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Mastering MRCP PACES |
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Case 15 – Post Mortem Examination |
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A 68 year old male patient unexpectedly died within 24 hours after being admitted to hospital with progressive shortness of breath. All observations, examinations and basic investigations (ECG, CXR and ABG) were within normal parameters. The case has been referred to the coroner who advices a post mortem examination. You have been asked to discuss post mortem examination with the family. - Introduce yourself. - Show sympathy and give your condolences. Pause. Await family’s reaction. - Explain that the cause of death is unknown. Further explain that the case has been discussed with the coroner and that it has been decided to proceed with a post mortem examination. - It is difficult to predict families reaction, nevertheless, the information that needs to be conveyed may include [1] - A post mortem is an examination of a body after death. It is also called an autopsy. - Post mortems are carried out by pathologists – doctors who specialize in the diagnosis of disease and the identification of the cause of death. - A post mortem examination can provide information about the illness or other cause of death. - A post mortem examination cannot always provide a reason for the death. - Post mortem examinations help the medical profession by providing information about illness and health that would not be discovered any other way. - Post mortem examinations help to - Identify the cause of death. - Confirm the nature of the illness and/or the extent of the disease. - Identify other conditions that may not have been diagnosed. - Assess the effects of treatments and drugs, and identify any complications or side-effects. - Who can request a post mortem examination? - Coroner. - Hospital with the consent from next of kin. - Hospital if patient prior to death gave permission for post mortem examination. - What if family objects to post mortem examination? - If requested by the coroner, next of kin’s consent is not required to carry out post mortem examination. - If requested by the hospital, next of kin can decline to consent for the post mortem examination. - When is a post mortem examination done? - Post mortems are usually carried out within 2–3 working days of death because the earlier the examination is held, the more likely it is to yield useful information. - They take place in a mortuary. - If due to religious reasons, a funeral needs to take place within 24 hours, a pathologist may be able to carry out the post mortem examination within the time frame. - The coroner’s office will normally know the date, time and place of a post mortem ordered by the coroner. - Full vs. limited post mortem examination. - Full – whole body examined. - Limited – only certain parts of the body is examined. - This will provide limited information about the cause of death or illness. - What happens in a post mortem examination? - The pathologist will remove and examine all the major internal organs (or those agreed beforehand with next of kin if limited post mortem examination) and will take samples of tissue and fluid (such as blood) for later inspection in detail (under microscope). - The organs are then returned to the body (although they cannot be returned to their original positions within the body). - Can the next of kin see the body after the post mortem? - Yes. After the post mortem the mortuary staff will prepare the body. - When will the result be back? - Few weeks. - The candidate should summarise what have been discussed and ask the family if they have any questions. The candidate may want to state the he/she will provide some information leaflets. - If death occurs due to below reasons, the coroner should be informed [2]. - After an accident or injury. - Following an industrial disease. - During a surgical operation. - Before recovery from an anaesthetic. - If the cause of death is unknown. - If the death was violent or unnatural. - Suicide, accident or drug or alcohol overdose. - If the death was sudden and unexplained. - A sudden infant death (cot death). - If the deceased was not seen by a medical practitioner during the 14 days before the death. - If the deceased was not seen by the doctor issuing the medical certificate after he or she died. - Anyone who is concerned about the cause of a death can inform a coroner about it, but in most cases a death will be reported to the coroner by a doctor or the police. - Ethical principles - AUTONOMY: - - BENEFICENCE and NON-MALEFICENCE: Act in the best interest of the patient. - JUSTICE: Legally obliged to proceed with post mortem examination if the coroner has requested the examination. [2]http://www.direct.gov.uk/en/Governmentcitizensandrights/Death/WhatToDoAfterADeath/DG_066713 |
