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Postmortem Medicine Khaldoon Aljerian MBBS, MHSc , FRCPC

Explore the comprehensive field of forensic pathology, its application in postmortem medicine, and the intricacies of determining causes of death. Discover the intersection between medicine, law, and ethics in this compelling realm. Delve into the various forensic sciences and the vital role they play in investigations. Uncover the significance of identification techniques and the process of surgical examination. Gain insights into changes after death and the crucial role of forensic pathologists in death investigations. Embrace the intersection of science, investigation, and justice in the captivating world of forensic pathology.

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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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