Inquiries of Death

INQUIRIES OF DEATHINQUIRIES OF DEATH

DATO’ DR ZAHARI BIN NOOR DIMP.DATO’ DR ZAHARI BIN NOOR DIMP.MD(USM), DLM(Sheffield), DMJ(Lond),MD(USM), DLM(Sheffield), DMJ(Lond),MSc(Sheffield), DipForMed(Monash). MSc(Sheffield), DipForMed(Monash).

FFFLM(Lond)FFFLM(Lond)

Ketua Jabatan dan Pakar Perunding ForensikKetua Jabatan dan Pakar Perunding ForensikJabatan Perubatan ForensikJabatan Perubatan Forensik

Hospital Pulau PinangHospital Pulau Pinang

Legal defination of Sudden Legal defination of Sudden deathdeath• NoneNone• S329 and S330 CPC as a reference. S329 and S330 CPC as a reference. • Police handling death inquiriesPolice handling death inquiries

i)i) Death from criminal, violenceDeath from criminal, violence investigates under Penal Code investigates under Penal Code S302 or S302 or S304S304

ii)ii) Death in MVA – Traffic cases S44 Death in MVA – Traffic cases S44 RTARTA

iii)iii) Others – Sudden Death ReportOthers – Sudden Death Reportiv)iv) Death in custody/institutions – Death in custody/institutions –

apart apart from SDR also need from SDR also need Magistrate Magistrate notificationnotification

Inquiries of deathInquiries of death

S 329 Criminal Procedure CodeS 329 Criminal Procedure Code

Police officer investigate an apparent Police officer investigate an apparent cause of death and what manner that cause of death and what manner that death has taken place.death has taken place.

Those types of death are:Those types of death are:

•SuicideSuicide

•Killed by another, or animal or machinery Killed by another, or animal or machinery or by accidentor by accident

•Suspicious circumstancesSuspicious circumstances

•Body found dead and death is unknownBody found dead and death is unknown

•Sudden deathSudden death

Sudden death- Sudden death- CircumstancesCircumstances• Chronic disease, death complication Chronic disease, death complication

albeit sudden (expected)albeit sudden (expected)• Apparently healthy person.Apparently healthy person.• Acute onset/ short history of illnessAcute onset/ short history of illness

Absence of medical attentionAbsence of medical attentionFailure to diagnosed correctlyFailure to diagnosed correctly

• An underlying illness, death unexpectedAn underlying illness, death unexpected• Brought in dead – no known informationBrought in dead – no known information• A person found dead – no known A person found dead – no known

informationinformation

Death in Emergency RoomDeath in Emergency Room

• Brought in Dead Body (BID)Brought in Dead Body (BID)

• Patient declared dead in the Patient declared dead in the department (DID)department (DID)

• Patient died just after admitted to Patient died just after admitted to the wards or while in transit to the the wards or while in transit to the wardswards

Most cases History and medical Most cases History and medical records often are not known or records often are not known or information are scarce.information are scarce.

Brought in dead cases (BID)Brought in dead cases (BID)

• All BID’s should be reported to the All BID’s should be reported to the policepolice

• Paticularly those BID’s brought by Paticularly those BID’s brought by persons other than the police.persons other than the police.

• Whether or not the cause of death is Whether or not the cause of death is known.known.

Why?Why?

All Brought in Dead (BID)All Brought in Dead (BID)• 11stst hand history from the patient not hand history from the patient not

available (Obvious reason. Patient available (Obvious reason. Patient already dead)already dead)

• History obtained inadequate or hearsay History obtained inadequate or hearsay

• Doctor has not examined or has not Doctor has not examined or has not investigated the patient during life.investigated the patient during life.

• Cause of death and the manner of death Cause of death and the manner of death are are not objectively not objectively known or determinedknown or determined

Deaths require police Deaths require police investigationinvestigation• Sudden death cause is unknownSudden death cause is unknown

• Body found deadBody found dead

• Death result from accident - MVA, Death result from accident - MVA, animal, persons, machinery etcanimal, persons, machinery etc

• Death caused by someoneDeath caused by someone

• Death from violence or criminal act Death from violence or criminal act or omissionor omission

• Death suicides, poisonsDeath suicides, poisons

Power to order or prevent Power to order or prevent forensic post mortemforensic post mortem

Police (sergeant and above) within Police (sergeant and above) within jurisdictionjurisdiction

Magistrates or higher (within the Magistrates or higher (within the jurisdiction)jurisdiction)

Wakil rakyat/ Member of Wakil rakyat/ Member of ParliamentParliament

DoctorDoctorWaris or busybodiesWaris or busybodies

What happens after the police What happens after the police report has been made?report has been made?

• The police officer usually with the The police officer usually with the rank of a Sergeant or above will rank of a Sergeant or above will conduct the investigation under S329 conduct the investigation under S329 CPCCPC

• The police will decide whether to The police will decide whether to issue a post mortem examination issue a post mortem examination request form or not.request form or not.

What will the police do?What will the police do?

Is su e P o lis 6 1

U se S 3 3 0 C P C

Issu e b u ria l p e rm it & fill u p D eath C ert. F orm

N ot In voke S 3 3 0 C P C

P olice O ffice r ran k S g t an d ab ove

B od y b rou g h t to h osp ita l

The police officer may not The police officer may not issue P61 Formissue P61 Form

• The Cause of death will be The Cause of death will be determined by the police officerdetermined by the police officer

• The Police Officer shall issue the The Police Officer shall issue the Burial Permit and Death Certification Burial Permit and Death Certification Form (LM03 Form)Form (LM03 Form)

• The Medical Officer may be asked by The Medical Officer may be asked by the police for assistance.the police for assistance.

What form of assistance the What form of assistance the attending doctor could give?attending doctor could give?

• Obtaining and provide whatever relevant Obtaining and provide whatever relevant information on the information on the circumstances circumstances of deathof death

• Examine externally Examine externally to ensure there are no to ensure there are no obvious external injuries or abnormalities obvious external injuries or abnormalities on the body.on the body.

• May provide May provide some kind of a signed memo some kind of a signed memo or statement when required by the police or statement when required by the police officer, but only limited to the above officer, but only limited to the above information and findings.information and findings.

But do notBut do not

• Issue or sign on the Burial PermitIssue or sign on the Burial Permit

• Issue or sign the Death Certification Form Issue or sign the Death Certification Form (LM03)(LM03)

• Write any Medical Report or Statement to Write any Medical Report or Statement to the police pertaining to the Cause of Deaththe police pertaining to the Cause of Death

** All the above must be carried out by the All the above must be carried out by the Police Officer.Police Officer.

When the Police Officer issue When the Police Officer issue the P61 Formthe P61 Form

• That means the police has invoke That means the police has invoke S330 CPCS330 CPC

• The police has requested for a post The police has requested for a post mortem examination.mortem examination.

• A magistrate has ordered the post A magistrate has ordered the post mortem examinationmortem examination

Polis 61: postmortem orderPolis 61: postmortem order


If a police officer has reasons to believe orIf a police officer has reasons to believe or

suspects that death issuspects that death is•SuddenSudden

•Unnatural MannerUnnatural Manner

•Death by violenceDeath by violence

•Death by Unlawful act or omissionDeath by Unlawful act or omission

Nearest Government Medical OfficerNearest Government Medical Officer

Nearest government hospital for post mortem Nearest government hospital for post mortem examination byexamination by

a a Government Medical OfficerGovernment Medical Officer

Provided that the Government Medical Officer is Provided that the Government Medical Officer is satisfied assatisfied as

to the cause of death and the deceased came by his to the cause of death and the deceased came by his death by death by

accident he may order the body to be buried.accident he may order the body to be buried.

Once the police has issued P61 Once the police has issued P61 FormForm

• The doctor must examined the body and The doctor must examined the body and decide on the extent of the examination decide on the extent of the examination whether to dissect or not. The power to whether to dissect or not. The power to decide to decide whether to just decide to decide whether to just examine externally or proceed with the examine externally or proceed with the internal examination and taking any internal examination and taking any specimens from the body is vested to specimens from the body is vested to the doctor.the doctor.

• Based on S330 and S331 CPC.Based on S330 and S331 CPC.

• If the doctor is at a private hospital. It’s If the doctor is at a private hospital. It’s the duty of the police officer to send the the duty of the police officer to send the body to a nearest government hospital body to a nearest government hospital for the post mortem examination by a for the post mortem examination by a Government Medical Officer.Government Medical Officer.

• The doctor after conducting the post The doctor after conducting the post mortem examination, shall then do the mortem examination, shall then do the followings:-followings:-

• Determine the Cause of Death (S328 Determine the Cause of Death (S328 CPC)CPC)

• Issue or make to issue Burial Permit, Issue or make to issue Burial Permit, LM02 and LM08 FormLM02 and LM08 Form

Government Medical OfficerGovernment Medical Officer

• A Registered Medical Practitioner A Registered Medical Practitioner (S14 Medical (S14 Medical Act 1971)Act 1971) who is employed by the who is employed by the Government of Malaysia to work in a Government of Malaysia to work in a government hospital or health facility include government hospital or health facility include public universities.public universities.

• Any Medical Officer must conduct a post Any Medical Officer must conduct a post mortem examination when ordered by a mortem examination when ordered by a magistrate or requested by the police. magistrate or requested by the police. (Bab F (Bab F Perubatan Perkara II Tanggungjawab Pegawai Perubatan Perkara II Tanggungjawab Pegawai Perubatan, butiran 10-17, ms217-219.) Perubatan, butiran 10-17, ms217-219.)

• S34(C) Medical Act 1971 S34(C) Medical Act 1971 –A Medical –A Medical Practitioner authorized by the DG to be Practitioner authorized by the DG to be deemed a Govt. Medical Officer deemed a Govt. Medical Officer

1.1. The DG may authorized in writing any The DG may authorized in writing any fully fully registered medical practitioner not in registered medical practitioner not in public public service to undertake any of the service to undertake any of the following following functions iefunctions ie

a) Ex, Ix, Rx/Mx any patients ora) Ex, Ix, Rx/Mx any patients or

b) Perform an autopsy or post mortem b) Perform an autopsy or post mortem examination of any deceased personexamination of any deceased person

2. 2. …. Shall be deemed a Govt. Medical …. Shall be deemed a Govt. Medical Officer Officer for the purpose of CPC or any for the purpose of CPC or any relevant laws relevant laws in Malaysia.in Malaysia.


S 331(I)S 331(I) A Government Medical A Government Medical Officer Officer as as soon as soon as practicablepracticable make a make a post post mortem examination.mortem examination.

S 331(II)S 331(II) If necessaryIf necessary to ascertain to ascertain the the cause of death cause of death shall shall extendextend the the examination to the examination to the dissectiondissection of the body and the of the body and the

analysis of any portion of analysis of any portion of the the body.body.


Transmit a report certifying the Transmit a report certifying the cause of death and conclusions to cause of death and conclusions to the police officer in charge.the police officer in charge.

The report and anything relevant The report and anything relevant shall be admissible as evidence and shall be admissible as evidence and shall be shall be prima facieprima facie evidence of the evidence of the facts at any inquiryfacts at any inquiry..

Registration of Birth and Death Registration of Birth and Death Act 1957Act 1957

S 22S 22 Any medical practitioner, the Any medical practitioner, the last in last in attendance of the attendance of the deceased must register deceased must register his or her his or her death within 12 hoursdeath within 12 hours

S 23S 23 Report within 12 hours after a Report within 12 hours after a post post mortem examinationmortem examination

S 22S 22 Any medical practitioner can Any medical practitioner can refuse to refuse to sign the death certificate if he sign the death certificate if he suspects suspects that death was from an that death was from an infectious infectious disease and not disease and not satisfied with any satisfied with any diagnosis diagnosis written, unless the problem written, unless the problem has has been rectifiedbeen rectified..

Prevention and Control of Infectious Disease Act 1988

S 16 An authorized officer may order any person who died of an infectious disease to be conveyed to such appointed place to be examined.

S 17 Only the authorized person can give direction on manner of burial or cremation.Applies only to patients who died from infectious

diseases .Only stated the person to be examined, nothing said about post mortem dissection/autopsy/internal examination.Authorized person = DG or person authorized by DG eg MOH, State Health Directors or Hospital Directors.

Destruction of Disease- Bearing Insects Act 1975

S 10(1)c The Director General or a Medical Officer of Health may-Cause a post mortem

examination to be made on any corpse where death is suspected to have been caused by any insect-borne disease.S 10(2) Any person having custody of

any corpse who refuses or obstructs the post mortem examination shall be guilty of an offence and liable to a fine not exceeding RM 2000.

Applies only to patients who died from Vector borne diseases.

How we investigate death?How we investigate death?

Death

Cause knownClinical,records & Ix

S 330 CriminalProcedureCodePolicereport

Clinical post mortemConsent

Control ofInfectiousDiseaseAct 1988S 16

Destructionof Disease Bearing Insect Act1975S 10(1)C

Forensic ConsultationForensic Consultation1.1. HomicidesHomicides

2.2. SuicidesSuicides

3.3. Body found dead- cause is unknown and/unidentifiedBody found dead- cause is unknown and/unidentified

4.4. Unwitnessed accidents - hit and runUnwitnessed accidents - hit and run

5.5. Child death not certifiedChild death not certified

6.6. Maternal death not certifiedMaternal death not certified

7.7. Young adult <45 years not certifiedYoung adult <45 years not certified

8.8. Suspicious circumstancesSuspicious circumstances

9.9. Medical/surgical procedures/treatmentMedical/surgical procedures/treatment

10.10. Potential litiginousPotential litiginous

11.11. Multiple deaths >4Multiple deaths >4

12.12. Skeletal remainsSkeletal remains

13.13. All PoisoningAll Poisoning

14.14. Death in custody cause not certifiedDeath in custody cause not certified

15.15. Potential Tissue and organ donorPotential Tissue and organ donor

16.16. Notifiable infectious diseaseNotifiable infectious disease

17.17. Unascertained cause after you have opened upUnascertained cause after you have opened up

Mandatory forensic Mandatory forensic consultationconsultation• HomicidesHomicides

Body found with injuries of sharp Body found with injuries of sharp weapon, blunt trauma, gunshot etcweapon, blunt trauma, gunshot etc

• Child deathChild death

suspected child abusesuspected child abuse

BID with no apparent causeBID with no apparent cause

• Unascertained young adult with no Unascertained young adult with no apparent cause.apparent cause.

• Mass disaster/multiple deathMass disaster/multiple death

• ExhumationExhumation

Post Mortem ExaminationPost Mortem Examination

POST MORTEM EXAMINATION

FORENSIC-Police/Magistrate orders, Polis 61-No need consent-Evidence & documentation-Cause, manner, mechanism, time of death-Reconstruction-Criminal & Civil-Government doctor

CLINICAL-doctors, police not involved-Consent mandatory-Clinical Dx, Px & RxScientific study-Cause, mechanism & Severity-Civil-Registered doctor

Clinical Post MortemClinical Post Mortem

• Examination and dissection on a Examination and dissection on a dead patient to determine cause and dead patient to determine cause and effect of a disease that result into the effect of a disease that result into the death.death.

• Requested by the doctor from the Requested by the doctor from the deceased next of kindeceased next of kin

• Informed consent mandatoryInformed consent mandatory

Medico legal(Forensic) post mortem examination

Performed on the instructions of the legal authority responsible for the investigation of sudden, suspicious, obscure, unnatural, litiginous or criminal deaths.Police, magistrate (coroner) or judge.Permission not required

(Knight B. Forensic Pathology 2ed 1996)

Objectives of medico-legal Objectives of medico-legal autopsyautopsy

• To determine the cause of deathTo determine the cause of death• To determine the manner of death To determine the manner of death

and time of death where necessary and time of death where necessary and possibleand possible

• To document all findingsTo document all findings• To determine or to exclude other To determine or to exclude other

factors that may have contributed to factors that may have contributed to the death or how the manner of death the death or how the manner of death should be classifiedshould be classified

To collect trace evidence from the bodies in To collect trace evidence from the bodies in criminally related casescriminally related cases

To positively identify a bodyTo positively identify a body

To provide a full written reportTo provide a full written report

To offer an expert interpretation of those To offer an expert interpretation of those findingsfindings

To restore the body to the best possible To restore the body to the best possible cosmetic condition before release to the cosmetic condition before release to the relativesrelatives

Objectives of medico-legal autopsyObjectives of medico-legal autopsy

Objectives of medico legal post mortem examination

IdentificationCause of deathManner of deathTime of deathDemonstrate & interpret all abnormalities Detect,describe & interpret all injuriesSamples collection & Lab. Ix.Retain evidenceDocumentationRestoration

Methods of Post Mortem Methods of Post Mortem ExaminationExamination

• Scene of incident examinationScene of incident examination• History from relative/police and History from relative/police and

recordsrecords• Clinical recordsClinical records• External examinationExternal examination• ImagingImaging• Limited internalLimited internal• Full internalFull internal• Specialized procedures - eyeball, Specialized procedures - eyeball,

spinal, lung en bloc, brain, marrowspinal, lung en bloc, brain, marrow• Laboratory IxLaboratory Ix

Preliminaries to an autopsyPreliminaries to an autopsy• Authorization and consentAuthorization and consent

– Police P61 form is issued orPolice P61 form is issued or– Consent from relative is obtainedConsent from relative is obtained

• Identification of the bodyIdentification of the body– By policeBy police– By relativeBy relative

• History from relatives/police/recordsHistory from relatives/police/records

• Clinical recordsClinical records

• RadiographsRadiographs

• Examination of the locus/scene of incident/crimeExamination of the locus/scene of incident/crime

Scene of incident Scene of incident examinationexamination• Homicides - determine the cause & manner of Homicides - determine the cause & manner of

death, evidence mx and Reconstruction of eventdeath, evidence mx and Reconstruction of event• Suspicious circumstances – determine the cause & Suspicious circumstances – determine the cause &

manner of death, evidence mx and Reconstruction manner of death, evidence mx and Reconstruction of eventof event

• Major Incidents – Assess the number of casualties, Major Incidents – Assess the number of casualties, workload, manpower & logistics requirement, workload, manpower & logistics requirement, evidence collection, reconstruction of eventevidence collection, reconstruction of event

• Recovery of human remains – search, recover, Recovery of human remains – search, recover, identify human remains, determine the cause & identify human remains, determine the cause & manner of death, evidence mx and Reconstruction manner of death, evidence mx and Reconstruction of eventof event

• Exhumation – clandestine or known burial grounds- Exhumation – clandestine or known burial grounds- search, recover, identify human remains, search, recover, identify human remains, determine the cause & manner of death, evidence determine the cause & manner of death, evidence mx and Reconstruction of event.mx and Reconstruction of event.

Scene of incident – Determine Scene of incident – Determine the cause & manner of deaththe cause & manner of death

Scene of Crime- Recovering Scene of Crime- Recovering human remainshuman remains

Scene of Scene of IncidentIncident- Exhumation- Exhumation

Scene of Crime- Reconstruction Scene of Crime- Reconstruction of Eventof Event

Scene of Crime- Determine the manner Scene of Crime- Determine the manner of death in suspicious caseof death in suspicious case

Scene of Crime- HomicidesScene of Crime- Homicides

Scene of Incident- Major Scene of Incident- Major incidentincident

Highland Tower Collapse-1994

Helicopter crash

EXTERNAL EXAMINATIONEXTERNAL EXAMINATION

• Identification FeaturesIdentification Features

• Condition of the BodyCondition of the Body

• Post Mortem ChangesPost Mortem Changes

• Abnormalities of Deformities, Abnormalities of Deformities, diseasesdiseases

• InjuriesInjuries

• Detail examination of injuriesDetail examination of injuries

External Examination-External Examination-IdentificationIdentification

External examination - External examination - identificationidentification

External Examination-External Examination-Condition of the bodyCondition of the body

External Post mortem External Post mortem ChangesChanges

External Examination- External Examination- Examine injuriesExamine injuries

External Examination - External Examination - Describe injuries in detailDescribe injuries in detail

External Examination - External Examination - Describe injuries in detailDescribe injuries in detail

Types of injuryTypes of injury

abrasionabrasion bruisebruise


Intradermal bruisesIntradermal bruises bruisesbruises


lacerationlaceration fracturefracture


Incised woundIncised wound Self inflicted incised Self inflicted incised woundwound


Stab woundStab wound Gunshot woundGunshot wound

Internal ExaminationInternal Examination

• Body Regions – Head, Chest, Body Regions – Head, Chest, Abdomen, Pelvic, LimbsAbdomen, Pelvic, Limbs

• Organs examinations – all organs, Organs examinations – all organs, vessels, sections, weightvessels, sections, weight

• Collections of specimensCollections of specimens

• Grossing for tissue samplesGrossing for tissue samples

Internal Examination - BrainInternal Examination - Brain

Fulminant Bacterial Meningitis

Duret Hghe- Brainstem

Internal examination - neckInternal examination - neck

Examination of the Neck and chest

Examination of the air passages-A case of saltwater wet drowning, seen here froth in the trachea.

Sectioning of the organsSectioning of the organs

Gross view: Mitral valve opened to show row of vegetations on the margins of cusps.

Internal Examination - Heart

Internal Examination- Pleural CavityInternal Examination- Pleural CavityHemothorax refers to blood in the pleural space. Hemothorax refers to blood in the pleural space. Hemothorax should be included in the differential Hemothorax should be included in the differential diagnosis of any pleural fluid seen on X-ray.diagnosis of any pleural fluid seen on X-ray.

Sectioning the lungs – case of pulmonary Sectioning the lungs – case of pulmonary EmbolismEmbolism

Limbs – examination of the Limbs – examination of the veins for DVTveins for DVT

Specimens collection for Specimens collection for analysesanalyses• ToxicologyToxicology

• AlcoholAlcohol

• HistopathologyHistopathology

• MicrobiologyMicrobiology

• BiochemicalBiochemical

• SerologySerology

• Weapons/Tool Weapons/Tool markingsmarkings

• BallisticsBallistics

• EntomologyEntomology

• DNA analysisDNA analysis

• Physical Trace Physical Trace evidenceevidence

Toxicological investigationToxicological investigation

• BloodBlood• Stomach contentStomach content• Stomach wallStomach wall• Tissues - liver, kidney, Tissues - liver, kidney,

lungs, spleen, brain, lungs, spleen, brain, musclesmuscles

• UrineUrine• BileBile• VitreousVitreous• CSFCSF• Hair & nailsHair & nails• Maggots?Maggots?

• Blood from site away Blood from site away than near the than near the stomach- passive stomach- passive diffusiondiffusion

• Not from paracolic Not from paracolic gutter after gutter after evistrationevistration

• Blood in plain Blood in plain container except container except flouride in alcohol, flouride in alcohol, CN or cocaine.CN or cocaine.

Histopathological Histopathological InvestigationInvestigation

• Sections of tissuesSections of tissues

• Grossing of tissuesGrossing of tissues

• Processing in the laboratoryProcessing in the laboratory

• Microscopic Examinations of the Microscopic Examinations of the tissues slidestissues slides

Stomach contentStomach content

• To detect ingested poison or drugs.To detect ingested poison or drugs.• Only stomach content (Not stomach Only stomach content (Not stomach

and content). Whole content or at and content). Whole content or at least 50ml. Note the whole volume.least 50ml. Note the whole volume.

• Stomach wall if empty, whole or cut Stomach wall if empty, whole or cut 1/2 along lesser & greater 1/2 along lesser & greater curvatures. In plain container only. curvatures. In plain container only.

• Scrap the walls with spatula or Scrap the walls with spatula or spoon, place the scrapings in spoon, place the scrapings in another container.another container.

Tissues for toxicologyTissues for toxicology

• Various tissues but at least liver, lungs, Various tissues but at least liver, lungs, kidney. Each 100 gm or the size of a kidney. Each 100 gm or the size of a matchbox. NO NEED WHOLE ORGANS.matchbox. NO NEED WHOLE ORGANS.

• Other tissues- adipose tissue, brain, Other tissues- adipose tissue, brain, heart, musclesheart, muscles

• Do not contaminate liver with bileDo not contaminate liver with bile

• Use plain container or with Normal Use plain container or with Normal Saline. No need formalinSaline. No need formalin

Tissues IITissues II

• Hair and nails for heavy metals. Eg Hair and nails for heavy metals. Eg Arsenic poisoning, other Pb, Thallium Arsenic poisoning, other Pb, Thallium etcetc

• Bile in gallbladder for paracetamol and Bile in gallbladder for paracetamol and opiate.opiate.

• Whole lungs with airways, ligate & Whole lungs with airways, ligate & closed the top end for solvent abuse.closed the top end for solvent abuse.

• Tissues around the injection site incl. Tissues around the injection site incl. Skin, subcutaneous and muscles for Skin, subcutaneous and muscles for drugs via injectiondrugs via injection

UrineUrine

• Urine best by direct puncture with Urine best by direct puncture with needle and syringe.needle and syringe.

• Not to contaminate with blood or Not to contaminate with blood or other fluids.other fluids.

• Useful for most poisons especially Useful for most poisons especially drugs of abuse & common poisons.drugs of abuse & common poisons.

Vitreous fluidVitreous fluid

• Needle puncture with syringe, into Needle puncture with syringe, into the sclerae of the eyeball. Aspirate the sclerae of the eyeball. Aspirate slowly, then replace with equal slowly, then replace with equal amount of water.amount of water.

• Used for biochemical analysis of Used for biochemical analysis of NaNa++, K, K++, Cl, Cl--, HCO, HCO3 3 and glucose. and glucose. Thus a small portion in flourinated Thus a small portion in flourinated container.container.

Specimens for Chemistry Specimens for Chemistry DepartmentDepartment

Urine, bile, CSF & tissuesUrine, bile, CSF & tissues• Urine, CSF, bile, stomach content for Urine, CSF, bile, stomach content for

toxicology and drugs of abuse use plain toxicology and drugs of abuse use plain containers.containers.

• Stomach wall and tissues for toxicology Stomach wall and tissues for toxicology use plain containers without formalin use plain containers without formalin apart form Normal saline.apart form Normal saline.

• Muscles and marrow for DNA or Muscles and marrow for DNA or toxicology in sterile plaintoxicology in sterile plain..

Specimens to Specimens to PathologyPathology

• Tissues in containers with 10% Tissues in containers with 10% formalinformalin

• Vitreous fluid in plain containers but a Vitreous fluid in plain containers but a small portion may be flourinated small portion may be flourinated container.container.

• CSF in plain containersCSF in plain containers• Swabs for microbiology in Amie’s or Swabs for microbiology in Amie’s or

Stuart’s Transport media.Stuart’s Transport media.

Under the vegetation, granulation tissue is seen. Healing produces scarring which deforms the valve and causes stenosis and/or incompetence.

Heart valves - vegetation

Pulmonary oedemaPulmonary oedema

At high magnification, the alveoli in this lung are filled with a smooth to slightly floccular pink material characteristic for pulmonary edema. Note also that the capillaries in the alveolar walls are congested with many red blood cells. Congestion and edema of the lungs is common in patients with heart failure and in areas of inflammation of the lung.

At the left the alveoli are filled with a neutrophilic exudate that corresponds to the areas of consolidation seen grossly with the bronchopneumonia. This contrasts with the aerated lung on the right of this photomicrograph.

At high magnification, the alveolar exudate of mainly neutrophils . The surrounding alveolar walls have capillaries that are dilated and filled with RBC's. Such an exudative process is typical for bacterial infection.

Bronchopneumonia- Microscopic appearance

Always tell the truth. That Always tell the truth. That way, you don’t have to way, you don’t have to remember what you said.remember what you said.

Documents

Inquiries of Death