D

Damage, Diffuse Alveolar (See "Syndrome, Adult Respiratory Distress [ARDS].")

Death, Abortion-Associated

Related Terms: Criminal abortion; stillbirth.*

NOTE: Anesthesia-associated death* must be considered in some of these cases. If criminal abortion is suspected, notify coroner or medical examiner.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination and breasts

Peritoneal cavity Blood vessels and heart

Blood Lungs

Pelvic organs

Fetus

Prepare roentgenograms of chest and abdomen. Describe appearance of breasts and sample glandular tissue for histologic study. Record appearance of external genitalia. Submit exudate for bacteriologic study (p. 102). Inspect and puncture right atrium and right ventricle of heart under water, also retroperitoneal and pelvic veins. Submit for bacteriologic (p. 102) and toxicologic study (p. 16).

Submit portion for bacteriologic study (p. 103). Prepare sample for electron microscopy (p. 132).

If there are vascular lacerations, identify vessel. Submit samples of placenta and fetal parts for histologic study. Submit liquid intrauterine contents for toxicologic study. Sample ovaries for histologic study.

Determine weight and length, and estimate age (pp. 557 and 560).

Pulmonary air embolism.* Pregnancy changes.

Instrument marks on vulva. Peritonitis.*

Pulmonary air embolism.* Abdominal and pelvic veins may also contain air.

Septicemia. Absorption of intrauterine corrosives or other chemicals. Abscesses; bacterial pneumonia. Thromboembolism; embolism of soap and other chemicals.

Lacerated blood vessels; pelvic hemorrhages. Instrument marks; foreign bodies;* perforation(s). Placenta, fetus, and fetal parts. Soap or other toxic foreign intrauterine materials. Corpus luteum of pregnancy. Malformations. See also under "Stillbirth."

Death, Anaphylactic

Synonym: Generalized anaphylaxis.

NOTE: Autopsy should be done as soon as possible after death. Neck organs should be removed before embalming. If death is believed to be caused by drug anaphylaxis, inquire about type of drug(s), drug dose, and route of administration (intravenous, intramuscular, and oral or other). This will determine proper sampling procedures—for instance, after penicillin anaphylaxis. Allergy to bee stings, wasp stings, fire ants, and certain plants may also be responsible for anaphylaxis. However, envenomation also can be fatal in the absence of anaphylaxis.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Search for injection sites or sting marks. If such lesions are present, photograph and excise with 5-cm margin.

Freeze excised tissue at -70°C for possible analysis. Prepare chest roentgenogram.

Foam in front of mouth and nostrils. Swelling of involved tissue.

Antigen-antibody reaction in involved tissues.

From: Handbook of Autopsy Practice, 3rd Ed. Edited by: J. Ludwig © Humana Press Inc., Totowa, NJ

Organs and Tissues

Procedures

Possible or Expected Findings

Blood

Neck organs

Tracheobronchial tree and lungs

Submit sample for immunologic study and study of drug levels. For serum IgE testing (Mayo Medical Laboratories), sample must be kept refrigerated (frozen or refrigerated coolant). Remove as soon as possible after death. Photograph rima of glottis from above, together with epiglottis. For histologic study, fix larynx and epiglottis in Zenker's (p. 131) or Bouin's (p. 129) solution.

Record character of contents of tracheobronchial tree. Photograph lungs and record weights. In order to avoid artificial distention, do not perfuse with fixative. For proper fixation, see above under "Neck organs." Request Giemsa stain (p. 172).

Spleen

Antibodies against suspected antigen.

Laryngeal edema may recede soon after death.

Foamy edema in trachea and bronchi; diffuse or focal pulmonary distention ("acute emphysema") alternating with collapse; pulmonary edema and congestion; accumulation of eosinophilic leukocytes.

Eosinophilic leukocytes in red pulp.

Death, Anesthesia-Associated

NOTE: There are many possible causes of anesthesia-associated death that are not drug-related, such as acute airway obstruction* by external compression, aspiration, tumor, or an inflammatory process. Some of the complications are characteristically linked to a specific phase of the anesthesia, and many cannot be proved morphologically.

The most important step in these autopsies is to obtain the anesthesia-associated records and to secure the consulting services of an independent anesthesiologist. When information is gathered about drugs and chemical agents that had been administered or to which the victim may have had access, patholo-gists must keep in mind that some nonmedical chemicals and many drugs are known to affect anesthesia. Drugs and their metabolic products, additives, stabilizers, impurities, and deterioration products may be present and can be identified in portmortem tissues. Therefore, all appropriate body fluids, particularly bile, and organs (see p. 16) should be submitted for toxicologic examination. If the anesthetic agent had been injected into or near the spinal canal, spinal fluid should be withdrawn from above the injected site, preferably from the suboccipital cisterna; 250 mg of sodium fluoride should be added per 30 mL of fluid. If the anesthetic agent was injected locally, tissue should be excised around needle puncture marks, at a radius of 2-4 cm. Serial postmortem analysis of specimens may permit extrapolation to tissue concentration at the time of death. The time interval between drug administration and death sometimes can be calculated from the distribution and ratio of administered drugs and their metabolic products. For a review of anesthetic death investigation, see ref. (1).

Halothane anesthesia and some other anesthetic agents may cause fulminant hepatitis and hepatic failure. The autopsy procedures suggested under "Hepatitis, viral" should be followed.

Reference

1. Ward RJ, Reay DT. Anesthetic death investigation. Legal Med 1989;

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