Step-by-Step Diagrams
I.
EXTERNAL EXAMINATION
Identify the body. Verify autopsy permit: validity and extent. Weigh, measure, and inspect the body for: - presentation - marks of therapy - identication - perimortem/postmortem changes Measure and compare leg circumferences at 10-cm intervals above the medial malleoli. Make the primary incisions. 1. Y-incision. Stay above the anterior axillary line. 2. Knee incision. 3. Chest-only incision. 4. Abdomen-only incision
II.
1. Reect the skin aps. Cut perpendicular to the ribcage. Make relaxing incisions in the peritoneum and musculature about 15 cm above the symphysis. 2. Check for tension pneumothorax. Make a pool of water in the axilla. Push closed clamp through an intercostal muscle beneath the water level. 3. Release the chest plate. Cut ribs medial to costochondral junction and the clavicle lateral to the sternoclavicular joint, with either: a. an oscillating saw; b. a linoleum knife and bone shears; or c. pruning shears (inexpensive alternative). 4. Preserve the muscle attachments to the manubrium and head of the clavicle. 5. Detach the diaphragm from the chest plate. Inspect surfaces and contents of the pleural spaces.
III.
THORAX
1. Reect chest plate and strap muscles to expose the lower neck. 2. Blunt dissect thymic fat pad from the pericardium. Carry reection upward to lower pole of thyroid. Cut the thymic vein where it enters the innominate vein. 3. Double-clamp, divide, and reect the innominate vein. 4. Open pericardium and clamp edges. Inspect pericardial surfaces and contents. 5. Extend the pericardial incision through the pericardial reection. 6. Isolate and ligate the carotid arteries. 7. Lift the heart cranially and draw blood samples from the left atrium. IN SITU EXAMINATION. Examine the heart. Elevate, palpate, and inspect the lungs. Collect specimens for microbiology, toxicology, etc. Take any cultures after searing the surface.
IV.
ABDOMEN 1
IN SITU EXAMINATION. Inspect and palpate all organs and surfaces. Collect specimens for microbiology, toxicology, etc. 1. Open the greater omentum between the stomach and colon to inspect the pancreas. 2. Locate the ligament of Treitz. 3. Make a slit through the mesentery close to the bowel wall. 4. Ligate the bowel near the duodenal-jejunal junction. 5. Clamp the proximal jejunum. 6. Cut across the bowel. 7. Detach the mesentery close to the bowel wall, with either: a. scalpel strokes perpendicular to the bowel, or b. scissors. 8. Remove colon. Empty the bowel and cut at the rectosigmoid junction.
V.
ABDOMEN 2
1. Obtain transverse sections of unopened bowel from: a. proximal jejunum, b. distal ileum, and c. sigmoid colon. 2. Open the small bowel adjacent to or within the line of mesenteric attachment with an enterotome. 3. Open colon and appendix along anterior taenia. 4. Carefully clean and examine the entire intestinal mucosa by pulling the bowel between the index and middle ngers under running water. 5. Take additional sections as needed. Lay the serosal surface on paper towel, invert, and oat in xative.
VI.
PELVIC ORGANS
1. Free the male pelvic organs from the pelvic wall by blunt nger dissection in the extraperitoneal space. 2. Identify and cut the membranous urethra with scissors, and transect the rectum with a knife. 3. Push the testes from the scrotum into the inguinal canal and detach by cutting the spermatic cord (left long). 4. Expose the shaft of the penis below the symphysis pubis and remove a segment. 5. Free the female pelvic organs by blunt nger dissection in the extraperitoneal space, and transect the urethra, vagina, and rectum with a knife. Elevate the pelvic organs, separate any remaining fascial attachments, and lay them back into the pelvic cavity.
IX.
REMOVAL OF BRAIN
1. Open superior longitudinal sinus. 2. Cut dura along the line of skull cut and reect toward the midline. Inspect the brain. 3. Retract frontal poles and cut anterior attachments of falx. 4. Elevate olfactory bulbs, retract brain, and cut: a. optic nerves, b. carotid arteries, and c. other nerves 5. Retract brain medially and cut tentorial attachments along the petrous ridges. 6. Retract brain posteriorly and cut remaining cranial nerves as close to bone as possible, vertebral arteries and spinal cord as distally as possible within the spinal canal. 7. Retract cerebellum and brainstem. Support brain and cut remaining dural attachment with scissors.
X.
BASE OF SKULL
Inspect base of skull. 1. Open dural sinuses. 2. Strip basilar dura by rolling on a large clamp. 3. Pull on skull to check for basilar fractures. 4. Take the pituitary gland; either: a. remove a block which includes the optic nerves, cavernous sinuses, and sella turcica (this exposes spheroid sinus and posterior nasopharynx), or b. remove it from the sella turcica: i) chisel off the posterior clinoid processes, ii) elevate it, iii) blunt dissect the pituitary gland from the sella turcica, and iv) cut the anterior dura. 5. Examine the middle ears; either: a. open the cavity with a chisel, or b. remove a block of petrous ridge. 6. Remove the eyes; either: a. unroof the orbit with a chisel, or b. incise the conjunctiva, hook the eye muscles, and cut muscles and optic nerve with scissors.
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XI.
1. Remove the psoas muscles. 2. With the oscillating saw, expose the spinal cord between L5-S1 and C3-C4 discs. a. In the lumbar region, cut the pedicles and try to avoid injury to the cord. b. In the thoracic area, it is helpful to use the osteotome to expose the heads of the ribs, and aim the saw cut toward the cord through the neck of the rib and the pedicle of the vertebra. c. In the cervical region, cut through the lateral part of the vertebral body downward into the vertebral canal. Beginning at the lower end, lift the vertebral column and detach the anterior ligamentous connections to the cord. 3. Expose all posterior ganglia and nerve roots of interest to be removed in continuity with the cord. Develop the sacral plexus by forcing a nger between it and the pelvic wall. Cut sacral roots but maintain lumbar connections. Remove cord and attached nerves from below upward. Free the upper cervical cord by cutting the dura from within the foramen magnum. 4. Examine the cord by opening the dura in the anterior and/or posterior midline or by sectioning the cord transversely with dura intact, usually after adequate xation. College of American Pathologists 2005 11
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