Autopsy Test 2

Photographing the Body After it is Cleaned

1. Begin with a close-up view of the face from the mid-neck to the top of the head on a clean background. - taken with and without case number, this helps verify the case number corresponds to the face to avoid mix ups. 2. Overhead of torso from mid-neck to upper thighs. 3. Overhead of upper thighs to feet 4. Side view of mid-neck to thighs (R & L) 5. Side view of thighs to feet (R & L) 6. Back of the head to mid-neck 7. Back of the torso from mid-neck to base of the buttocks. 8. Back of the legs from buttocks to feet. 9. Back and top of feet and hands.

Bite-Mark Ruler Features

1. Shaped in a right angle for two-dimensional documentation of an injury pattern. 2. Gray and white scale to document standard gray and white coloration 3. Circles on the surface to document the photo was taken at a true right angle from the wound to prevent misinterpretation of measurements and characteristics.

Photographing the Body Before Autopsy

1. Upon opening the body bag general views of the entire body from the sides and top are done prior to removing the clothing. - this documents how the body is received at the time of the exam. 2. Close-ups of gunshot wounds are done prior to the clothing being removed. 3. Any necessary evidence from the surface of the body is also retrieved and documented 4. The body is then undressed and washed and overalls and more detailed photographs are obtained.

X-rays: Suicide Gunshot Wound

A localized view of the area can be done (Usually the head or chest) - If the body is decomposed, then use a full trauma panel to assure other wounds are not missed.

American Board of Forensic Odontologist Bite-Mark Ruler

A standard scale used in forensic photo documentation - developed to use on bite-mark wound documentation, but is now used in all wounds.

Plastic Sealing Machine

A useful method to secure valuables and money within the body bag to prevent bodily fluids from spilling into clean areas.

Data Entry at the Morgue

Accurate demographic information - verification of spelling of the official name as it should appear on the death certificate - date of birth - date and time of death - location of death.

Order of Evidence Collection from Hands

After the bags are removed: 1. gunshot residue 2. DNA swabs 3. Fingernail clippings. - keep the bags sorted (in terms of rights and left) and bivalve the brown bags so one hand has a clean surface to rest on while working on the other hand.

New Imaging Technology

Allows for three-dimensional reconstructions of bullet and knife trajectories. - also allows for research into application of radiology for a virtual autopsy.

Cardiac Blood

Also typically used to obtain toxicology, metabolic screens, and cultures. - For individuals who have scant femoral blood. - Should only be a last resort because it can be contaminated by stomach contents and give inaccurate results. - especially a risk during blind sticks at an external exam - right pleural cavity is preferred because it is father away from the stomach.

X-rays: Homicides, Unidentified, and Decomposed Bodies

Anterior and lateral views of the head - Anterior views of the chest, abdomen, and pelvis views past the hips. - Allows for an overview of the entire body, devoid of extremities - showing teeth restorations, spine alignment, and skull and rib contours. - useful in locating bullets that are hard to find, because it gives a third dimension to locate the projectile.

Vitreous Fluid

Clear viscous fluid that fills the eyeball. - useful in quantifying alcohol and verifying blood alcohol level. - Can also lag behind BAC and show the alcohol level prior to death. - used if the decedent received IV fluids that can dilute specimens. - Placed in a preservative gray top tube.

Trace Evidence Collection

Collected into cone-shaped filter paper and sealed inside and envelope. - Foreign hairs are discerned from decedent's hairs by taking samples from the decedent's head, eyebrows, and pubic region for comparison.

Unknown Identification/Unrecognizable

Common in traffic accident victims, burned decedents, skeletal remains, and decomposed or otherwise severely traumatized individuals. - Policies differ but entry in to the database is typically with "Unidentified #" "Doe #).

Identification Method

Determined by the pathologist - prints - dental records - or anthropology consultation.

DNA Swab Collection

Done after the hand collections and before the body is washed or handled. - Sterile cotton swabs are dipped in saline solution and rolled over the upper edge of the cup to remove excess water. - The swab is rolled over the desired surface and placed into the dryer - A second, dry swab is rolled over the dampened area and combined with the first collection. - When swabs are dry they are packaged into envelopes or small collection boxes: labeled, and released to law enforcement through the chain of custody.

Viewable Body

Done from the decedent's right side with ceiling of the right face and with the left hand placed over the right hand on the covering blanket.

X-Ray Procedures

Done with the decedent still in the body bag and the clothing intact. - Bullets can be entangled in clothing and it is important to document the number of projectiles that arrives with the body. - Also helps the investigator locate hazards (needles, knives, personal effects etc.)

Toxicology Specimens Collection

During External Examination: - vitreous fluid - peripheral blood - urine During Autopsy: - vitreous fluid - femoral blood - urine - liver tissue (right lobe) - gastric sampling - A clean syringe should be used between each specimen type

Types of Evidence Collected During Autopsy

Fingerprints - Gunshot residue - Fingernail clippings. - Trace evidence - DNA Swabs - Rape kits - Toxicology Specimens

Sexual Assault Kit Order of Collection

Gloves should be changed between swabbing each location. - Photographer is recommended to be present to obtain photographs of all traumatized areas. 1. Begin with oral swabs- attention to crevices salon the fumbling and teeth. Then rolled onto a glass slide marked with the case number and "oral" 2. Pubic Hair combings onto a half-folded paper that is placed in the envelope with the comb. 3. Vaginal Swabs that are obtained and placed on a drying rack before being packaged. 4. Inner or anterior thighs if secretions are visualized, added to the kit in plain white envelopes and marked by case labels. 5. Anal swabs obtained by separating the buttock cheeks and inserting the swab, then rollin git onto the glass slide. - all samples should be separate, dried, and labeled before they are packaged and place back in the box.

Evidence Collection During Autopsy

Individualized to the type of case and requirements are determined by the forensic pathologist and investigating law enforcement agencies. - Much of the evidence is collected from the hands and nails. - If trace evidence is going to be collected, handle the hands with a fresh pair of gloves and minimize contact with the hands until these collections are complete.

Hair Collection

It is best to pull rather than cut to include the root. - collected from three to five regions of the scalp or pubic area to get a general sampling - placed into a cone-shaped filter paper and sealed inside an envelop.

Photographs During Autopsy

Main purpose is to serve as a permanent record of the injuries and injury patterns, and for identification purposes. - Also used for documentation of clothing and personal effects so there can be no question about loss. - Begin with a photo of the identifying tag/bracelet on the body and the number assigned to the body. - Each field of view should overlap with the previous view to avoid missing elements. - Photographs should be taken at right angles to prevent distortion

Obtaining Height

Measured from the heel of the foot (from a leg that is not fractured) to the top of the head.

Pre-death Electrolytes

Measured with vitreous fluid because postmortem blood is not good for this. - Vitreous glucose is useful when there's a history of diabetes mellitus and can be used in a personal glucometer

Trace Evidence

Minute fragments of debris, fibers, hair, vegetation, paint chips, plastic and glass fragments, and more that are adherent to the body. - Can be useful in homicides where little is known about a suspect or crime scene, or the body is discarded. - Useful if they are distinctive or embedded within the wounds or blood.

Arrival of the Body at the Morgue

Needs to be signed in with the name, location it was removed from, date, time, and person delivering the decedent. - The decedent needs to be logged into the office database where the coroner or medical examiner will assign a case number (which can sometimes be done in the field). - Body should be weighed and updated after undressing and removing extraneous materials (water, clothing or heavy scene items)

Correct 90 Degree Angle

Occurs between the camera lens and the surface being photographed. - ruler needs to be located at the level of the injury or structure being photographed (not above of below the plane of view).

DNA Swabs

Packages of sterile cotton swabs and a small cup of sterile saline solution are used. - If available dry the samples after collection in a swab dyer. - Best to target areas not overwhelmed by the victim's blood. - Consider retrieving from the neck, breasts, thighs, fingertips and outer labia/penis. - These are marked at the edge for the site of collection

Trace Evidence: Hit and Runs

Paint chips, plastic and glass fragments may be necessary evidence to identify a suspect car and link it to the decedent.

Trash Disposal From the Morgue

Placed in a biohazard bad inside transmittal receptacles and disposed of by biohazard companies. - how long it can be stored before disposal and how it is disposed of is set by state.

Vitreous Fluid Collection

Placing a 16 g needle attached to a syringe or vaccutainer into the eye sclera. - total volume is usually less than 5 ml and is placed in the red top tube followed by the gray top tube.

Vitreous Glucose Levels

Postmortem this drops to zero - evaluated upon admission to the morgue after the eyes are evaluated for hemorrhages and petechiae. - Collected into a red top tube (non preservative and no gel)

Femoral Blood

Preferred to collect sample from the most distal area possible. - Blood can be encouraged into these vessels by milking the legs proximally rather than from the inferior vena cava.

Traffic Accident Victims

Receive a trauma panel x-ray procedure. - This can be useful in identifying critical fractures.

X-rays: Dental

Requires a different system: digital sensor probes attached to a laptop to view and record the images. - Ease in communicating the information obtained - Greatly speeds up the identification process.

Virtual Autopsy

Requires high quality x-rays to document internal injuries and can be used in lieu of a traditional autopsy in certain cases. - i.e. religious objection, or mass disasters.

X-rays: Infants

Routinely whole body imaging is done, including the extremities. - Requires proper alignment: - Arms should be positioned down by the side, with the palm facing upward (to view the arms with little rotation of the forearm bones) - In some cases sections of healed or recent fractures need to be excised and imaged for healing and dating purposes.

PPE Examples

Shoe covers - N-95 mask - Clean lab coat or disposable jumpsuit - Disposable gloves. In the morgue: - eye protection - surgical gown or jumpsuit - shoe covers - N-95 mask - two pairs of disposable gloves, usually one over another.

Transporting Medications

Should be collected into vinyl evidence pouches and sealed to prevent spilling and contamination of work surfaces. - these pouches should be marked with the decedents name, date and time of collection, location, and initialed by the collecting agent.

Sexual Assault Kits

Standardized by each state crime laboratory, and are available from them or law enforcement (should have two available) - a collection of swabs (usually 4 swabs for each orifice) and photographs from traumatized areas - This should be sealed and chain of custody established.

Toxicology Specimen Packaging

The specimen should be placed directly into the tube and labeled with the patient's name, specimen type, date, time , and initials of person drawing it.

Toxicology Specimens

The type will be determined by the forensic pathologist and the forensic toxicologist. - The quality of these specimens is determined by the condition of the body as well as the skill of the person retrieving them.

Fingernail Clipping Collection

These are usually collected in homicides where there was physical connection between the victim and assailant. - May contain DNA linking the two near time of death. - Note the condition (evidence of tearing or loss of acrylic nails) - Collected into cone-shaped filter papers and placed separately into individual envelopes. - Clean clippers and gloves are used for each hand to prevent cross-contamination. - Clip only the nail to prevent contamination of the decedent's blood with the assailant's DNA.

Central Blood

This is closer linked to absorption areas from the arms, neck, or small intestines. - in these areas blood has no passed through the liver or kidneys where drugs are metabolized into a more inactive chemical structure or metabolized into their active structure. - quantified values may be less accurate.

The Body

This is considered evidence and needs to be documented upon removal from the scene (transportation person, date and time). - needs to be placed in a sealed body bag to protect property and valuables, that will only be opened at the time of autopsy.

First DNA Swab

This is dipped in the saline solution and rolled over the collection site and loosens any epithelial cells adherent to the skin.

Peripheral Blood

This is the desired specimen for toxicology testing because it is thought to reflect most accurately what the brain and body was experiencing at the time of death.

Second DNA Swab

This remains dry and is rolled over the collection site to pick up the epithelial cells that are loosened.

Personal Protective Equipment (PPE)

Used to reduce potential health hazards and precent transmission of biohazards outside of the autopsy room to clean office areas. - all patients and decedents are to be treated as if their bodily fluids are infectious (like HIV and hepatitis) - not required for visitors with no direct contact with the body, but for observation should wear a disposable cover. - also used in scene investigations where there is a potential for contamination of personal clothing or of evidence.

Scene Photography

Useful to document the position of the body in relationship to its surroundings. - Using an index card with the location, date, and his or her last name. - location verification is done by taking photos of identifying landmarks (street sign or house number) to separate multiple cases on the camera.

Gunshot Residue Collection

Uses a special kit - applied to the backs of the right and left hands separately at: - The thumb - The web of the thumb - and the first finger.

Close-up Photos

Views that are used to document any bullet wounds, clean and dirty, with and without a scale. - also any patterned injuries or those relate to death, with and without a scale.

Midrange Photos

Views that are used to localize injuries that will require close-up views. - Help localize where on the body the following close-up views will be photographed.

Lateral Views of the Torso

X-rays of this portion of the body are difficult to obtain because of its position on a morgue tray. - difficult for x-ray penetration.

Disposing of Sharps

should be collected at the scene and transported in proper evidence containers to prevent injury to others. - need to be placed in special containers and disposed of separate from regular trash.

Autopsy Purpose

to systematically dissect and view the organs and their relationships to determine a cause of death.