Autopsy Policy

[Mrbojangles]

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Does your residency program have special policy for autopsies on patients with documented AIDS or Hepatitis C?

 

[stormjen]

Does your residency program have special policy for autopsies on patients with documented AIDS or Hepatitis C?

We do treat those cases differently. I believe HIV bodies have to sit for 48 hours. For Hep C cases (and probably for HIV pts too, although I haven't done one of those) we put a plastic sheet over the body when doing things like sawing that can send particulate matter into the air. Other than that, we are just extra safe when using a blade.

 

[yaah]

We don't really do anything different except maybe extra gloves for HCV. The only cases we are very wary of are TB and CJD cases.

 

[beary]

I believe HIV bodies have to sit for 48 hours.

Sorry, this is probably an ignorant question. Why would it matter if HIV bodies sit for 48 hours?

 

[stormjen]

Sorry, this is probably an ignorant question. Why would it matter if HIV bodies sit for 48 hours?

It's not ignorant at all; I have no clue either! I will have to ask. *shrug*

 

[MoosePilot]

Treating a living patient balances the danger to the physician against the need of a living person for medical care. Why would you risk your life for an autopsy? Seems like a risk for very little positive result.

 

[yaah]

An autopsy on an HIV positive or HCV positive patient poses very little risk. And every patient should be treated as potentially HCV or HIV positive. I believe there is at least one case report of a pathologist acquiring HIV during an autopsy but it is vanishingly rare.

 

[deschutes]

Oh, I was hoping you'd talk about the "very little positive result" part.

 

[MoosePilot]

Oh, I was hoping you'd talk about the "very little positive result" part.

Well, I understand that an autopsy adds knowledge to the medical profession and that knowledge might save other lives. After this many years of autopsies and the number of patients that arent' confirmed HIV positive, it seems like a small enough benefit that it does not outweigh the risk to the doctor (except that Yaah says that is tiny). If the benefit is that great, why isn't there any effort to force autopsies? That's the kind of thing I mean. It's not enough to mandate autopsies, but it's enough to risk a doctor's life?

Again, I'm not knowledgeable about pathology, it's just something that I wondered about after reading the original post.

 

[DarksideAllstar]

CJD cases are done solely by faculty (Neuropath and Autopsy), I believe. Everything else is fair game and I'm not sure what the precautions are for HCV (TB requires a N95 respirator).

As an aside, how fast can you guys complete an autopsy (from the external exam to having everything out, weighed, and examined)? This is my first month of autopsy and everything is so painfully slow that I dread calls from the morgue. I think the most frustrating thing is figuring out what I've got in my hand, and whether or not I can cut through it without someone being pissed later. Things are progressing but I yearn for the restricted cases (heart only, lungs only, brain only, etc).

 

[Mindy]

We seem to not do HIV cases generally.

I have done a zillion Hep C cases (our transplant surgeons are excellent autopsy requestors.) Usually the question is, how does the transplant look.

My first autopsy was a suspected (and then proven) CJD patient. I used no special precautions. I am still a little p/o about this autopsy for several probably obvious reasons.

Regardless, I have since decided to go into forensic pathology, therefore none of my concerns about autopsies on infectiously diseased patients raise much of an eyebrow for me. (Save Ebola, mainly due to the terrifying unshakeable description in "The Hot Zone" !)

My advice: Be careful, do everything the same way, wear a cut proof glove (at least) on your dependent hand, wear an eye shield, watch out for bone fragments, greenfield filters, and staples.

Mindy

 

[yaah]

Time course of autopsy is always different. I had some where from start (including reviewing chart) to finish (including dictation and prelim paperwork) took 4 hours. The actual autopsy usually 2 hours or so. The complicated dissections can be frustrating - I spent over an hour on a bypassed scarred heart once I think. I think the quickest from incision to pulling off gloves was an hour and 15 minutes.

 

[Mrbojangles]

I originally asked to see if there was a consensus on how autopsies for HIV and HCV patients are done. I geuss there is none. I talked to two residents from two different institutions during my ME rotation and they said that the organs are eviscerated by dieners and then allowed to fix in formalin for two weeks. It seems like the risk is very low and that you would need a needle stick injury with a large gauge needle to be really at risk. Hep C being more of a risk than than HIV.

A few months ago I had an autopsy on a patient with HCV and HIV on the weekend (I was a newbie to autopsies) and was asked by the attending if there is some special protocol for such patients, because he was worried. Of course I didn't know and I found out none existed and I was pissed that the topic of doing autopsies on risk patients came up on a weekend.

 

[yaah]

That is annoying...Did you have a diener on call, because they normally know these things.

We have no such policy - our HIV and HCV autopsies are done the normal way.