SEMINAR 2 (WEBINAR)

DEATH and AUTOPSY (General Pathology with Histopathologic and Cytologic Techniques)
Guest Speaker: Wins C. Esteban, RMT, MD, DIPSUI, MMPHA, MPH
Transcribed by: DAPNolasco | March 2024
TOPIC OUTLINE On the other hand cessation of brain activity can
I. DEATH be detected by:
a. Definition  Electroencephalogram (EEG) – painless test.
i. Organ donation act of 1991 During this procedure, the px is being placed flat
ii. Importance of determination of death in bed wherein small sensors are attached to
b. Determination of death their scalp to pick up the electrical signals
i. Brain death produced by the brain. These signals are
recorded by the machine and are read by the
ii. Cardiorespiratory death
medical doctors/practitioners.
c. Kinds of death
Why is it “If the person is really dead, the property of a person
i. Somatic / clinical death
important to is transmitted to their heirs at the time of their death
ii. Molecular / cellular death determine if and the criminal liability is extinguished by this.
iii. Death or “State of Suspended Animation” the patient is Therefore, if the person is really dead, hindi na siya
d. Signs of death really dead makukulong. The civil case for claims which does not
i. Cessation of heart and circulation especially in survive is also diminished upon the death of the
ii. Cessation of respiration the medico- defendant and that is really far away from life because
e. Changes in the Body following Death (changes in legal life is a sum total of all the vital processes by which
MUSCLE) aspects? the physical integrity of the body is maintained. On
i. Stage of primary flaccidity or period of muscular the other hand, death is the termination of life and the
irritability complete cessation of vital functions without the
ii. Stage of post-mortem rigidity (cadaveric rigidity, or possibility of resuscitation and it is irreversible. Death
death struggle of muscles/ rigor mortis) is a complete persistence cessation of respiration,
circulation, and other functions of the body.”
iii. Stage of secondary flaccidity or secondary relaxation
f. Changes in the Body following Death (changes in blood)
i. Difference between ante-mortem and post mortem Determination of Death
clot Brain Death It is a deep irreversible absence of brain electrical
g. Changes in the Body following Death (autodigestive activity. One of the protocols followed to say if the
changes after death) person is really brain dead is the Harvard Report of
h. Changes in the Body following Death (putrefaction of the 1968 which states that the person is already brain
body) dead if:
i. Timeline of putrefaction  Unreceptivity and unresponsibility – total
II. AUTOPSY unawareness to externally applied stimulus.
a. Types of autopsy  No movements or breathing – observations
b. When shall autopsy be performed on a dead body? covering at least one (1) hour by physicians
c. Manner of death that should be autopsied  No reflexes – irreversible coma with abolition of
d. Guidelines for autopsy the central nervous system activity is evidenced
e. Autopsy procedures in part by the absence of elicitable reflexes.
f. Organ removal Puplsi are fixed and dilated.
 Flag EEG – great confirmatory value

Cardio- Occurs when there is a continuous and persistent

The legal aspect of forensic medical laboratory diagnosis separates it from
clinical diagnosis. This legal perspective requires some ways of handling
samples, use of specific diagnostic techniques required by law, followed by
chain of custody.
Forensic medical laboratory – deals with gathering of data for analysis
and use in legal preceding depending on a particular jurisdiction.
Chain of Custody – concerns with documentation of every person who
has handled the sample and anywhere it has been
 If the chain of custody procedure is handled correctly, forensic
medical laboratory evidence can be admitted in court with
assurance that the item was collected from the stated location
and/or person without compromising the evidence.
DEATH
Organ Death is defined as cessation of cardiopulmonary
Donation functions and/or cessation of brain activity.
Act of 1991
Guest speaker key notes:
In cessation of cardiopulmonary function, dapat:
 Nagdecrease na yung blood pressure of the px
 Pulse of the px is not palpable
This is confirmed by doctors by getting the ECG of the
px and once acquired, it should indicate that patient
is having a flat rate.
respiratory cessation of heart action and respiration. This can be
death noted by the family members or medical practitioners
based on common sense and/or intuition.
KINDS OF DEATH
Somatic Death Complete, persistent, and continuous cessation of
/ Clinical Death the vital functions of the brain, heart, and lungs
which maintain life and health.
Molecular or After the cessation of the vital functions of the body,
cellular death there is still animal life among individual cells. This
happens three to six (3 – 6) hours later and there is
individual cell death.
Guest speaker key notes:
This is something na we can see sometimes in
horror vids, wherein yung mga dead bodies can be
caught on cam na biglang gumalaw  and the
reason behind that is because the molecular or
cellular death is not yet happening. So there’s a
possibility na kahit nasa morgue na yung px,
p’wede pa rin siyang magkaroon ng subtle
movements.
Death or “State Not really death but merely a transient loss of
of Suspended consciousness or temporary cessation of the vital
Animation” functions of the body on account of disease,
external stimulus or other forms of influence. This is
different from Lazarus effect/phenomenon.
Examples:
 Px with uremia or those with electric shock

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 SEMINAR 2 (WEBINAR)
DEATH and AUTOPSY (General Pathology with Histopathologic and Cytologic Techniques)
Guest Speaker: Wins C. Esteban, RMT, MD, DIPSUI, MMPHA, MPH
Transcribed by: DAPNolasco | March 2024

Lazarus effect / phenomenon: delayed return of on the water or mercury contained

your spontaneous circulation after cessation of in a saucer and placed on chest or
cardiopulmonary resuscitation abdomen if respiration is not taking
place.
SIGNS OF DEATH Cooling of The progressive fall of the body temperature is one of
the body the most prominent signs of death.
Cessation Examination of Heart (done by doctors) (Algor Post mortem caloricity – rise in temperature of the
of Heart  Palpation of the pulse (if the px is dead, pulse is non- mortis) body after death due to rapid and early putrefaction
and palpable) changes in the internal organs and happens in the first
Circulation  Auscultation for the heart sound at the precordial two hours of death.
area (if the px is dead, there is no heart sound) Insensibility  After death, the whole body is insensible
of the body  No stimulus is capable of producing voluntary
Examination of the Peripheral Circulation (done by and loss of movement
Medtechs and Forensic medicine practitioners) power to
move
Magnus Done by medtechs alongside with
test the doctor wherein they will put a Changes in the Body following Death (changes in MUSCLE)
ligature or a string wrapped around
the base of the finger of the px with Stage of  Immediate after death
moderate tightness. In a living primary  Last about 3 – 6 hours
person, the finger with a string flaccidity or  In warm places, the average duration is only 1 hr
wrapped around it will exhibit color period of and 51 minutes
change. However, if the person is muscular  The extremities are flexed, lower jaw falls, eyeball
dead, there will be no color change. irritability loses its tension, and there may be
incontinenceChemically, the reaction of the
Alive: color change muscles are alkaline
Dead: no color change  Muscles are still contractile with stimuli due to
Icard’s test A solution of fluorescein is injected molecular life after somatic death
subcutaneously. If the circulation is  Chemically, the reaction of the muscles are alkaline
still present, the dye will spread all
over the body and the whole skin
Stage of  Onset: 3 – 6 hrs after death same with stage of
will change in color (greenish to
post-mortem primary flaccidity
yellow).
rigidity  Temperate countries: 2 – 3 days
(cadaveric  Tropical countries
Alive: color change
rigidity, or
Dead: no color change  Cold weather: 24 – 48 hrs
death
Diaphanous Fingers are being spread wide, and struggle of  Summer: 18 – 36 hrs
test the fingers web are viewed through muscles/  The muscles gradually stiffen. It usually starts at
a strong light. In the living the finger rigor mortis) the muscles of the neck and lower jaw and spreads
webs is red, but in dead, it is yellow. downwards
 Usually, the whole body becomes stiff in 12 hrs
Alive: RED
Dead: Yellow  All muscles are involved (both voluntary and
Application Alive: has reaction involuntary)
of heat on Dead: no reaction  Chemically, there is an increase of lactic acid and
the skin phosphoric content of the muscles and the
Palpation of Alive: pulse is palpable reactions become ACIDIC, setting in the lactic
radial pulse Dead: pulse in non-palpable acidosis.
Dropping of Most important and easiest to do.
melted wax Basically, melted wax will be put on HEAT STIFFENING ( in rel. to RIGOR MORTIS)
the breast of the person. If the - If the dead body is exposed to temperatures
person is dead there will be no above 75 degrees cel (placed in boiling fluid or
inflammatory edema/ blisters. burned to death) it will coagulate the muscle
proteins and cause the muscles to be rigid
Alive: formation of blisters/ - The body assumes a pugilistic attitude – lower
inflammatory edema and upper extremities flexed and the hand
Dead: no reaction clenched because of the flexor muscles are
stronger than the extensors.
Cessation Some of the ways to determine cessation of respiration
of are:
respiration Examination The surface of a cold looking glass
with a mirror is held in front of the mouth and
nostril. If there is dimming of the
mirror after a time, there is still
respiration.
Examination
with feather
or cotton
fibers
Examination
with a glass
of water
Winslow There is no movement of the image
test formed by reflecting artificial light

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 SEMINAR 2 (WEBINAR)
DEATH and AUTOPSY (General Pathology with Histopathologic and Cytologic Techniques)
Guest Speaker: Wins C. Esteban, RMT, MD, DIPSUI, MMPHA, MPH
Transcribed by: DAPNolasco | March 2024

Pugilistic attitude / boxer’s stance

AUTOPSY
COLD STIFFENING ( in rel. to RIGOR MORTIS)
- Stiffening of the body may be manifested when An autopsy is a comprehensive study of a dead body, performed by a
the body is frozen, but exposure to warm trained physician employing recognized dissection procedure and
condition will make such stiffening disappear techniques. It is very different to post mortem examination because:
- The cold stiffening is due to the solidification of  Autopsy indicates an external and internal exam of the body
fat when the body is exposed to freezing while;
temperatures.  Post mortem examination is an EXTERNAL examination of the
Stage of  After the disappearance of rigor mortis, the body
secondary muscles become soft and flaccid. It does not This is best performed within 24 hours of death before organs deteriorate
flaccidity or respond to mechanical or electrical stimulus. This
and before embalming which can interfere with toxicology and blood
secondary is also the stage where we can already smell the
relaxation cultures.
dead body which starts the onset of decomposition
 The most notable bacteria responsible for
decomposition is the Clostridium welchi / Ancient Egyptians: one of the first civilizations to practice the removal and
perfringes. examination of the internal organs of humans in the religious practice of
mummification
Changes in the Body following Death (changes in BLOOD)
Other notes:
 The stasis of the blood due to the cessation of circulation enhances the  In morgue, there are chambers for the body which could be
coagulation of blood inside under positive temperature or negative temperature.
 Blood may remain fluid inside the blood vessels after death for 6-8  If the body will be placed in positive temperature – this is
hours most usually used for keeping bodies for few days or weeks with
a temperature of 35.6F – 39.2F
Difference between post mortem and ante-mortem clot:  Unidentified bodies are placed in negative temperature
Ante-mortem clot Post mortem clot chambers of the morgue. They are completely frozen there and
Clot firm Soft the temperature is 5 – 13F.
consistency
uniformity Color is uniform Has distinct layers TYPES OF AUTOPSY
Surface of the Very raw after removal of Smooth and healthy Hospital / Non-official /  Autopsy done on a human body with the
blood vessel blood clots Non-medicolegal consent of the deceased person’s
autopsy relatives for the purpose of determining
Other notes: the cause of death.
 If the person is intoxicated with carbon monoxide – the color of  Important in suicide and murder cases.
the blood is BRIGHT PINK  Provides correlation to clinical diagnosis
 If the person has asphyxia – the color of the blood is dark red and clinical symptoms
 If the person has anemia – the color of the blood is less dark  In here, the body is owned by the
 if the person is exposed to snow or ice – the color of the blood relatives
will be bright red  Needs consent in order to perform
Medico – legal or  For determining the cause, manner, and
official autopsy time of death
Changes in the Body following Death
(Autodigestive changes after Death)  Separating death due to disease from
death due to external causes
 After death, proteolytic, glycolytic and lipolytic ferments of glandular  Suspicious case to rule out foul play
tissue continue to act which lead to audigestion of organs.  Important for preserving evidence
 Mandatory process
Changes in the Body following Death  In here, the body of the px will be owned
(Putrefaction of the Body) by the state / government until the
autopsy done
Putrefaction – breaking down of the complex proteins into simpler
 If the px is Muslim or belonging to religion
components associated with the evolution of foul smelling gases and
that does not allow autopsy, the state
accompanied by the change of color of the body. There is formation of can overrule through police works
greenish color of the skin which is seen in the right iliac fossa and it will
gradually spread to the whole abdominal wall. There will be also formation When shall autopsy be performed on a dead body?
of gasses that causes distention of the abdomen and bloating of the whole  Whenever required by special laws
body.
 Upon order of the court, mayor, and a provincial city fiscal
 Upon written request of police authorities
TIMELINE OF PUTREFACTION (IN TROPICAL REGIONS)
 Whenever the solicitor general, provincial or city fiscal shall
deem it necessary
12 hrs
Rigor mortis present all over  Whenever nearest kin shall request in writing the authorities
24 hrs concerned.
Rigor mortis absent all over

48 hrs (+) ova of flies seen and moving maggots

The following manner of death should be autopsied:
 Death by violence
72 hrs (+) hair and nails loose  Accidental death
 Suicides
1 week Soft viscera
Soft viscera putrefied
putrefied  Sudden death of persons apparently of good health
 Death unattended by a physician
Body skeletonized
Body skeltonized
1 month  Dead on arrival
 Death occurring in unnatural manner

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 SEMINAR 2 (WEBINAR)
DEATH and AUTOPSY (General Pathology with Histopathologic and Cytologic Techniques)
Guest Speaker: Wins C. Esteban, RMT, MD, DIPSUI, MMPHA, MPH
Transcribed by: DAPNolasco | March 2024

GUIDELINES IN PERFORMANCE OF AUTOPSIES

 The pathologist must be properly guided
 Bodies which are severely mutilated, decomposing or damaged
by fire are still suitable for autopsy
 All autopsies must be performed in a manner which show respect
to the dead body
 Unnecessary dissection must be avoided
 Proper identity of the deceased autopsied must be established
 A dead body must not be embalmed before the autopsy
 The body must be autopsied in the same condition when found
in the crime scene.

AUTOPSY PROCEDURES
Y incision  Starts near the acromion
process and progresses
downwards towards the
xiphoid process.
 Extended till the symphysis
pubis

Modified  Made from suprasternal notch

Y over the clavicle to its center
procedure on both sides and passes
upwards over the neck,
behind the ear to symphysis
pubis

I incision Straight line incision extending

from the chin to the symphysis
pubis

REMOVAL OF ORGANS
Virchow Organs are removed one by one from the body to be
technique examined

This is done in following order:

 Expose the cranial cavity  spinal cord 
thoracic, cervical and abdominal organs
Rokitansky This method is characterized by the in situ dissection.
method The dissection begins at the neck and slowly works its
way down the body and the organs is removed as a
block.

A cut is first made at the larynx to separate the

esophagus from the pharynx. Larynx and trachea are
pulled downward, and using a scalpel, the chest organs In case no one had told you today, YOU MATTER!! May you find joy in studying no
are cut. matter how hard and tiring it is. Better days are about to come! <3
Ghon The Ghon method, also known as the en bloc
Technique technique, is a method of autopsy where organs are
removed in three individual blocks: the thoracic,
abdominal, and pelvic. This technique can help
expedite the process of dissection and preserve
anatomic relationship
Letulle Thoracic, cervical, abdominal, and pelvic organs are
technique removed “en masse”, meaning as one big organ
block.

It allows the body to be made available for examination

in less than 30 mins because the process of removing
organs is much quicker

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