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Autopsy Group LGI

Overall

Make the most of the attachment by asking to do what you need to, seeing as much of the other cases as possible, and reading around your cases.

Starting

Aim to arrive at 9.00, or let us know if you need to be late. Please let us know if you will be away.

Ring the bell at the mortuary (if the “Quiet please, chapel of rest in use” light is lit, use the other door on the main corridor)

If there are no autopsies at all (unusual) you can leave again.

Faxes for the coroner’s cases should be in the pathologist’s office for you to look at. You should only start your autopsy alone if this has been pre-arranged with the supervising consultant.

Equipment should be provided but if you want a shower please bring your own toiletries, and if you are not wearing socks it is a good idea to bring some to wear inside wellies, since we have too many trainees to own your own boots.

Autopsy

If you are not allocated a case, choose a suitable one for yourself, aiming to cover:

• Hospital death
• Industrial lung disease (mesothelioma and asbestosis)
• Hanging
• Overdose
• Alcoholic
• Road traffic incident
• Post operative death

Pre part 2 choose any straightforward case, post part 2 it is a good idea to get used to doing more than one case, and if you wish you may do high risk cases.

Decide how you will approach your case, if there are any special tests you need to do. Preferably discuss it with other people.  Eviscerate and dissect as per “Hospital autopsy” by Burton and Rutty.

Pre part 1 practice evisceration and dissection and try to formulate a cause of death. Pre part 2 you will need to practice displaying your findings, presenting the case and deciding on the cause of death. Post part 2 you will only need to make a brief summary with the relevant findings and it is possible to arrange for you to report independently if you wish.  After the autopsy the cause of death form and the histology form should be faxed to the coroner, as should toxicology forms so the coroner’s office knows that samples need collecting.

Health and safety

The safety clothing as recommended by the Royal College should be worn (see below). We should provide you with the equipment you need.

Do not use blunt instruments, this increases the risk of cutting yourself. There is a box provided for them to be put in for sharpening.

Please dispose of your own sharps except PM40 and brain knives, which should be left clearly visible.

It is helpful to avoid contaminating other areas of the mortuary with blood as much as possible.

Do not remove contaminated equipment such as clipboards and pens from the mortuary, and avoid contaminating your own notes.

Histology

Pots should be provided and labelled with the name, autopsy number, date, and both your name and the consultant’s name. You can either put tissue into cassettes in the mortuary (advisable if you need to identify the site of origin of blocks – number them with a pencil and keep a note on your sheet of what they are) or put them loose in formalin and cut them to block size at the Algernon Firth Building (probably more awkward for you, but necessary if you are struggling to cut thin enough blocks) Leave the pots in the mortuary for collection. At present all autopsy histology is done at the LGI.

The slides will be sent to you; look at them, request special stains if you know they are needed, and add to the report if you wish before checking.

Toxicology

Both plain white and yellow-topped fluoride-preserved tubes are used. Put them in a plastic bag, and add the request form once it has been faxed. You can sign this yourself.  The result may come to you or the consultant who should show it to you. It should be added to the report.

Afternoon

Please dictate your report on the same day even if histology and toxicology will need to be added later, since it is very difficult to remember cases later; you should include the Royal College recommended information (see below) It can be given to Kathleen in the Algernon Firth Building, or the typing pool at Bexley Wing.  You can use the afternoon for background reading.

Assessment

The autopsy attachment is a good place to do case-based discussions, and DOPs. Please try to plan one while you are there, and not ask for it retrospectively.

Recommended report format

You may use your own format if it contains all the necessary information.

The format generally used here includes:

• Cause of death, as on your fax, at top
• Clinical history as on the coroner’s fax (and/or hospital notes)
• External examination including identification, medical intervention, natural disease, injuries, BMI
• Internal examination with subheadings: central nervous system, cardiovascular system, respiratory system, gastrointestinal system, genitourinary system, reticuloendothelial system, endocrine system, musculoskeletal system. Each system should include relevant weights.
• Summary of findings (optional)
• Histology and toxicology reports if done
• Comment/discussion
• Revised cause of death if necessary
• Statement that histology and toxicology have not been taken (if they haven’t), or that a supplementary report will be issued

Recommended reading

• Royal college of pathologists autopsy guidelines, and autopsy scenarios.
• An autopsy dissection manual
• Robbins on physiology of the heart
• Tissue Act
• Coroner’s rules/ Dorries on coroner’s courts

Royal college Guidelines for autopsy practice section 6.11.2

“ Pathologists and APTs should wear the following for all adult autopsies:

• Surgical scrub suit
• Waterproof or water-resistant disposable gown that completely covers the arms chest and legs
• Plastic disposable apron to cover chest trunk and legs
• Eye protection or plain unventilated visor
• Face mask to protect the mouth and nose from direct splash contamination if visor is not worn
• Disposable paper hat (optional)
• Gloves: outer latex over neoprene cut-resistant gloves
• Rubber boots with reinforced toe-caps”