Postmortem Medicine Khaldoon Aljerian MBBS MHSc FRCPC Pathologist

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

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

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.

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

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

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

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

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

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

Forensic Pathology Prevent: Injury, disease, and death

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

Triangle of COD Disease COD TRAUMA Drugs, alcohol & toxins

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

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

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

“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)

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

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

Thank you : o)