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Difference between revisions of "Autopsy"
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===General=== | ===General=== | ||
*This is usually where the money is in hospital autopsies. | *This is usually where the money is in hospital autopsies. | ||
*Like surgeons say... ''you should never cut anything until you're sure what it is''. | |||
===Neck=== | ===Before the first incision=== | ||
If there is suspicion of pneumothorax - one the the three following can be done:<ref name=Ref_HospAuto120-1>{{Ref HospAuto|120-1}}</ref> | |||
#Create a "pleural window" (between ribs by removing soft tissue... without entering the pleural cavity). | |||
#Open chest underwater and watch for air bubbles. | |||
#Needle puncture with water filled syringe - where plunger has been removed. | |||
*If there are neck abnormalities or suspicion of pressure on the neck, it is prudent to remove the cranial contents and thoracic contents ''before'' doing the neck dissection.<ref name=HospAuto118>{{Ref HospAuto|118}}</ref> | |||
**If the above does ''not'' apply, i.e. there is no neck injury/suspected neck injury, the tongue & neck can be taken together with the thorax pluck or organ pluck. | |||
===Incisions=== | |||
*Y-shaped incision (standard): | |||
**Superior "points" of the Y ~ at the deltoid muscle. | |||
**"Confuence of lines" in the Y ~ at the suprasternal notch. | |||
*Neck dissection incisions: | |||
**Deltoid to mastoid process. | |||
====Sternum==== | |||
*Usually of no interest. | |||
*May have cleft or foramen - as an anatomical variant.<ref name=pmid10803333>{{cite journal |author=Fokin AA |title=Cleft sternum and sternal foramen |journal=Chest Surg. Clin. N. Am. |volume=10 |issue=2 |pages=261–76 |year=2000 |month=May |pmid=10803333 |doi= |url=}}</ref> | |||
===Retrieval of the (organ) "pluck"=== | |||
One piece (standard): | |||
*Cut diaphrgam @ chest wall. | |||
*Superior cut: through arch vessels. | |||
*Inferior cut: through the common iliac vessels. | |||
*Posterior: | |||
**Thorax: cut paravertebral. | |||
**Abdomen: blunt dissection for kidneys, then paravertebral. | |||
Two pieces (thorax & abdomen): | |||
*May be preferred in a "glued" (fibrosed/post-surgical) abdomen. | |||
*Procedure - similar to ''one piece'' but: | |||
**Cut aorta distal to the left subclavian + detach from thoracic pluck. | |||
**Cut esophagus distal to pharynx + detach from thoracic pluck. | |||
===Neck organ pluck=== | |||
#Trim tissue posterior to horns of the thyroid. | #Trim tissue posterior to horns of the thyroid. | ||
#Cut between thyroid horns & hyoid. | #Cut between thyroid horns & hyoid. | ||
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*May appear fractured if triticeous cartilage (or triticeal cartilage) is present;<ref name=pmid15075682>{{cite journal |author=Di Nunno N, Lombardo S, Costantinides F, Di Nunno C |title=Anomalies and alterations of the hyoid-larynx complex in forensic radiographic studies |journal=Am J Forensic Med Pathol |volume=25 |issue=1 |pages=14–9 |year=2004 |month=March |pmid=15075682 |doi= |url=}}</ref><ref>URL: [http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf]. Accessed on: 10 September 2010.</ref> triticeous cartilage may be confused with a fragment of hyoid bone. | *May appear fractured if triticeous cartilage (or triticeal cartilage) is present;<ref name=pmid15075682>{{cite journal |author=Di Nunno N, Lombardo S, Costantinides F, Di Nunno C |title=Anomalies and alterations of the hyoid-larynx complex in forensic radiographic studies |journal=Am J Forensic Med Pathol |volume=25 |issue=1 |pages=14–9 |year=2004 |month=March |pmid=15075682 |doi= |url=}}</ref><ref>URL: [http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf http://faculty.ksu.edu.sa/Prof.Hamam/curses/Jurnals%20Club/225-Triticeous%20cartilage.pdf]. Accessed on: 10 September 2010.</ref> triticeous cartilage may be confused with a fragment of hyoid bone. | ||
**''Triticeous'' is pronounced ''tri-tish´us''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/triticeous http://medical-dictionary.thefreedictionary.com/triticeous]. Accessed on: 15 September 2010.</ref> | **''Triticeous'' is pronounced ''tri-tish´us''.<ref>URL: [http://medical-dictionary.thefreedictionary.com/triticeous http://medical-dictionary.thefreedictionary.com/triticeous]. Accessed on: 15 September 2010.</ref> | ||
===Blood clots - ''pre- and post-mortem''=== | ===Blood clots - ''pre- and post-mortem''=== | ||