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6.3.6 Fourth step — examine the oral cavity and neck
• Examine the pharynx and exterior of the larynx and tongue before dicing the tongue. • Separate the oesophagus and trachea from the other neck tissues to the first rib but
maintaining their connections to the tongue and larynx • Starting at the dorsal larynx incise the length of the trachea to the first rib and examine
and sample as required. • Incise the length of the oesophagus to the first rib, examine and sample as required.
6.3.7 Fifth step — examine the thorax
• Incise the pericardium and note the presence of any fluid or exudates. • Palpate the lungs and heart, and then sever their dorsal and ventral attachments to the
thorax keeping the heart attached to the lungs to form the “pluck”. • Inspect the epicardium and inner surfaces of the pericardium. Petechial and ecchymotic
haemorrhages on the epicardium are a normal agonal change related to terminal asphyxia.
• Separate the heart from the pluck by severing the great veins, aorta and pulmonary artery well distal to the aortic and pulmonic valves.
• Examine the external myocardium then open the heart by incising vessels, valves and chambers in the direction of blood flow from the posterior vena cava to the aorta with
heart valves being closely examined. • Inspect the great veins, right atrium, right AV valves, moderator band, the right ventricle
and its outflow tract, the pulmonary valve cusps and pulmonary artery • Incise the pulmonary veins, left atrium, left ventricular outflow tract, through the aortic
valves into the aorta and inspect. •
“bread slice” the heart to adequately examine the interventricular septum and myocardium before collecting a slice of left ventricular papillary muscle for histological
examination if a sample is required
• Inspect the surfaces of and palpate both lungs. Estimate the percentage of lung affected by pneumonic lesions. Red discolouration alone does not mean that pneumonia is
present. Normal lungs feel spongy, oedematous lungs feel rubbery, and pneumonic lung feels consolidated like liver. Consolidated lung sinks in formalin.
• Incise the trachea through to primary and secondary divisions of bronchi. • Collect lung and tracheal tissue for histological examination if required.
6.3.8 Sixth step — revisit the abdomen
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