Autopsy

Norm of Autopsy

Requires interpretation.

 

Usage of Autopsy

Determination of cause and manner of death, reporting of contagious diseases, quality assurance, teaching, and legal purposes.

 

Description of Autopsy

A postmortem examination and dissection of a corpse. The procedure is usually performed by two pathologists and an assistant.

 

Professional Considerations of Autopsy

Consent form IS required.
Preparation

1. After death, determination should be made whether the circumstances of death require that the coroner be notified. Coroner's cases usually include unexpected death, death within 24 hours of admission to a hospital, death while under anesthesia, suspected homicides or suicides, accidental or violent deaths, deaths of clients with contagious disease, or any death occurring under unusual circumstances or involving the public interest. If any of these conditions apply, the coroner should be called by the physician for a determination of the need for an autopsy. If the coroner determines that an autopsy is required, the family should be notified, but next-of-kin permission is not needed.
2. Autopsy may also be performed without next-of-kin permission when it is necessary to complete the death certificate or when the deceased client has given consent before death.
3. When the need for an autopsy is determined, other than for coroner's cases, next-of-kin permission must be obtained by means of a signature on the consent form or possibly by a witnessed telephone conversation between the physician and the next of kin. Guidelines vary depending on area laws and institution.
4. All invasive lines, tubes, and devices should be left intact in the body.
5. Obtain an autopsy knife with a blade, a scalpel with a disposable blade, toothed forceps, forceps with serrated tips, a medium-long knife with a blade, a long knife with a blade, scissors with one pointed and one blunt blade, scissors with two blunt blades, scissors for cutting bones, intestinal scissors (enterotome), scissors with long curved blades, a 1-mm probe, a metal metric rule, a costotome, rib shears, intestinal clamps, a vibratory saw with large blades, an amputating saw, a band saw, a hammer with a hook, a chisel, bone-cutting forceps, a meter stick, a body scale, an organ scale, balances, a ladle, a graduate, sea sponges, pans with fixative, pan and pail containers, a large container for fixation of gross organs in solution, fixing solution, string, needles, abrasive whetstone and oil, and a slicing machine.
6. Obtain containers for the samples for toxicologic studies, culture, or cytologic tests.
7. Make sure that the autopsy-permit name and identification number correspond to the name and identification number on the client's body. If there are no tags on the body, have the nurse, physician, or relative identify the body.
8. Wear a mask, an eye or face shield, gloves, and a plastic apron.

 

Procedure

1. Recording: The sequence of events and findings of autopsy are recorded either by concurrently written notes or by a foot-operated dictation machine. Descriptions of the body and organs, including condition, arrangement, and weight of the organs, are made and recorded as the dissection is performed.
2. Sequence: The sequence of the autopsy may vary. In cases in which a specific cause of death is suspected, the appropriate body cavity for that cause may be opened first. A usual autopsy proceeds in the following order: external examination; incision of the skin, ribs, and sternoclavicular joints; examination of thoracic and abdominal cavities; removal and examination of the organs of the trunk (thymus, heart, lungs, mediastinal lymph nodes, spleen, intestines, diaphragm, liver, gallbladder, pancreas, stomach, duodenum, rectum, spermatic cords, testes, adrenals, uterus, ovarian tubes, ovaries, bone marrow [sternal, vertebral, femoral], neck organs, bones, joints, and muscles); and removal and examination of the organs of the cranium and spine (brain, eyes, ears, paranasal sinuses, pituitary gland, spinal cord, and spinal root ganglia).
3. Content of assessment: In the external examination, the body is observed and palpated, and the length, size, and weight are measured. Rigor mortis, edema, and jaundice are noted. The head, lymph nodes, and genitalia are assessed. A Y incision is then made on the torso, and the thoracic and abdominal cavities are assessed. The arrangement and status of the organs and the presence of adhesions, excess fluid, or gas are noted. As they are excised, the weight, size, and contents of the organs and blood vessels are assessed. Biopsy specimens, sections, and smears may be taken throughout the process. The organs of the cranium and spine are then assessed. An incision is made from ear to ear over the vertex of the cranium, and the scalp is separated from the skull with a scalpel. The anterior portion of the scalp is pulled down over the forehead and face. After the skull is opened with a saw and the top portion removed, the brain is removed and placed in 10% formalin. Biopsy specimens of the brain are taken if a virus is suspected. The remainder of the head organs are removed and examined. Formalin is injected into the eyes before removal. The spinal cord is then removed and examined for lesions. Complete organs or portions of organs may be fixed in solution for later reference. An alternative method is to remove the trunk organs in one block, with examination of organs on a dissecting table.

 

Postprocedure Care

1. The body is cleansed, and the incisions are sewn. The body may or may not be embalmed at this point.

 

Client and Family Teaching

1. Autopsy incisions will not be visible should an open-casket wake be held.
2. Durable Power of Attorney for Health Care does NOT apply after death.

 

Factors That Affect Results

1. A routine hospital autopsy should be interrupted and the coroner notified if any unexpected findings that may be of traumatic origin are encountered.

 

Other Data

1. The order of authority for granting permission for an autopsy is normally spouse, adult child, parent, adult sibling, other relative, and any other person accepting responsibility for burial of the body. This order may vary by area laws.
2. Be aware of religious considerations concerning autopsy.
3. There is a 44% discordance rate between clinical and autopsy diagnosis of malignant neoplasms.