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.