By referring to the attached autopsy, I

By referring to the attached autopsy, I need ti answer the following questions: 1. What would you certify as the cause of death on a death certificate? (Please adopt the format of the death certificate (i.e. Part I, Part II) when presenting your cause of death.); 2. What do you think the manner of death might be?; 3. What additional information do you require before you are confident that you know the cause of death? 4. Has the autopsy assisted in the determination of the cause of death and, if so, how? AUTOSPY: INTERNAL EXAMINATION Cardiovascular System: Heart (450 g): is mildly to moderately enlarged. Pericardial sac: contains less than 5 mls of clear straw-coloured fluid. Atria: normal; contain no thrombus. Right ventricle: normal in configuration and thickness. Left ventricle: shows no evidence of old or recent ischaemic changes; normal in configuration and thickness. Valves: normal. Coronary arteries: have a normal distribution. The coronary ostia occupy a normal anatomical position and are widely patent. The coronary arteries are widely patent with no significant atheroma. There is no coronary thrombosis. Aorta: no significant natural disease. Carotid arteries: widely patent with no significant atheroma. Venae cavae: normal. Renal arteries: widely patent with no significant atheroma. Pulmonary vessels: no thrombo-emboli. Other vessels: unremarkable. Mediastinum: normal. Respiratory System: Hyoid bone and laryngeal cartilages: intact. Larynx: is heavily soot stained. Soft tissues of neck: show a moderate degree of heat damage. Trachea and main bronchi: are heavily soot-stained. Pleural cavities: no adhesions or free fluid. Lungs (right 800 g; left 750 g): both lungs are oedematous. Hilar lymph nodes: unremarkable. Digestive System: Tongue: no trauma. Mouth: unremarkable. Tonsils: normal. Pharynx: normal. Oesophagus: normal. Peritoneal cavity: unremarkable; no excess of fluid and no adhesions. Stomach: healthy mucosa and wall. Stomach contents: empty. Duodenum: normal. Small intestine: normal. Large intestine: normal. Contents of bowel: normal; no bleeding. Appendix: present. Rectum: normal. Liver ( 1750 g): no evidence of natural disease but some evidence of heat damage. Gall bladder: contains clear bile. There are no gall stones. Bile ducts: healthy and unobstructed. Pancreas: unremarkable. Genito-urinary System: Kidneys (right 170 g; left 170 g): the capsules strip with ease revealing smooth surfaces. The cortices are of normal width. Ureters: unremarkable. Bladder: contains a small amount of clear urine. Internal genitalia: unremarkable. Gonads: unremarkable. External genitalia: unremarkable. Lymphatic System: Spleen (120 g): healthy externally and on section. Cervical lymph nodes: unremarkable. Mediastinal lymph nodes: unremarkable. Mesenteric lymph nodes: unremarkable. Para-aortic lymph nodes: unremarkable. Peripheral lymph nodes: unremarkable. Thymus: not recognisable. Vertebral bone marrow: not examined. Endocrine System: Parathyroids: unremarkable. Thyroid: unremarkable. Adrenals: unremarkable. Pituitary: no obvious abnormality on in situ examination. Cranium and Nervous System: Scalp: see External Examination Skull: shows heat fracture. Middle ears: exposed but not opened. No apparent abnormality. Air sinuses: not opened. Meninges: brown friable blood clot is present w ithin the extradural space, consistent with heat haematoma. Cranial vessels: have a normal anatomical distribution with no aneurysmal dilatation and no significant atheroma. Brain (1200 g): shows extensive heat damage. No obvious evidence of pre- existing natural disease. Spinal cord: not examined. Peripheral nerves: where exposed during routine dissection, unremarkable. Musculo-skeletal System: Spinal column: no visible fractures. Limb girdles: no visible fractures. Long limb bones: no fracture evident externally or on palpation. Hands and feet: left wrist fracture see, above. Ribs/sternum: no visible fractures. General condition of skeleton: normal for age. Muscles: where exposed during routine dissection, unremarkable. SAMPLES A range of routine tissue samples have been retained for histology. No other organs retained. TOXICOLOGY Blood, urine, stomach contents, bile and liver have been retained for toxicological analysis.

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