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20 Cards in this Set
- Front
- Back
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1. What are the four questions which must be answered by a Coroner’s Inquest? Give examples of the problems arising in providing the answers.
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- Who is the deceased? (Determine identity)
Debt transfer? - What is the medical cause of his/her death? May indicate malpractice/ medical negligence and prompt a lawsuit against the doctor. May indicate accidental drug overdose which the family may not of known about/ be comfortable with. - Where did they die? (place of death) May indicate that the body was moved/tampered with/ disrespected. - How: In what environment did they die? (Circumstances of the death) May reveal suicide or “undignified accidental death”, such as autoerotic asphyxia, which may trouble the family and loved ones, who would want to remember him/her in a different way. |
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2. Discuss those deaths, which require to be reported to the coroner and the role of the coroner in death investigation.
3. List the types of death which should be reported to the Coroner. |
-Not due to natural causes
-Not seen and treated by a doctor within one calender month -Sudden and unknown cause -Suspicious circumstances, violence or misadventure -Self-inflicted -Due to drugs or poisons -As a result of a RTA -Following surgery or anaesthetic -Due to negligence, misconduct or malpractive -Accident or disease at work -In prison or Garda custody -Mental Health Act 2001 -Occurring within 24 hours of admission to hospital -Death in a nursing home -If any doubt |
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Role of the coroner in death investigations:
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1.To obtain a positive identification of the deceased.
-initially a relative or friend of the deceased will identify them to the coroner or his appointed officer ( usually a member of the Guardai ) -the coroner or his officer will then identify the body to the pathologist who is to carry out the autopsy. 2.To determine a time of death 3.To provide both a cause and a mode of death 4.To record all internal and external abnormalities 5.To carry out any auxiliary investigations e.g. toxicology, histology, microbiology, virology and serology, necessary to establish the cause of death 6.To collect any trace evidence in suspicious deaths 7.To provide a coherent account of the cause of death and any diseases contributing to it on the basis of the above results. |
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4. Discuss the information required on a certificate of the cause of death and the roles of the GP and the coroner in the investigation of a sudden and unexpected death.
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A registered doctor that attended the person during their last illness and seen them in their last month of life must declare death. If the death doesn’t fall into the category of being reportable to the coroner, or the family complains of the medical care, then its ok to do it.
Information needed on the certificate: Patients name, address, date of birth, date of death, next of kin etc. Ia – Final event that resulted in death (haemetemesis) Ib – What the final event arose from (bleeding duodenal ulcer) Ic – Any underlying condition that may have contributed (peptic ulcer disease) II – Any other medical conditions not related to the above, which may have contributed to the death (Arthritis, Ischemic heart disease) |
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Name some ways of identifying a clothed but decomposed human body.
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A)General: determine human – race – sex (from clothing or presence of prostate or uterus which resist decomposition, bone features such as pelvis/skull/groove of muscle attachments, sex chromatin) – stature (long bones) – Age – bone markers such as ossifcation, teeth eruption, epiphysial plates etc)
B) Personal: facial features – fingerprints – dental comparison – blood group – DNA – Xrays – personal effects (circumstantial) – personal defect. |
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a) Identification of human remains in a mass disaster
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A) Treat each body as potential UNKNOWN. Match with information regards those known missing, if ante and postmortem match - become SUSPECT
B) Thereafter facial identification, or other positive, confirms identity as PERSON X. DO NOT RELEASE ANY ONE BODY UNTIL ALL ARE IDENTIFIED C) If some bodies are mutilated then estimate number of persons from incomplete bodies or body parts, treat each part as UNKNOWN. (Where possible, relatives to confirm identity) -DNA ON EVERYTHING THAT DOESN’T MOVE -DO NOT RELEASE ANY ONE BODY UNTIL ALL THAT CAN BE ARE IDENTIFIED D) ONLY RELEASE BODIES WHEN ALL INVESTIGATIONS EXHAUSTED |
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8.Describe the process of identification of a body prior to autopsy and discuss the problems with skeletalised remains.
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Skeletalized remains:
Loss of soft tissues – Certain identification techniques impossible (facial recognition, fingerprints etc.) Assisted by animal activity Remains scattered Anthropologist required for identification Only bone injury apparent in homicide cases |
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What are the signs of putrefaction or decomposition?
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Liquefaction of tissues
Chemical and enzymatic process Bowel bacteria proliferate, breakdown Hb. Green discoloration abdominal wall Gas formation, swelling and bloating ‘marbling’ of skin due to bacteria in vessels Skin blistering, ‘slippage’ Liquefaction of internal organs e.g. bowel, lungs and brain Purging of fluid from orifices Vessels, uterus and prostate relatively resistant +/- insects – common flies, bluebottles etc., lay eggs which hatch into maggots |
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10. Discuss your findings on examination of a body: a) At the time of or immediately after death
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Cardio-respiratory failure
Absent breath sounds Absent chest movement Absent pulse Absent heart sounds Pupils not reacting to light Loss of corneal reflexes Muscle flaccidity |
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Discuss your findings on examination of a body: b) Within 24hours after death
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Rigor Mortis – Chemical reaction due to a decrease in ATP of the muscles and an increase in ADP and lactic acid
Warm and flaccid, dead less than 3hours(before rigor mortis sets in) Warm and stiff, dead 3-8hours (rigor mortis) Cold and stiff, dead 8-36hours (rigor mortis) Cold and flaccid, dead more than 36hours(decomposition begins, rigor mortis ends) Hypostasis - Blood vessels relax and blood settles under the influence of gravity Colour depends on colour of the blood; Normally RED to PURPLE - depending on the oxygen level in blood. Visible within 2 to 3 hours Usually fixed after about 12hours Useful as an indicator of movement of the body after death Cooling of the body - Normal temperature 37C After death – circulation and cell metabolism stop, inside and outside temperatures equilibrate, after delay of minutes to hours ‘core’ temperature begins to fall. Useful to estimate time of death. |
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Discuss your findings on examination of a body: c) 48hours or more after death.
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Decomposition
Putrefaction Mummification Adipocere Skeletonisation Animal scavenging |
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Persistent vegetative state
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functioning brain stem but non functioning higher centres
respiratory centres functioning do not require permanent assisted ventilation require parenteral feeding if heart protected from hypoxic damage and nutrition sustained, may survive for years |
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Brain stem death
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COMA due to damage to the ascending reticular activating system
require assisted ventilation due to failure of the respiratory motor system beating heart |
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12. “Sudden Adult Death Syndrome.” Give examples of causes of “sudden death in sport.”
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Males > females
USA - 1 : 133,000 males USA - 1 : 800,000 females usually underlying, undiagnosed congenital heart disease cardiomyopathy most common anomalous coronary circulation viral myocarditis More than 40 years of age - coronary artery disease |
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13. Discuss causes of sudden natural death.
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Cardiac Causes – coronary artery disease, hypertensive heart disease, cardiomyopathy, valvular heart disease, myocarditis, aortic dissection, arrhythmogenic right ventricular dysplasia, rupture of aortic aneurism
CNS causes – epilepsy (SUDEp- sudden unexpected death in Epilepsy), subarachnoid heamorrhage, intracerebral haemorrhage, intracranial pathology associated with acute hydrocephalus or epilepsy, neuroleptic malignant syndrome. Respiratory causes – epiglottitis, pulmonary thromboembolism, asthma, haemotptysis, spontaneous pneumothorax of the newborn. GI causes – haematemesis, chronic alcoholics (acute fatty degeneration of liver), adrenal haemorrhage Other causes – Air-fat-amniotic fluid emboli, ruptured ectopic pregnancy, toxic shock syndrome, sudden death in diabetes/alcohol, commotio cordis (blunt force trauma to the heart) |
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14. Write short notes on Sudden Adult Death.
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Sudden Adult death Syndrome is unexpected death in an adult
no signs or symptoms prior to death postmortem shows no anatomical cause of death specialised pathology examinations negative e.g. neuropathology toxicology negative bacteriology etc. negative presumed cardiac dysrrhythmia - Now agreed to be due to acute onset of a chaotic rhythm in the heart |
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Risk factors include for sudden adult death
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-A family history of unexplained sudden death in a relative under 40years
-Unexplained fainting in young people -Approx 1000 cases/year in UK |
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Differential Diagnosis for sudden adult death
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-ARVD – abnormal ECG, anatomical changes may not be obvious at postmortem; 30-50% have a family history
-Disorders of the Ion Channel – Long QT syndromes, Brugada Syndrome (south east Asia), Catecholaminergic Polymorphic Ventricular Tachycardia (AD; Finland and Italy) |
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Treatment for sudden adult death
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-Defibrillation
-Implantable defibrillator |
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Discuss accidental deaths occurring in the home
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The nature of accidental deaths in the home are age dependant:
Young- poisoning(antifreeze, chemical cleaners, corrosives) - Drowning (unattended during bath with siblings) - Neglect at birth by mother - fire Young adult: - intoxication injuries - fire (associated with smoking and being intoxicated - substance abuse overdose Elderly : - overdose of prescription medicine (depression, dementia) - fire (fall asleep while smoking) |
