Forensic Medicine and Toxicology Unit Department of Pathology College of Medicine King Saud University Postmortem Medicine Khaldoon Aljerian MBBS, MHSc, FRCPC Pathologist – Bioethicist – Forensic Expert Forensic Neuropathologist

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

Islamic jurisprudence Council, of the Muslim World League Based on necessities which calls for the postmortem examination of dead bodies, and with which the postmortem examination, becomes more a benefit than a depravity of violating the dignity of the dead human.

Medicine The science of diagnosing, treating, or preventing disease & other damage to the body or mind.

Forensic Medicine Forensic medicine: One of the largest & most important forensic science. Medical knowledge - criminal & civil law. Medical science specialties: Therapeutic, diagnostic & basic

Forensic Sciences Forensic Pathology Forensic Toxicology Forensic Psychology Forensic Anthropology Forensic Archeology Forensic Entomology Forensic Odontology Forensic Serology Forensic Botany

Forensic Sciences Computer Forensics Criminalistics DNA typing Fingerprints Document Examination Forensic Reconstruction Forensic microanalysis Ballistics

Pathology Anatomic Pathology: Molecular Pathology Cytology Surgical pathology Postmortem examination Clinical Pathology Biochemistry Haematology Immunology Microbiology

Forensic Pathology Subspecialty Examination of living or dead persons Provide an opinion concerning: Identification Cause, manner: disease, injury, death Biological and physical evidence Wounds, patterns, and sequence Death investigation

Forensic Pathology Prevent: Injury, disease, and death

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

Systems Coroner or medical examiner Particular geographic jurisdiction Quasi-judicial powers Inquiry into deaths Complete the certificate of death Recommendations/inquiry

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

Reportable cases Unnatural (suspicious, abuse -/+, iatrogenic, unexpected) Unattended, within 24H ( arrival, anesthesia, procedure) Drugs (prescription, non) Special circumstances: custody, occupation, children, pregnancy, unable to complete certification

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

Changes after Death Rigor - Livor - Algor mortis Decomposition: Autolysis Putrefaction Mummification – Adipocere - Skeletalization Post-mortem injuries -Immersion Burial – Cremation – Medical preservation

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

What does a forensic pathologist do? Authority History Imaging Laboratory tests Physical examination Surgical examination Report Communication Recommendations

Identification of the Living and the Dead Morphological characteristics Fingerprints Dental DNA profiling Tattoos and body piercing Identity of decomposed or skeletalized remains

Surgical examination Incisions Tissue samples (surg path, molecular) Tissue, fluid (microbiology and toxicology) Retention  correlates all the information

 draws conclusions: Cause, manner of death Report Communicate Recommendations: prevent disease, injury & death

The Autopsy Lexicon Suggested Headings for the Autopsy Report Randy L. Hanzlick, MD, for the Members of the Autopsy Committee, College of American Pathologists (Arch Pathol Lab Med. 2000;124:594–603)

Postmortem Medicine PM medicine law & definition Systems Reportable cases PM changes Management COD - DC

Cause of Death Injury or disease that results in the cessation of life “results in” Causal linkages in a temporal chain Temporal delay not relevant

Triangle of COD Disease Drugs, alcohol & toxins TRAUMA COD

Disease Ischemia due to coronary atherosclerosis Hemorrhage due to Chronic alcoholism Infection due to pneumococcus

Trauma Blunt Sharp Projectile Asphyxia Heat, electricity and radiation

Alcohol, drugs & toxins Alcohols: Ethanol, methanol, ethylene glycol Street: Heroin, cocaine OTC, OTS: Diphenhydramine Prescription: Antidepressants, analgesics Terrorism: Botulinum, SEB

“Pending” After the autopsy the cause of death is not clear = “pending” Medical or scene information needed Toxicology Microscopy (histologic examination) Examination of retained tissue (brain)

Manner of Death Natural Accident Suicide Homicide Undetermined

Acute myocardial infarction Atherosclerotic coronary artery disease Hypertension, diabetes, obesity

Thank you :o)