1. In Depth: Autopsy Videoconference An Introduction & Pre-Visit Activities

2. Videoconference Details Date: Wed, April 4 th, 2007 Time: 10:45 am – 12:40 pm Place: Library

3. Introduction to Videoconference Along with students from 4 other schools, you will be: – Viewing a video of an autopsy recorded at The Ohio State University Hospital Autopsy Services – Hearing live commentary with Dr. Larry R. Tate, retired Forensic Pathologist

4. During the Videoconference You will be called upon to ask or answer questions from Dr. Tate – Dr. Tate will rotate through the schools. Be aware of the rotation pattern. Our school will always follow the same school. – Be at the microphone ready to speak when our school’s turn comes. – Speak loudly and clearly (directly) into the microphone.

5. Things to bring to the Videoconference Student guide to autopsy Vocabulary list Pencil to take notes Questions to ask forensic pathologist

6. Overall Goal of Autopsy Program Students are to determine the cause of death How? – Complete pre-activities: Pathology Autopsy Plan – Autopsy Organ measurements – Complete post-activities: Toxicology Histology Autopsy Report Forensic Pathology: External Findings

7. Pathology Activity You will distinguish between healthy and unhealthy organs You will make observations about physical characteristics of the organs – Texture – Colour – Size

8. Autopsy Plan You will develop an autopsy plan in accordance with the family wishes and based on the medical history and case information You will compare your plan to the pathologist’s plan during the videoconference

9. Videoconference 15 min: Dr. Tate will begin by: – Discussing the student autopsy plans that have been submitted – Giving the results of the external exam of the deceased 1 hour: Students will be: – Watching entire autopsy from external exam to examination of brain – Taking notes throughout entire autopsy – Listening to interviews from various professions associated with autopsies 15 min: Student questions – Student questions will be answered in a round-robin fashion. – Please prepare at least 3 questions in advance. You may also ask questions based on what you’ve seen in the autopsy – Dr. Tate will guide you towards a determination of cause of death, but he will not directly answer this question.

10. Case History

11. Autopsy Room

12. What is an Autopsy? A systematic external and internal examination of a dead body to determine if any abnormalities are present 2 main methods: – Virchow Method – remove and examine organs one at a time – Rokitansky Method – remove organs (heart, liver, kidneys, urinary bladder, prostate gland, etc.) at one block, separate and then dissect each organ Prosector (person performing autopsy) will: – Make a Y-incision from the chest to the abdomen to examine heart, lungs and abdominal organs – Use a Stryker saw which has a vibrating blade to cut through the bone, without damaging any surrounding soft tissue Be mentally, emotionally and physically prepared to see somewhat graphic images during autopsy – Next 4 slides are photographs from various autopsies

13. Y-Incision First step to open the body cavity

14. Rokitansky Method Organs removed as single block Organs will then be separated Each organ will be dissected

15. Intermastoid Incision Made from behind each ear across the top of the head Allows examination of brain

16. Removal of the Brain

17. Class Activity Working in groups of 4 – 5, research one of the following areas:  Pathology: Heart (slides 18 -21)  Pathology: Coronary artery (slides 22 – 24)  Pathology: Brain (slides 25 – 27)  Pathology: Lungs (slides 28 – 30)  Pathology: Kidneys (slides 31 – 33)  Autopsy plan Pathology Groups  Each group has a copy of the student sheet with questions that must be answered.  Use the appropriate PowerPoint slides that follow as resources (contains images of organs and websites)  Only study the diseases indicated on the PowerPoint slides  Develop a 5 – 10 minute PowerPoint presentation based on the information you have collected. All presentations must include images of normal and healthy organs as well as diseased organs so that students have pints of comparison while watching the autopsy.  Prepare a list of new vocabulary from your area of research Autopsy Plan Group  Follow procedure on Student sheet  Create an outline for a general autopsy  Develop criteria to decide which parts of body need to be examined during autopsy  Review patient case history.  Discuss and make notes about organs that you think might have abnormalities  Revise autopsy outline to reflect how this patient should be examined.  Discuss safety procedures.

18. Normal Heart Images: Heart: Cross section of a heart: http://radiology.uchc.edu/eAtlas/CV/606.htm Whole normal heart: http://www-medlib.med.utah.edu/WebPath/CVHTML/CV001.html Information on heart anatomy and physiology: Gray ’ s Anatomy – Heart: http://www.bartleby.com/107/138.html Anatomy of the Human Heart: http://www.tmc.edu/thi/anatomy.html How Stuff Works: http://health.howstuffworks.com/adam-200083.htm

19. Acute Myocardial Infarction Heart Cross Section Light- colored tissue indicates a myocardial infarction Normal fatty tissue Dark area shows beginning of healing – increased blood supply

20. Old Myocardial Infarctions Scar tissue from an infarct at least two weeks old.

21. Myocardial Infarction Images: Myocardial infarction: Infarction as shown on a cross section of a heart (tan=infarction): http://www-medlib.med.utah.edu/WebPath/CVHTML/CV021.html Infarction in the left ventricular wall of the heart: http://www-medlib.med.utah.edu/WebPath/CVHTML/CV020.html Information on myocardial infarctions: Medline Plus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000195.htm MedicineNet.com: http://www.medicinenet.com/heart_attack/article.htm

22. Normal Coronary Artery Images: Coronary artery: Microscopic image of a cross section of a coronary artery: http://www-medlib.med.utah.edu/WebPath/CVHTML/CV004.html Information on coronary artery anatomy and physiology: Cleveland Clinic Heart Center: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/cad_arteries.htm Cardiovascular Consultants: http://www.cardioconsult.com/Anatomy/

23. Coronary Artery Thrombosis Thrombosis or blood clot Atheroscleros is or build up of artery wall

24. Coronary Artery Disease or Atherosclerosis Images: Coronary artery disease: Microscopic cross section of narrowed coronary artery: http://www-medlib.med.utah.edu/WebPath/CVHTML/CV007.html Gross cross section of atherosclerotic coronary artery: http://www-medlib.med.utah.edu/WebPath/CVHTML/CV108.html Information on coronary artery disease: Medline Plus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000171.htm How Stuff Works: http://health.howstuffworks.com/adam-200034.htmhttp://health.howstuffworks.com/adam-200034.htm - Atherosclerosis http://health.howstuffworks.com/adam-200138.htmhttp://health.howstuffworks.com/adam-200138.htm - Coronary bypass surgery http://health.howstuffworks.com/adam-200082.htmhttp://health.howstuffworks.com/adam-200082.htm - Coronary artery blockage

25. Normal Brain Images: Brain cross sections: Horizontal through the top of the skull: http://www- medlib.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1080R.html Horizontal through the midbrain: http://www- medlib.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1120R.html Information on brain anatomy and physiology: Gray ’ s Anatomy – Brain: http://www.bartleby.com/107/189.html How Stuff Works: http://health.howstuffworks.com/brain.htm

26. Brain Stroke Hemorrhage Brain Cross Section (Vertical)

27. Brain Stroke Images: Brain stroke: Stroke shown on a vertical cross section of a brain: http://www-medlib.med.utah.edu/WebPath/CNSHTML/CNS223.html Information on brain strokes: Medline Plus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000761.htm National Institute of Neurological Disorders and Stroke: http://www.ninds.nih.gov/disorders/stroke/stroke.htm

28. Normal Lungs Images: Lung: Lung cross section: http://www.meddean.luc.edu/lumen/bbs/p/ppi2.html Normal lungs and heart: http://www.meddean.luc.edu/lumen/bbs/p/ppi1.html Information on lung anatomy and physiology: Gray ’ s Anatomy – Lungs: http://www.bartleby.com/107/240.html The Candian Lung Association: http://www.lung.ca/copd/anatomy/normal.html

29. Cancerous Lung

30. Lung Cancer Images: Lung cancer: Gross cross section: http://www-medlib.med.utah.edu/WebPath/LUNGHTML/LUNG068.html Multiple masses: http://www-medlib.med.utah.edu/WebPath/LUNGHTML/LUNG078.html Quit Smoking Support (multiple types of diseased lungs pictured): http://www.quitsmokingsupport.com/lungphotos.htm Information on lung cancer: Medline Plus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000122.htm American Lung Association: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35427

31. Normal Kidney Images: Kidney cross section: http://www- medlib.med.utah.edu/WebPath/RENA HTML/RENAL116.html Information on kidney anatomy and physiology: Gray ’ s Anatomy – Kidneys http://www.bartleby.com/107/253.html National Kidney and Urologic Diseases Information Clearinghouse: http://kidney.niddk.nih.gov/kudiseases/ pubs/yourkidneys/

32. Renal Cell Carcinoma Kidney Tumor

33. Renal Cell Carcinoma Images: Renal Cell Carcinoma: Gross cross section of a carcinoma: http://www-medlib.med.utah.edu/WebPath/RENAHTML/RENAL053.html Kidney with very large carcinoma: http://www-medlib.med.utah.edu/WebPath/RENAHTML/RENAL052.html Information on Renal Cell Carcinoma: Medline Plus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000516.htm Ellis Fischel Cancer Center: http://www.ellisfischel.org/urologic/kidney.shtml