Posts Tagged ‘Autopsy’


November 25, 2008

Inflammation could relate to forensic nursing in that forensic nurses sometimes take tissue samples from the bodies they are performing autopsies on or patients they are working on that may be criminals or victims for evidence of a crime that has been committed. If the mechanism of injury or death was from trauma, there may be lasting evidence of acute inflammation in the tissues. Some signs of acute inflammation are swelling, redness, pain, heat, and loss of function. Obviously if someone is dead, they would probably no longer have those signs I just mentioned. They may however have increased neutrophil or eosinophil levels and possibly an increased amount of macrophages out of the venules and into the interstitial tissues. If there is evidence of MBP (major basic protein) present, that could serve as evidence that the person’s body was trying to fight off a parasite.

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Sudden Infant Death Syndrome versus Child Abuse

August 13, 2008

The topic of this discussion is the assessment findings that would distinguish between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse. It is in the realm of forensic nursing to share the responsibility of rendering a medicolegal opinion as to the cause of death.
The interview assessment will need to include the epidemiology trends identified with SIDS. Some of these are: early gestation, low birth weight, mother who used tobacco or recreational drugs during pregnancy. Post birth incidences of thrush, pneumonia, cyanotic spells and vomiting. It will also be important to note last visit to pediatrician and any immunizations received. Current thinking is having one child with SIDS does not predispose future children to SIDS, however, it would be important to know if considering abuse.
The mother needs to be questioned regarding psychiatric disturbances, postpartum depression or history of maltreatment themselves. There is an epidemiology trend indicating that a mother with one of these histories has a tendency to infanticide.
New standards of markers to check in the autopsy have increased as SIDS is studied in greater detail. Some but not all are:
• Develop a timeline for baby illness as it is trended many of these babies who subsequently died had previous hospitalizations for failure to thrive.
• Check for patterns of viral infections as respiratory syncytial virus, cytomegalovirus, Hepatitis.
• Forensic nurse could also have a role in the investigation of the child’s home for environmental risk factors. The crib will need to be assessed for cleanliness, repair, type of pillows, blankets, type of sheets, check stuffed toys for tight seams to hold stuffing, strings of any type the baby could get in the airway or around the neck. The environmental assessed for cleanliness and observe family members interaction with each other.
• Pathology review needs to include assessing the brainstems for glial nodules as there is speculation these may affect cardiorespiratory control.
o Intrathoracic petechia is a controversial marker for SIDS that should be observed for.
o Samples need to be taken of body fluids such as: vitreous humor, CSF, blood, urine and stool. Tissue needs to be taken from the brain, liver, kidney heart, adrenals, pancreas skin, and muscle
o Chemistry panels would be required due to thoughts on metabolic diseases accounting for SIDS in infants with fatty livers.
o Radiology studies would need to complete to rule out past or recent physical abuse with residual injuries to skeletal system.
A nurse trained in forensics could serve as a pivotal member of a trauma response team for a infant brought by EMS. The staff all need maintain a supportive approach to parents during the death review process. The forensics training would allow timely gathering of evidence such as bed linens, clothes, and initial reactions from care giver, photograph any contusions or physical signs of maltreatment before the body is taken to the morgue. Photographs could help determine postmortem lividity from bruising or other skin lesions. Reports emphasize the need for evaluation that includes thorough physical examinations, autopsies, and death scene investigation. The information compiled by means of the detailed investigation suggested could provide a greater determination of cause and manner of death. Overall minimize mistakes in determining the cause and manner of death in these tragic cases.


Peterson DR Clinical implications of sudden infant death syndrome epidemiology Pediatrician1988;15:198-203

Reece DR Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision Pediatrics Vol 91 February 1993


Autopsy defined

February 12, 2008

An autopsy is also commonly called a post-mortem examination. This procedure is a detailed and very careful medical examination of a person’s body and its organs after death in order to help establish the cause of the person’s death. A physician, most commonly a pathologist who specializes in the study of human diseases, performs the autopsy along with a forensic nurse/death investigator or nurse coroner. Surgical techniques are used to remove and examine each organ, and some tissue samples are selected for microscopic or other special tests. An autopsy is usually carried out within 48 hours after the death of a person. An autopsy can be hospital-based or coronial. The state coroner orders coronial autopsies, whereas hospital based autopsies may be performed at the request of the family. Autopsies will usually include testing for any infections through microbiology, changes in body tissue and organs by looking at the anatomical histology, and also any chemicals, medication or drugs poisons.



October 3, 2007

I recently attended an autopsy of a lady who committed suicide. The reason for the autopsy was because the boyfriend was with her when she shot herself in the abdomen and the detectives stated he was way too calm when they arrived on the scene. I found the autopsy to be very interesting because the doctor checked every organ to make sure this was a suicide, even though the woman’s daughter and boyfriend were witnesses to her suicide. The forensic pathologist was so thorough with every step in the investigation part of the autopsy; he even took hair samples and vaginal swabs to make sure there wasn’t any kind of sexual assault. I did not realize an autopsy was so detailed.



September 7, 2007

I work with infants and we have had a few cases of SIDS come up in the last few years. When we have a family in the unit who has had a child die from SIDS we do take precautions and send them home on an apnea monitor. Studies say there is no genetic link but who knows. We don’t really know why SIDS happens. If you had a SIDS case I think the forensic nurse should look at more factors than what was listed in the article. It is hard to determine what happened. One should be looking at family, environment, second hand smoke, nutritional status of the infant, growth and development of the infant and not just the autopsy finding. With the new newborn screens that have come out in some states, hopeful some of the screens will pick up if it is a metabolic/genetic disorder prior to the event happening. Maybe some of these different labs should be added in addition to the autopsy. So maybe it could be genetic disorder.


Death Investigation

August 1, 2007

I have been reading a book called “Bodies We’ve Buried” by Jarrett Hallcox and Amy Welch. It is an inside look into the National Forensic Academy, which is the world’s top CSI Training School. Chapter 8 is about death investigation, which has always been interesting to me. I did not realize there were different stages of death. There are the earliest signs, such as cessation of breathing and circulation of blood. Within the first hour after death all the muscles in your body relax and there is extreme paleness of the skin, called pallor. The book tells that there are 3 M’s of forensic pathology: rigor mortis, algor mortis, and livor mortis. Rigor mortis is the contracting of the muscles in the body and usually takes 2-3 hours to begin, usually ending by 48 hours. When rigor has set in the person will be in the same position as they were when the death occurred. Heat will speed up the process of rigor, as cold temperatures will slow the process down. Algor mortis is the cooling down of the body temperature after death, and is a classic death measurement. Livor mortis begins immediately after death and does not end until about 5-6 hours after death. Livor mortis is the pooling of blood to the lowest points in the body, and plays a critical role in death investigation. When a person has died while sleeping on their back, they will have a purplish look to their backside from the pooling of blood from livor mortis. I think it is amazing that investigators can narrow down almost to the hour that the person expired.


Organ Donation

May 9, 2007

In Ohio we are asked the question “would you like to be an organ donor?” every time we renew our drivers license. I believe at that time if you decide you would like to donate any organs after time of death, there should be some sort of social worker there to find out exactly what organs you would like to donate. A relative of mine died unexpectedly one month ago, and after her death her husband received a phone call about 1/2 hour after she had expired from the hospital asking what organs he would like to have donated from her body. I just found this not to be the right time to call someone that just lost his or her spouse. They also had called back several times that evening for more questions for him about donating organs. In an autopsy report does the medical examiner report what organs were donated and to whom? And do they use these donations for science?


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