Embalming III - Quarter Final

Procedure for embalming the cornea donor (Corneal sclera button)

- Aspirate the eyeball with a needle and syringe - Use cavity packs inside the eyeball during embalming - After embalming dry the inside of the eyeball and fill with sealer - Eye caps are used to project the natural contours - Eye lids are secured with adhesive

Notes on cranial treatment of autopsy case

- Before reflecting the scalp thoroughly cream and lubricate the face and forehead - Open the cranial incision and remove the calvarium - Ligate or clamp leaking vessels in the interior of the cranium - Try to inject both the R&L internal carotid and the R&L subclavian arteries

Spinal autopsy (Dorsal Removal)

- Body is placed in a prone position for ventral removal - Incision on the back presents the potential for leakage - Incision must be tightly sutured - Coveralls are recommended

Problems with ventral harvest for vertebral donation

- Chances are, circulatory system is already disrupted by organ removal

Wiring between drilled holes method of calvarium attachement

- Drill opposing holes in calvarium and temporal bone - Wire the calvarium in position - Crisscross the wires

Before closing incision of embalming procedure for long bone recovery - Method 1 (internal access)

- Dry tissue bed with absorbent cotton - Coat tissues with paraformaldehyde powder - Cavity packs or autopsy gel may be used - Prosthetic devise is replaced at this time - Incisions are then closed using a baseball or lock stitch - Additional drying compound or powdered sealer is used during suturing - Plastic stocking are required

Procedure for ventral harvest for vertebral donation

- Examine damage done to the blood vascular system - Use a sectional embalming technique to thoroughly preserve all areas of the body - In this instance removal of vertebral tissues will not significantly alter the embalming procedure

After calvarium is secure

- Fill bone incision with mortuary putty or mastic compound - Use powdered sealer on the reflected scalp and return scalp to its normal position

Suggested order of preparation for autopsy

- Primary disinfection of the body - Position the body using block and bridges as needed - Open the cavities and remove all viscera - Decide on treatment method for viscera - Locate and ligate the vessels needed for sectional embalming - Prepare arterial solution according to proper analysis - Begin sectional embalming - Supplemental hypodermic injections - Drain all liquids from body cavities - Treat all internal surfaces with hardening compound or gel - Return viscera (in sections or in bag) - Suture thoracic and abdominal cavities - Dry cranial cavity and treat with powder or gel - Suture the scalp - Perform terminal disinfection - Glue thoracic and abdominal incisions - Dress in coveralls or union-alls

Dorsal harvest (posterior incision) for vertebral donation

- Recovery through a posterior incision - Typical when no autopsy or other organ recovery takes place - Vascular system should not be disrupted by this procedure - Embalmer can approach arterial injection and venous drainage using standard procedures

Embalming procedure for long bone recovery - Method 1 (internal access)

- Remove all suture lines - Remove prosthetic devices to provide unobstructed access - Locate any ligatures on vessels provided by procurement team - Dissect and ligate the R&L femoral arteries to isolate circulation to the legs, but do not embalm the legs at this point - Now inject the trunk, hips, head, and neck, using cervical and/or femoral vessels as injection and drainage sites - Inject the leg and thigh using the R&L femoral arteries - Take care to clamp off leaking vessels - Pay particular attention to leakage from the genicular vessels - Large number of hemostats will be needed - Lower leg and foot are injected using the L&R popliteal arteries - Take care to clamp off leaking vessels - More hemostats will be required - Use hypodermic injection to supplement arterial injection of any under-embalmed areas

Calvarium clamps

- Several varieties are available - Small notches must be made to prevent a gap from forming

Suturing through the temporalis muscle method of calvarium attachement

- Suture through temporalis muscle and up across the calvarium - Suture through the cut portion of the temporalis muscle still attached to the temporal bone and through that portion of the muscle still attached to the calvarium or - Separately suture the cut temporalis muscles on either side of the head

Embalming report should note the treatment and disposition of viscera

- Was viscera present - Was viscera stripped or sectioned - Did you return viscera to body - Was viscera treated with fluid or powder (or both) - Was viscera placed in a separate container or bag outside the body - If viscera is not present what was used to fill the cavity

Use of prosthetic devices for vertebral donation

- Whenever bone is removed from the body a prosthesis is recommended - If the procurement agency has not provided or installed a prosthetic replacement it is recommend that the embalmer fabricate such a device

Procedure for embalming after eye enucleation

- With this method most of the treatment of the eye socket occurs after the arterial injection of the head - Remove from the eye-socket any packing used by procurement personnel - Replace with packing saturated with autopsy gel or cavity fluid - Fill the eye with enough cotton to recreate the normal appearance of the closed eye - Embalm the body and then the head - After arterial injection, remove cavity packs from the eye socket - Seal the base of the eye socket with powder - Pack the eye-socket with fresh cotton or mortuary putty - Insert a commercial eye cap - Properly pose the eyelids and apply adhesive

General guidelines for need of an autopsy

Child with evidence of injury without explanation Death in workplace Homicide Suspected drug overdose Motor vehicle accidents Pedestrian accidents Prison fatalities SIDS Suspected drug overdose Suspected poisoning Trauma Unexplained Death

Arterial injection of the head be sure to

Clean and dry the interior of the cranium, and cover the base of the skull with quick drying sealer

Autopsies can be either

Complete or partial

Safety and work practice controls for the embalmer

Continuous aspiration Cover broken or cut bones Clamp leaking arteries and veins Wash gloved hands frequently Run water on table continuously at low pressure Be aware of where sharp instruments are laid during embalming

Complete autopsy includes removal of

Cranial cavity and its contents Organs and glands of the neck Thoracic cavity and its contents May include eye enucleation

Medico-legal/Forensic autopsy

Death of the mother during an abortion (legal or illegal) Fetal death or death within 24 house of birth Spontaneous abortions and miscarriages Operative and peri-operative death Unidentified or unclaimed body Violent or traumatic death Suspicious death Sudden death Uncertainty

Problems the embalmer faces if a body is in a prone position include

Disfigurement Discoloration Distention

During sectional embalming, distribution is provided to what areas from the following arteries: Axillary arteries

Distal arms and hands

Injecting the head using the subclavian arteries will insure

Distribution to the neck and back of the head via the vertebral arteries

Tips for embalming the long bone donation

Do not pre-inject Use a strong solution Continuous aspiration of drainage

When working an autopsy alone

Do one thing at a time

Autopsy case: Continuously aspirate all ________ during injection

Drainage

Removal of the spine from the normal autopsy incision (through the front) should present no additional problems for the

Embalmer

Types of tissue

Epithelium Connective tissues: i.e. Blood, bone, cartilage Muscle tissue Nerve tissue

If the viscera is not present what should be use to fill the body cavity

Excelsior Cedar chips Clean sheets Clean sawdust Padding & upholstery

Removal of a single organ (sometimes multiple organs) from the body

Exploratory/Partial autopsy

May be referred to as the "free-flow" method

External access procedures

Not recommended: external access procedures or internal access procedures

External access procedures

During sectional embalming, distribution is provided to what areas from the following arteries: Common carotid arteries

Face and head

Long bones of the leg

Femur Fibula Tibia

It may be easier to "find room" for the viscera, if

Fluid is not added until the bag is in position

Medico-legal autopsy

Forensic autopsy

During sectional embalming, distribution is provided to what areas from the following arteries: Internal iliac arteries

Gluteal, pelvic, and perineal areas

Organs most frequently donated

Heart Kidney Liver Lungs Pancreas

Medical autopsy

Hospital autopsy

Long bones of the arm

Humerus Radius Ulna

Notes on replacing the calvarium

In a proper autopsy there are notches in the area of the temporal bone If the notches are not present, extra care must be taken to secure the calvarium

Describe a long bone recovery

Incisions from the hip to the ankle Most dramatic of all tissue recovery Large scale disruption of the circulatory system

Procedure for embalming after eye enucleation - If swelling occurs

Increase the strength of the solution and decrease the volume

Internal access procedures working from the

Inside

Replace and secure the sternum and costal cartilage

Just before closing the incision

Tips for embalming the cornea donor (Corneal sclera button)

Just the lens of the eye is harvested Preparation work is greatly reduced Eyes can be set after the embalming Although always appropriate, restricted cervical injection is not required Use whatever injection technique and solution strength your analysis indicates

What purpose do the notches on the calvarium serve

Keep the calvarium from moving

Keys to success for treatment of organ donations

Knowledge of anatomical structure and relationships Anticipating which vessels have been cut Ability to locate the ends of vessels

Begin sectional embalming (in this order)

Legs Arms Head (left side first)

During sectional embalming, distribution is provided to what areas from the following arteries: External iliac arteries

Lower extremities and distal parts of the leg

Three types of autopsy

Medical Medico-legal Contract autopsy

During sectional embalming, distribution is provided to what areas from the following arteries: Subclavian arteries (Proximal end)

Neck

Autopsy case: When suturing pull on the thread, not on the

Needle

Medical/Hospital autopsy may be performed when

No firm diagnosis As a teaching tool Quality of care issues Medical complications Death during child birth Concerns about insurance Sudden, unexpected death Concerns about hereditary disease Environmental or work place hazards New or unusual or experimental treatment Death not under jurisdiction of the medical examiner

Internal access procedures involves

Opening the procurement incision and injection of the body utilizing the arterial structures that remain intact

Knowledge, skill, and experience of autopsy embalming can be directly applied to

Organ and tissue donation

Any part of the body exercising a specific function

Organs

External access procedures working from the

Outside

If a prosthesis is not supplied the embalmer is advised to fabricate a device materials might include:

PVC pipe Dowel rod Closet rod Electrical conduit

Embalmer must use his or her knowledge of anatomy to develop a custom protocol for

Partial autopsy

Problems with dorsal harvest (posterior incision) for vertebral donation

Possible leakage due to dorsal incision A tight stitch and plenty of sealer will be required Use of coveralls recommended

General recommendations for autopsy

Preparation of autopsied bodies are usually delayed Use a stronger than average arterial solution Use plenty of active dye Embalm the head slowly, avoid distention

Contract autopsy

Private autopsy

Locate and ligate the vessels needed for sectional embalming

R&L external iliac arteries R&L axillary or subclavian arteries R&L common carotid arteries

External access procedures embalming the organ donor is accomplished by

Raising vessels at one of the commonly used injection and drainage sites, without opening the procurement site

Ventral harvest (anterior incision) for vertebral donation With autopsy or other organ recovery

Recovery though the existing ventral incision Typical when other organs have been harvested Or when there has been a complete autopsy

Ligation of orifices

Rectum Esophagus

Materials you use to fill the body cavity should not be mistaken for

Refuse or trash

Autopsy of cranial cavity and its contents includes

Removal of the brain Removal of the pituitary gland Possible removal of temporal bone and inner ear

Organs: any part of the body exercising a specific function such as

Respiration Secretion Digestion Circulation

During sectional embalming, distribution is provided to what areas from the following arteries: Subclavian arteries (distal end)

Shoulder and upper extremities

Removal of the spine from an incision made on the back

Spinal autopsy (Dorsal Removal)

Autopsy case: Viscera must be _______ (especially if no bag is used)

Stripped or sectioned

For autopsy case before reflecting the scalp

Thoroughly cream and lubricate the face and forehead

Autopsy of organs and glands of the neck includes removal of

Thyroid gland, larynx, esophagus and trachea Possible removal of carotid arteries Possible removal of the tongue

To maintain air quality in the prep room... If viscera are treated with cavity fluid during embalming, be sure the container has a

Tight fitting lid

Collection similar cells and the intercellular substances surrounding them

Tissue

Refers to the procurement and transplantation of the tissues that fall into one these categories

Tissue Donation

Cavity pack in the mouth is crucial if the

Tongue is missing

Supplemental hypodermic injections

Trunk and ribs Shoulders and neck Buttocks and perineal area

Types of embalming after eye enucleation

Use a strong solution Use a restricted cervical injection Avoid pre-injection procedures (at least for the head) Let embalming solution drain from the eye during arterial injection

Needle injector wires method of calvarium attachement

Use four wires Two wires on each side Two attached to calvarium Two attached to temporal bone Wires should be crisscrossed

Adhesives (superglue) method of calvarium attachement

Use superglue to help hold the calvarium in position

Packing of orifices

Vagina Nose Mouth Trachea Neck area to conform to natural contours

Recommended methods for closing the cranial incision

Whip stitch Worm suture Intradermal suture Surgical adhesives Baseball suture/Sail makers stitch

Things to consider in regard to embalming vertebral donation

With or without autopsy Dorsal or ventral recovery With or without other organ recovery

For those who have bald heads which suture would you use for closing the cranial autopsy incision

Worm suture Intradermal sutures

External access procedures

Worst practice

Prepare arterial solution according to proper analysis

Cause of death Size and weight of body Moisture content (or lack of moisture) Time interval between death and preparation

Autopsy of thoracic cavity and its contents includes removal of

Abdominal cavity and its contents Pelvic cavity and its contents Possible removal of the spinal cord

Autopsy case: Using a hypo-valve trocar, thoroughly inject all areas that

Appear un-treated

When working an autopsy alone do not

Attempt to multi task

Treatment for most organ donations is the same as for

Autopsy

Most embalmers have become very adept embalming

Autopsy cases

Internal access procedures

Best practice

Exploratory/Partial autopsy organs that may be removed

Brain Heart Lungs Kidneys Stomach

This is the most common method of calvarium attachement

Calvarium clamps

Securing the calvarium

Calvarium clamps Needle injector wires Adhesives (superglue) Wiring between drilled holes Suturing through the temporalis muscle