contents · the small intestine is placed in a sink and its contents are washed away to expose the...
TRANSCRIPT
CONTENTSCase History
Autopsy Procedure
External Examination
Notes
Organ Measurements
Organ Reference Measurements
Careers
Glossary
Acknowledgements
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Autopsy Performed at The Ohio State University’s Wexner Medical Center
Autopsy Case Number: 10342L
Sex: Male
Age: 63
Race: Caucasian
Height: 67 inches, 5’7”
Antemortem Weight: 132 pounds
Postmortem Weight: 181 pounds
BMI: 20.7 kg/m2 - Normal
Time of Death: 15:54, 3:54pm
Clinical Information: The decedent was admitted to University Hospital East of the Ohio State Wexner Medical from an outside hospital for abdominal pain, nausea and vomiting, hypotension (78/41) and a blood culture positive for Methicillin Resistant Staphylococcus Aureus (MRSA).
A day after arriving to the hospital, the decedent became acutely mentally altered and had a noticeable decrease in responsiveness. He had difficulty maintaining his airway and was intubated. He was also experiencing atrial fibrillation with rapid ventricular rate for which he received cardioversion. Due to his poor prognosis, his code status as changed to “Do Not Resuscitate- Comfort Care” and he was terminally extubated.
Recent Medical History: The decedent suffered from diabetes mellitus, cellulitits of the right foot, MRSA bacteremia, hypertension, coronary artery disease, dysphagia, osteomyelitis, and chronic back pain. His past surgical history includes a right toe amputation, and open wound skin debridement, and an endoscopy.
Reported History: The decedent had been admitted to the hospital multiple times in the previous few months. He was not a smoker and did not use alcohol or drugs.
Family Wishes: Authority to perform the autopsy is granted with no restrictions
CASE HISTORY
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Plan the Autopsy Pathologist, Residents, and Technicians gather to plan the finite details of the autopsy The plan is based on medical, clinical, and family history, and other significant information collected
External Examination Body is weighed and measured Skin is inspected for marks and scars All hospital paraphernalia are examined and their location is recorded Bodily openings are examined including the nostrils, mouth, ears, etc. Eyes are examined
Exposure of Internal Organs Y-incision is performed Skin is reflected to expose the ribs and abdominal cavity A Stryker saw is used to cut away the sternum and rib cage to expose the thoracic cavity Fluid and tissues may be taken to avoid contamination during later steps of the autopsy
Running the Bowel Small intestine is tied off and cut at its ends The small intestine is separated from its surrounding fat and removed from the body The small intestine is placed in a sink and its contents are washed away to expose the internal surface
Organ Block Dissection The entire organ block is laid on the examination table facing down The order of removal is as follows: aorta, kidney and adrenal glands, stomach and pancreas, bladder and
reproductive organs, lungs, and heart
Examination of Individual Organs Each separated organ is weighed, measured, and examined for abnormalities Each organ is examined differently but all organs have their major vessels and musculature documented Tissue samples are taken and preserved in Formalin for further examination
Brain Removal and Examination The scalp is reflected from the base of the skull to the forehead A Stryker saw cuts a large wedge out of the top of the skull The brain is removed and placed in Formalin for several weeks to preserve and solidify it When the brain is sufficiently preserved, its blood vessels and tissue are examined The brain stem is examined separately but the cerebrum and Cerebellum are sliced and inspected
Autopsy Follow-Up Histology Toxicology Full analysis Final autopsy report
AUTOPSY PROCEDURE
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Make notes on this page about findings from the external examination
Color or Draw Scars, Abrassions, and Medical
Equipment onto the human body diagram
Irides (COLOR)
Pupillary FeaturesEar/ NoseFeatures
Dentition
Hair Color/Pattern
IDLocation
Scars
Tubes and Lines
Miscella-neous
EXTERNAL EXAMINATION
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Other Noticeable Abnormalities (i.e. Fluid content, color, consistency):
Questions to ask the Doctor:
Diagnosis Hypothesis:
NOTES
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CASE MEASUREMENTS
Cardiovascular System
Aorta (apperance)
Heart (grams)
Right Ventricle (Wall Thickness)
Left Ventricle (Wall Thickness)
Tricuspid Valve (Circumference)
Mitral Valve (Circumference)
Pulmonic Valve (Circumference)
Aortic Valve (Circumference)
Respiratrory System
Left Lung (grams)
Right Lung (grams)
Digestive System
Liver (grams)
Pancreas (grams) Urinary System
Left Kidney (grams)
Right Kidney (grams) Hematolymphatic System
Spleen (grams)
Endocrine System
Thyroid (grams)
Central Nervous System
Brain (grams)
Other Observations or AbnormalitiesMeasurements
ORGAN MEASUREMENTS
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NORMAL MALE MEASUREMENTS
Cardiovascular System Aorta
Heart
Right Ventricle (Wall Thickness)
Left Ventricle (Wall Thickness)
Tricuspid Valve (Circumference)
Mitral Valve (Circumference)
Pulmonic Valve (Circumference)
Aortic Valve (Circumference)
Respiratrory System
Left Lung
Right Lung
Digestive System
Liver
Pancreas
Urinary System
Left Kidney
Right Kidney
Hematolymphatic System
Spleen
Endocrine System
Thyroid
Central Nervous System
Brain
Smooth, thick and muscular
280 - 340g
0.35 - 0.4cm
1.05 - 1.25cm
10 - 12.5cm
8 - 10.5cm
6 - 7.5cm
6 - 7.5cm
420 - 600g
480 - 680g
1440 - 1680g
60 - 35g
125 - 170g
125 - 170g
155 - 195g
30 - 40g
1365 - 1450g
Measurements
ORGAN REFERENCE MEASUREMENTS
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Medical Pathologists are physicians that specialize in the diagnosis of diseases and injuries through the examination of bodily fluids and tissues. Medical Pathologists work in a hospital setting and may also conduct autopsies on cases of death in a hospital in which the cause is undeterminable or at the family’s request. Education required is a four-year college degree, followed by a four-year medical degree, and four years of pathology training (or pathology residency).
Forensic Pathologists are physicians who specialize in deaths by violence or criminal activity and sudden and unexpected deaths. They conduct autopsies and often have to testify in court about the possible manner of death. The extra education on top of that to become a pathologist is an additional year of education in forensic pathology fellowship
Neuropathologists are physicians that specialize in studying disease of the brain and spinal cord. They may study scans and samples from living or dead patients. After an autopsy, a neuropathologist will dissect and examine the brain for abnormalities. In addition to the education required to become a pathologist, there are an additional two years of training required to study the disease of the nervous system and musculoskeletal system.
Pathology Technicians aid in performing either medical of forensic autopsies. They aid in the operation of the autopsy facility, deal with funeral homes, acquire family permission forms, help in the preparation of autopsy reports, as well as assist in the autopsy. The minimal education requirement is a two-year technician degree, and most training happens on the job.
Medical Toxicologists study chemicals and their harmful effects on living organisms. They may study the presence of chemicals in the environment, in food, or in humans or animals. Toxicologists must obtain a four-year college degree, followed by another four to six years to obtain a PhD and two to three years of postdoctoral training
Forensic Toxicologists specialize in the analysis of bodily fluids to determine levels of different kinds of chemical compounds, primarily drugs. They work closely with forensic pathologists to help determine the cause of death and may also testify in court. A Bachelor’s degree in Chemistry or Toxicology is the only required academic requirement but as the field progresses so does the education. Many Forensic Toxicologists are now acquiring Master’s and even PhD’s.
Coroners are legal officers that are typically elected and are responsible for investigating and certifying different manners of death. Coroners are not required to be physicians.
Medical Examiners are legal and medical officers that are typically appointed and are responsible for investigating and certifying different manners of death. Medical Examiners are physicians but may not be required to obtain special training in pathology or forensic pathology.
CAREERS
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Histology Technicians are responsible for transforming the delicate tissue specimens taken from living or dead tissue into distinct and stained slides for observation. Education required is a one- or two- year laboratory program.
AK
CA
NV
AZ
TX
HI
WA
OR
MT
IDWY
COUT
NM
ND
SD
NB
OK
KS
MN
IA
MO
AR
LA
TN
KYNC
INIL
WIMI
OHPA
NY
ME
WV VA
SC
GAALMS
FL
MDDENJ
VT
NH
DC
MACT RI
Appointed medical examiner and/or coroner
Elected coroner; appointed medical examiner
Mixture of elected and appointed coroners
Elected coronor and/or medical examiner
Coroner’s System
Medical Examiner’s System
Coroner vs Medical Examiner Maps
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Directional Terms
ANTERIOR POSTERIOR
SUPERIOR
INFERIOR
MEDIAL LATERAL
DEEP SUPERFICIAL
PROXIMAL
DISTAL
Body Cavities
Skeleton
AXIAL
APPENDICULAR
DORSAL CAVITY
CRANIAL CAVITY
SPINAL CAVITY
VENTRAL CAVITY
ABDOMINOPELVICCAVITY
THORACIC CAVITY
ABDOMINAL CAVITY
PELVICCAVITY
GLOSSARY
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-itis inflammation-opathy disease or disorder-ectomy surgical removalOsteo- boneCardio- heartDys- disordered, defective, difficult, bad or abnormal
Prefixes and Suffixes Autopsy Specific
Pathology - the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes
Histology - the study of the microscopic anatomy (microanatomy) of cells and tissues of plants and animals
Toxicology - is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms
Algor Mortis - The cooling of the body that follows death; the body temperature falls to room temperature (about 70°F) at about 1.5°F per hour.
Livor Mortis - the pooling of the blood following death that causes a purplish-red discoloration of the skin
Rigor Mortis - stiffening of the joints and muscles of a body a few hours after death, usually lasting from one to four days
Chest Plate - the portion of the chest wall that is removed during an autopsy in order to gain access to the heart and lungs. The chest plate is composed of the sternum and part of the ribs
Virchow Method - the method of autopsy developed by Rudolph Virchow in which each organ is removed from the body separately. Each organ is taken out of the body individually and examined one at a time.
Rokitansky Method - the method of autopsy developed by Karl Rokitnasky that involves the removal of the body organs all at once. The heart, liver, kidneys, urinary bladder, prostate gland, etc. are removed in one block, separated, and then each organ is dissected.
Formalin - A 37% solution of formaldehyde in water which is used as fixative agent to preserve tissue.
Disease Related
Atherosclerosis - a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls
Hydrocephalus - a condition in which fluid accumulates in the brain enlarging the head and sometimes causing brain damage
Infarction - the obstruction of the blood supply to an organ or region of tissue causing local death of the tissue
Pneumonia - lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid
Hypotension - abnormally low blood pressure (100/60 mmHg or below for women, 110/70 mmHg or below for men)
Hypertension - abnormally high blood pressure (120/80 mmHg or above in men and women)
Necrosis - the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply
Ischemic - an inadequate blood supply to an organ or part of the body, especially the heart muscles
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COSI would like to thank The Ohio State University Wexner Medical Center for their support and guidance during the development of this program. We would also like to recognize the following individuals for their tireless efforts, consideration and knowledge. We could not have done it without them! Marti LeitchKaila Buckley, M.D.Jacob Durakovic, B.S., PA (ASP)Patricia Allenby, M.D.
COSI would also like to thank the Franklin County Coroner’s Office for their support and knowledge during the development of this program. We would like to recognize the following individuals for lending their time and expertise and the tireless work they do for our community. We couldn’t have don’t this without them!
Donald Pojman, M.D.Dan Baker
This program would not have been possible without the vision of retired Pathologist, Larry Tate, M.D. We thank him for his legacy that we are able to further through this program.
Before this particular patient was videotaped for the program, family members were asked to provide consent, which they did most willingly. We would like to thank them with sincerity and reverence for the learning op-portunity they have provided both now and for generations to come. Their support and selflessness is identified and appreciated by COSI and The OSU Wexner Medical Center.
Filming and editing contributions were made by the following individuals:Dave BukerStephanie Hernandez LeesonJordan RaderJessica TakacsKatie TrauschHannah Twining
ACKNOWLEDGEMENTS
