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Postmortem Medicine Khaldoon Aljerian MBBS, MHSc , FRCPC

Forensic Medicine and Toxicology Unit Department of Pathology College of Medicine King Saud University. Postmortem Medicine Khaldoon Aljerian MBBS, MHSc , FRCPC Pathologist – Bioethicist – Forensic Expert Forensic Neuropathologist. Postmortem Medicine. PM medicine law & definition

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Postmortem Medicine Khaldoon Aljerian MBBS, MHSc , FRCPC

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  1. Forensic Medicine and Toxicology UnitDepartment of PathologyCollege of MedicineKing Saud University Postmortem Medicine Khaldoon Aljerian MBBS, MHSc, FRCPC Pathologist – Bioethicist – Forensic Expert Forensic Neuropathologist

  2. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  3. Islamic jurisprudence Council, of the Muslim World League • Based on necessities which calls for the postmortem examination of dead bodies, and with which the postmortem examination, becomes more a benefit than a depravity of violating the dignity of the dead human.

  4. Medicine • The science of diagnosing, treating, or preventing disease & other damage to the body or mind.

  5. Forensic Medicine • Forensic medicine: One of the largest & most important forensic science. • Medical knowledge - criminal & civil law. • Medical science specialties: • Therapeutic, diagnostic & basic

  6. Forensic Sciences • Forensic Pathology • Forensic Toxicology • Forensic Psychology • Forensic Anthropology • Forensic Archeology • Forensic Entomology • Forensic Odontology • Forensic Serology • Forensic Botany

  7. Forensic Sciences • Computer Forensics • Criminalistics • DNA typing • Fingerprints • Document Examination • Forensic Reconstruction • Forensic microanalysis • Ballistics

  8. Pathology • Anatomic Pathology: • Molecular Pathology • Cytology • Surgical pathology • Postmortem examination • Clinical Pathology • Biochemistry • Haematology • Immunology • Microbiology

  9. Forensic Pathology • Subspecialty • Examination of living or dead persons • Provide an opinion concerning: • Identification • Cause, manner: disease, injury, death • Biological and physical evidence • Wounds, patterns, and sequence • Death investigation

  10. Forensic Pathology Prevent: Injury, disease, and death

  11. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  12. Systems • Coroner or medical examiner • Particular geographic jurisdiction • Quasi-judicial powers • Inquiry into deaths • Complete the certificate of death • Recommendations/inquiry

  13. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  14. Reportable cases • Unnatural(suspicious, abuse -/+, iatrogenic, unexpected) • Unattended, within 24H (arrival, anesthesia, procedure) • Drugs(prescription, non) • Special circumstances: custody, occupation, children, pregnancy, unable to complete certification

  15. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  16. Changes after Death • Rigor - Livor - Algor mortis • Decomposition: • Autolysis • Putrefaction • Mummification – Adipocere - Skeletalization • Post-mortem injuries -Immersion • Burial – Cremation – Medical preservation

  17. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  18. What does a forensic pathologist do? • Authority • History • Imaging • Laboratory tests • Physical examination • Surgical examination • Report • Communication • Recommendations

  19. Identification of the Living andthe Dead • Morphological characteristics • Fingerprints • Dental • DNA profiling • Tattoos and body piercing • Identity of decomposed or skeletalized remains

  20. Surgical examination • Incisions • Tissue samples (surg path, molecular) • Tissue, fluid (microbiology and toxicology) • Retention  correlates all the information

  21. draws conclusions: • Cause, manner of death • Report • Communicate • Recommendations: prevent disease, injury & death

  22. The Autopsy Lexicon • Suggested Headings for the Autopsy Report • Randy L. Hanzlick, MD, for the Members of the Autopsy Committee, College of American Pathologists (Arch Pathol Lab Med. 2000;124:594–603)

  23. Postmortem Medicine • PM medicine law & definition • Systems • Reportable cases • PM changes • Management • COD - DC

  24. Cause of Death • Injury or disease that results in the cessation of life • “results in” • Causal linkages in a temporal chain • Temporal delay not relevant

  25. Triangle of COD Disease COD Drugs, alcohol & toxins TRAUMA

  26. Disease • Ischemia due to coronary atherosclerosis • Hemorrhage due to Chronic alcoholism • Infection due to pneumococcus

  27. Trauma • Blunt • Sharp • Projectile • Asphyxia • Heat, electricity and radiation

  28. Alcohol, drugs & toxins • Alcohols: Ethanol, methanol, ethylene glycol • Street: Heroin, cocaine • OTC, OTS: Diphenhydramine • Prescription: Antidepressants, analgesics • Terrorism: Botulinum, SEB

  29. “Pending” • After the autopsy the cause of death is not clear = “pending” • Medical or scene information needed • Toxicology • Microscopy (histologic examination) • Examination of retained tissue (brain)

  30. Manner of Death • Natural • Accident • Suicide • Homicide • Undetermined

  31. Atherosclerotic coronary artery disease Hypertension, diabetes, obesity Acute myocardial infarction

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