SEMINAR 2

DEATH AND AUTOPSY

2nd Semester | AY. 2023-2024 02
TOPIC OUTLINE 2. Molecular or Cellular Death
I. Death → After the cessation of the vital functions of
A. Organ Donation Act of 1991 the body, there is still animal life among
B. Determination of Death individual cells
C. Kinds of Death ▪ In some instances, the body parts of a
D. Signs of Death deceased patient may move, particularly
II. Autopsy in the morgue, due to incomplete
A. Types of Autopsies molecular or cellular death processes.
B. Best Time to Perform Autopsy ▪ Usually happens after 3-6 hours after
C. When Shall Autopsy be Performed death
D. Who Should be Autopsied
E. Guidelines in Performing Autopsy
3. Death or “State of Suspended Animation”
F. Autopsy Procedure → Not really death but merely a transient
G. Removal of Organs loss of consciousness or temporary
cessation of the vital functions of the body
on account of disease, external stimulus,
DEATH AND AUTOPSY
or other forms of influence
• Speaker: Wins C. Esteban, RMT, MD, DIPSUI, → Examples:
MMPHA, MPH ▪ Uremia
• Subject covered: General Pathology with ▪ Electric shock
Histopathologic and Cytologic Techniques ▪ Cardioplexy
→ Different from Lazarus
DEATH effect/phenomenon (delayed return of
spontaneous circulation after cessation
DEATH AS PER ORGAN DONATION ACT OF 1991 of cardiopulmonary resuscitation)
• Organ Donation Act of 1991 – death is defined
as the cessation of cardiopulmonary SIGNS OF DEATH
functions and/or cessation of brain activity Cessation of Heart and Circulation
• Examination of the Heart (Doctors)
DETERMINATION OF DEATH → Palpation of pulse
Brain Death → Auscultation for the heart sound at the
• Manifestations of brain death: precordial area
→ Unreceptivity and unresponsibility – ▪ If the patient is really dead, the
total unawareness to externally applied pulse must be non-palpable and
stimulus the stethoscope must not cover
→ No movements or breathing – any heart sound.
observations covering at least 1 hour by • Examination of the Peripheral Circulation
physicians (Medtechs and Forensic Medicine)
→ No reflexes – irreversible coma with → Magnus test – application of ligature
abolition of the central nervous system around the base of the finger with
activity is evidenced in part by the moderate tightness
▪ Living person: finger will change color
absence of elicitable reflexes; pupils are
fixed and dilated ▪ Dead person: no change of color
→ Icards’ test – injection of fluorescein
→ Flat EEG (electroencephalogram) – a
great confirmatory value in determining solution subcutaneously
▪ Circulation present: dye spreads over
brain death of a person
the body and the whole skin changes
color GREENISH to YELLOW
Cardiorespiratory Death → Diaphanous test – fingers are being
• Death occurs when there is a continuous and spread wide and finger webs arfe viewed
persistent cessation of heart action and through a strong light
respiration ▪ Living person: finger webs → RED
▪ Dead person: finger webs → YELLOW
KINDS OF DEATH → Application of heat on the skin
1. Somatic Death or Clinical Death → Palpation of the radial pulse
→ Complete, persistent, and continuous
→ Dropping of melted wax – most
cessation of the vital functions of the important and easiest examination of
brain, heart, and lungs which maintain peripheral circulation
life and health

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 DEATH AND AUTOPSY | SEMINAR 2
▪ Put melted sealing wax on the ▪ Summer: 18-36 hours
breast of the person → The muscles gradually stiffen; it usually
o Dead person: no starts at the muscles of the neck and
inflammatory edema lower jaw and spreads DOWNWARDS
→ Usually, the whole body becomes stiff in 12
Cessation of Respiration hours
• Examination with a mirror - the surface of a → Both voluntary and involuntary muscles
cold looking glass is held in front of the mouth are involved
and nostrils → Chemically, there is increased LACTIC
→ If there is dimming of the mirror after a ACID and PHOSPHORUS content of
time, there is still respiration muscles and reaction becomes ACIDIC
• Examination with feather or cotton fibers 3. Stage of Secondary Flaccidity
• Examination with a glass of water → Also known as:
• Winslow test – most important; there is no ▪ Secondary relaxation
movement of the image formed by reflecting → After the disappearance of rigor mortis,
artificial light on the water or mercury the muscles become soft and flaccid.
contained in a saucer and placed on chest or → It does not respond to mechanical or
abdomen if respiration is not taking place electrical stimulus
→ Stage where the odor starts to emerge
→ Organism involved: Clostridium welchi or
Cooling of the Body
Clostridium perfringens
• Also termed as ALGOR MORTIS
• The progressive fall of body temperature is
RIGOR MORTIS
one of the most prominent signs of death
• First demonstrable changed observed Heat Stiffening • If the dead body is exposed to
shortly after death temperature above 75oC, it will
coagulate the muscle proteins and
• Post-mortem caloricity – rise in temperature cause the muscles to be rigid
of the body after death • The body assumes a ”pugilistic
→ Due to the rapid and early putrefaction attitude” – lower and upper
changes in the internal organs extremities flexed, and the hands
→ Happens in the first 2 hours of death clenched because the flexor
muscles are stronger than the
extensors
Insensibility of the Body and Loss of Power to Move • Also known as the “Boxer’s Stance”
• After death, the whole body is insensible
Cold Stiffening • Stiffening of the body may be
• No stimulus is capable of producing voluntary manifested when the body is frozen,
movement but exposure to warm condition will
make such stiffening disappear
Changes in Muscle • The cold stiffening is due to the
solidification of fat when the body is
1. Stage of Primary Flaccidity exposed to freezing temperatures
→ Also known as:
▪ Period of muscular irritability
Changes in the Blood
→ Onset: immediately after death
• The stasis of the blood due to the cessation of
→ Lasts about 3-6 hours
circulation enhances the coagulation of blood
→ In warm places, the average duration
inside
duration is only 1 hour and 51 minutes
• Blood may remain fluid inside the blood
→ The extremities are flexed; the lower jaw
vessels after death for 6-8 hours
falls, the eyeball loses its tension and
there may be incontinence
DIFFERENCE BETWEEN ANTE-MORTEM AND POST-
→ Chemically, the reaction of the muscle is
MORTEM CLOT
ALKALINE
→ Muscles are still contractile with stimuli PARAMETER ANTE-MORTEM POST-MORTEM
due to molecular life after somatic death Consistency Firm Soft
2. Stage of Post-mortem Rigidity Uniformity Uniform color Distinct layer
→ Also known as:
Surface of Raw after clots are Smooth and
▪ Cadaveric rigidity blood being removed healthy
▪ Death struggle of muscles vessels
▪ Rigor mortis
→ Onset: 3-6 hours after death COLOR OF BLOOD (FORENSIC MEDICINE)
→ Temperate countries: 2-3 days
→ Tropical countries: COLOR INDICATION
▪ Cold weather: 24-48 hours Bright pink Carbon monoxide poisoning

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Dark red Asphyxia TYPES OF AUTOPSY

Less dark red Anemia Hospital or Non-official or Non-Medicolegal Autopsy
Bright red Snow/Ice • Autopsy done on a human body with the
consent of the deceased person’s relatives
Autodigestive Changes After Death for the purpose of determining the cause of
death
• Proteolytic, glycolytic, and lipolytic ferments
• Provides correlation to clinical diagnosis and
of glandular tissue continue to act which lead
clinical symptoms
to autodigestion of organs
• Elective process
• Body belongs to the next of kin
Putrefaction of the Body
• Putrefaction – breaking down of the complex
Medicolegal or Official Autopsy
proteins into simpler components associated
• For determining the cause, manner, and time
with the evolution of foul-smelling gases and
of death
accompanied by the change of color of the
• Separating death due to disease from death
body
→ Foul-smelling gases will set in in accordance with due to external causes
Stage of Secondary Flaccidity • Suspicious case to rule out foul play
→ The early change is the GREENISH color of the skin • Mandatory process
seen in the region of right iliac fossa, which will • Body belongs to the state
gradually spread in the whole abdominal wall
→ Formation of gases causing distension of the
abdominal wall and bloating of whole body WHEN IS THE BEST TIME TO PERFORM IT?
• Autopsies are best if performed within 24
PUTREFACTIVE CHANGES hours of death before organs deteriorate and
PERIOD CHANGES before embalming, which can interfere with
Rigor mortis present all over
toxicology and blood cultures
12 hours
Hypostasis will develop → Positive temperature
Greenish discoloration of the body ▪ For keepings bodies only for few
24 hours Rigor mortis absent all over days or few weeks
Greenish discoloration over full abdomen ▪ Temperature: 35.6-39.2oF
Distended abdomen → Negative temperature
48 hours (+) Ova of flies seen ▪ For keeping unidentified bodies
(+) Moving maggots seen ▪ Temperature: 5-13oF
Bloated trunk
Face distorted and swollen
Blisters swollen WHEN SHALL AUTOPSY BE
72 hours (+) Hair and nails loose PERFORMED ON A DEAD BODY?
Whole body swollen • Whenever required by special laws
1 week Soft viscera putrefied • Upon order of the court, mayor, and a
1 month Body skeletonized provincial, or city fiscal
• Upon written request of police authorities
• Whenever the solicitor general, provincial, or
AUTOPSY city fiscal shall deem it necessary
• Whenever the nearest kin shall request in
DEFINITION writing the authorities concerned
• An autopsy is a comprehensive study of a
dead body, performed by a trained physician THE FOLLOWING MANNER OF DEATH
employing recognized dissection procedure SHOULD BE AUTOPSIED
and techniques • Death by violence
• MedTechs can assist the pathologists when • Accidental death
performing an autopsy • Suicides
• Ancient Egyptians were one of the first • Sudden death of persons apparently of good
civilizations to practice the removal and health
examination of the internal organs of humans • Death unattended by a physician
in the religious practice of mummification • Dead on arrival
• Death occurring in unnatural manner
NOTES:
• Autopsy is different from post-mortem examination
→ Autopsy: body is opened for internal exam
GUIDELINES IN THE PERFORMANCE OF AUTOPSIES
→ Post-mortem exam: external exam of the • The pathologist must be properly guided
dead body; no incision • Bodies which are severely mutilated,
decomposing or damaged by fire are still
suitable for autopsy
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 DEATH AND AUTOPSY | SEMINAR 2
• All autopsies must be performed in a manner REMOVAL OF ORGANS
which show respect to the dead body
Virchow Technique
• Unnecessary dissection must be avoided
• Organs are removed one by one from the
• Proper identity of the deceased autopsied
body to be examined
must be established
• This is done in the following order:
• A dead body must not be embalmed before
→ Expose the (1) cranial cavity, the (2)
autopsy
spinal cord, followed by the (3) thoracic,
• The body must be autopsied in the same
(4) cervical, and (5) abdominal organs
condition when found in the crime scene

Rokitansky Technique
AUTOPSY PROCEDURE
• Characterized by in situ dissection
Y Incision • Begins at the neck and slowly works its way
• Starts near the acromion process and down the body and the organ is removed as
progresses downwards towards the xiphoid a BLOCK
process
• Extended until the symphysis pubis
Ghon Technique
• Characterized by in situ dissection
Fig 1. Y Incision. • 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 are cut
• Maintain all connections between
physiologically related organs

Le Tulle Technique
• Thoracic, cervical, abdominal, and pelvic
organs are removed “en masse” meaning as
Modified Y one big organ block
• Made from suprasternal notch, over the • Allows the body to be made available for
clavicle to its center on both sides and passes examination in less than 30 minutes because
upwards over the neck, behind the ear to the process of removing organs is much
symphysis pubis quicker

Fig 2. Modified Y Incision. Fig 4. Equipment in Autopsy. (L) Cadaver Table; (R)
Materials being used while doing the procedure.

I Incision
• A straight-line incision extending from the
chin to the symphysis pubis

Fig 3. Modified Y Incision.

NOTE: The content of the transes is referenced from the

learning materials provided by the Faculty of LPU Batangas -
MLS Department. It also contains additional inputs from the
CAMP professors during class discussions and supplemental
information from the book and other reliable sites.

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