Cause of Death was?

today's class opened up another window for thought.

Medico-legalism. in the world of Forensics.

Ensuring you're protected.

Affording yourself protection.

(just a word of caution that the word dead and death will be mentioned numerously in this post. hope it doesnt cause uneasiness)

Doing an autopsy as a forensic specialist doesnt start with dissecting a patient - a body i mean. saying a patient sounds like he/she's alive.- and using all your years of expertise to analyse the cause of death and injuries on / in the body and then writing the autopsy report. This part, would be what most of us think as the most important part or the part that matters most. Determining / Confirming the cause of death.

Nope. Not really as I thought.

It starts with:

the Dr. in charge correctly identifying the person to be dead.

so i thought: ok that should be easy.

and then the Dr. asked: So, tell me, how do you know a person is realllllyyy dead?

*hmmmm.... awkward silence..

Answer:

There're 7 criterias that confirms a person to be dead:

1. No body movement

2. No respiration

3. No pulse / heart beat

4. Pupils fixed and dilated

5. Fragmentation of column of blood in retinal vessels

6. Primary flaccidity of limbs

7. ECG flat for more than 5 minutes continuously.

Misjudging the death of a person can bring a Dr. to face lawsuit. even pronouncing a person to be dead at the wrong time can bring you to court.

(most of us would think, sure, if a Dr. wrongly pronounced some1 who's still alive as being dead, that would be a really grave mistake that acceptably warrants a court case)

i do agree with that. but there're more technical things that we can worry about as well.

there was a case whr the Dr. clinically judged (without ECG) that a person was dead before arriving at the Hospital (as in he was dead already at the crime scene before being brought to the Hospital). the Dr. did, upon the arrival of the victim at the hospital, confirm his death with the ECG (showing the flat line).

later in court, the Dr. was bombarded by defense lawyers (of the suspected murderer) who tried to make the Dr. look incompetent for saying that he thought the person was dead before reaching the hospital.

with the reason that he couldnt be 100% sure of that (whether the victim was dead before reaching, or upon reaching the hospital) cz his clinical judgement cannot beat that of an ECG machine.

yups...

ok maybe that was quite confusing.

but conclusion is: be especially careful if u're facing a homicidal case. only officially confirm death when the ECG machine is there.

standard protocol when pronouncing death.

1. check that patient has fulfilled the 7 criterias. report as 'clinical death'.

2. reconfirm the death 1 hour later. then only register the death with time of death being the time 1 hour earlier.

before this bores u to the bones, thr's more. :P

Before performing the autopsy:

1. Ensure the police officer bringing in the body, the relative / next of kin of the body (is there for identification purpose and consent for autopsy) and yourself are there beside the body.

2. snap a photo where all can be seen clearly.

(to protect urself from false claims by the relative that he was not aware or explained to about the autopsy. relatives have tried suing Dr.s, accusing them of performing autopsy without their knowledge)

3. snap a photo of the next of kin looking with opened eyes at the body.

(eyes cannot even be closed in the photo cz in court they can say they were in too much stress to correctly identify the body and u as the Dr. who's not in apparent stress at that moment is at fault) - in cases of suing the Dr. for wrong identification of body.

now i think i just made the 'relative' sound like unethical ppl who would do anything to swindle ur $$ by suing you in court at any opportunity. no offense. not my intention at all.

but things like that have happened before. (innocent Dr.s performing autopsy, forgetting a protocol, ending up in court and swindled from their life savings) and can / is likely to happen in today's society where things do get screwed up, ill moral is everywhr and $$ matters a lot to most of us.

putting legal issues aside, i'd say that the forensic lectures did feel a little like watching the Professor analyse dead bodies CSI style.

wow. quite awed. but quite grossed out as well. lol >8P

wasnt mentally prepared to see images of mangled / strangled / suicidal remains esp right b4 dinner.

ok. that aside as well, it's been a pretty good week. 1st week in psychiatry has been relatively relaxing cz no assignments/presentations/case write ups due yet. missed home and taiwan so much last monday but the feeling has somewhat diminished. thank goodness. hav a great wkend ev1! :)

some photos: my housemates in our 4-person sharing unit in the taiwan hospital hostel (min jie, pei sun, wendy)

a group photo in front of the administrative office. the white coats for medical students are this length. residents@registrars wear slightly longer 1s, and specialists wear knee-length white coats like our med students ones back in Msia.

come to think of it, thats a pretty good way to differentiate ranks which can be really confusing for patients. hehe. sometimes patients wonder how come 10 different Dr.s visited them in 1 morning when in actual case 9 of them were medical students. heheh.