken during autopsy

* Examine all the papers carefully- read the inquest and note the injuries mentioned.

* Put signature on all the pages of the papers.

* In case of disparity in the inquest and the findings on the body- call the I.O. / inquesting officer, show the disparity and take his signature. Insist on photography / video recording.

* All the directions to the I.O. should be in writing, in case of inability on the part of the I.O. to comply with the directions, he has to inform that in writing.