FSE 212 Embalming Final Exam (Module 5-7)

Histoplasmosis common locations (1) & diagnosis sample types (3)

1. Lungs 2. Diagnosis determined by sputum, blood, bone marrow, biopsied lymph node tissue

Candidiasis common locations (4) & decedent types (3)

1. Oral mucosa, vulvovaginal mucosa, perineum of fingers, lesions of nails (onychia, paraonychia); 2. diabetic pregnant, cooks, aids

Explain comorbidity's embalming significance

Different diseases can cause differentside effects and cause various complications while embalming

Dry Gangrene

Pathological condition will cause a dull reddish to black discoloration

You should place documents related to shipping remains on what end of the shipping container?

The necessary legal documents and embalming case report should be placed in a sealed envelop and placed on top of the container in the document envelope.

Millicurie

The number of radioactive materials in which 37 million atoms disintegrate each second.

Tunica externa

The outer layer, composed mostly of connective tissues

These drugs can lead to dehydration, low protein levels, kidney dysfunction , and the retention of nitrogenous waste.

Tranquilizers

Phycomycosis common locations (4)

infection of lungs, ears, nervous system & intestinal tract

Provide an overview of best practices for preparing a decedent for identification viewing. (8)

A. Attach the identification tag B. Inspect the body by unwrapping / undressing and looking for any personal possessions that may be with the deceased. C. Clean the body. D. Close the eyes and mouth - while closing the mouth the dental tie is recommended as it is a non-invasive procedure. E. Wash and comb hair F. Position the body as in a casket G. Re-wrap, dress or cover the deceased with a sheet. H. Keep in secure location

This complication occurs as a result of altered carbohydrate metabolism leading to a buildup of lactic acid

Acidosis

This type of bacteria is commonly found in the mouth, intestinal tract, and vagina of healthy individuals:

Candida

Moist gangrene

Develops when the blood supply is suddenly cut off, as by a severe burn or an arterial blood clot. Tissue that has not been destroyed by the trauma begins to leak fluids, which then foster the growth of bacteria.

This is a commonly prescribed synthetic opioid similar to morphine, yet 50-100 times more potent.

Fentanyl

Renal failure

Kidneys stop working

Extravascular resistance

Pressure on the outside of an artery or a vein

Type 3 arteriosclerosis

The artery is completely occluded. These arteries cannot be used for injection.

Type 2 arteriosclerosis

The lumen is quite reduced in size and pushed to one side of the artery. This causes the small arterial tube to be used.

Cerebrovascular accident

A loss of blood flow to part of the brain, which damages brain tissue. Cerebrovascular accidents are caused by blood clots and broken blood vessels in the brain.

Edema that is generalized throughout the body

Anasarca

Purge from this area may have a white semisolid appearance

Brain

Restorative treatment usually accompanied by aspiration, gravitation, or external pressure to remove gases or excess liquids from tissues; passages are made through the tissues with a scalpel, hypodermic needle, or trocar.

Channeling

These drugs as the most widely used class of drugs.

Corticosteroids

This is a fatal disease caused by contamination of a wound infection by a toxin-producing, spore-forming, anaerobic bacterium.

Gas Gangrene

Which of the following is not a consideration when treating a body exposed to radiation:

Height/Weight of the body

These drugs are commonly used for pain relief and anesthesia.

Opiods

Wicking

Place one or more holes in edema tissue insert 12-inch cotton in hole & allow to drain with manual pressure. Close with trocar button

Subcutaneous Emphysema (source, characteristics, and treatment)

Source: Is caused by puncture in the lung or pleural sac, after CPT, puncture wounds to thorax, rib fractures, and/or tracheotomy. Characteristics: No odor; no skin slip; no bleeds; gas can reach distal points even toes; can create intense swelling rises to highest body areas. Treatment: Gas escape through incisions; establishment of good arterial preservation; channeling of tissues after arterial injection to release gases

Comorbidity

When a decedent or patient has two or more diseases or medical conditions.

Chronic alcholism complications (11)

1. Jaundice 2. Skeletal tissue edema 3. Ascites 4. Hyrdothorax 5. Multisite injection 6. Weak Espophageal veins 7. Purge 8. Firming difficulty 9. Tissue building required 10. Ecchymoses 11. Hepatic Failure depleting clotting factors (good drainage)

True or False: Contact with contaminated instruments may expose a decedent to tissue gas

True

What is the definition of opiods?

a compound resembling opium in addictive properties or physiological effects.

Recall numerous concerns presented with renal failure (8)

1. Acidosis 2. Neutralization of Formaldehyde 3. Edema 4. Jaundice and Discoloration (cosmetic utilization) 5. Lack of Firming 6. Bacterial proliferation in gastrointestinal tract 7. Minimum of 2 to 3 cavity fluid bottles 8. Re-aspiration

Radioactive isotopes

Atoms that contain an unstable combination of neutrons and protons, or excess energy in their nucleus

Intercellular edema

Edema between cells

Hydrocephalus

Edema of the cranial cavity

Hydropericardium

Edema of the pericardial sac surrounding the heart

Hydrothorax

Edema of the pleural (on or both cavities)

Intracellular edema

Edema within cells

Pulmonary edema

Edema within the lungs and/or pleural cavity

Proteolytic enzymes do not break down proteins

False

Accumulation of serous fluid in the saclike cavity int he tunica vaginalis testis of the male scrotum

Hydrocele

Tunica intima

Inner lining of endothelial cells

This is the second highest cause of preventable death in the United States

Obesity

This form of Histoplasmosis is progressive, forming granulomatous inflammation with caseation necrosis and cavitation.

chronic pulmonary

Why should you avoid placing flowers in the casket or shipping container prior to shipping human remains?

Flowers can cause color staining of the decedent.

This is an infection of the lungs, the ears, the nervous system, and the intestinal tract caused by a fungus commonly encountered as a saprophyte or a contaminant.

Phycomycosis

Vasodilation

The dilation of blood vessels, which decreases blood pressure.

Type 1 arteriosclerosis

The inner wall of the artery is hardened and thickened but the lumen is well defined and large.

Aneurysm

an abnormal swelling or bulge in the wall of a blood vessel, such as an artery

Aspergillosis common locations (4) & decedent types (7)

1. saprophytic, nonpathogenic 2. auditory canal, nasal sinuses, external genitalia, lung abscesses 3. Pneumonia, Tuberculosis, Carcinomatous, Debilitating diseases, Received steroid, Antibiotic, or Immunosuppresive therapy

Diabetes

A disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the bloodand urine

Transportation Security Administration-

Agency put together after September 11, 2001, requires all remains that will be shipped by common carrier (airline is the most utilized) for the shipper to be known.

Loss of moisture from body tissue that may occur antemortem or postmortem (antemortem: febrile disease, diarrhea, or emesis; postmortem: injection of embalming solution or through absorption by the air)

Dehydration

This organ is the main detoxification center of the body:

Liver

What effects do nitrogenous waste products have upon formaldehyde?

Nitrogenous waste neutralizes formaldehyde which increases the formaldehyde demand.

Histoplasmosis (Oval yeast-like organism Histoplasma capsulatum; common in Mississippi Valley) stages (4)

1. Acute Pulmonary: asymptomatic, coin lesion confused w/ lung cancer 2. Chronic pulmonary: progressive necrosis and cavitation, commonly misdiagnosed with pulmonary tuberculosis 3. Acute disseminated: either benign or progressive; found in young children or AIDS adults can be rapidly fatal; enlarges the spleen, lymph nodes and liver; septic type fever with anemia and leukopenia 4. Chronic disseminated: can be seen in elderly and healthy individuals and may be fatal; can target: heart valves i.e., endocarditis, adrenal glands, gastrointestinal tract, spleen, liver, lymph nodes, lungs, bone marrow, meninges, colon, tongue, larynx, pharynx, mouth, nose and lips

List all the necessary documents placed in the shipping envelope during the shipment of human remains to another funeral establishment.

1. Burial Transit permit 2. Death Certificate 3. Embalming Case Report 4. Consulate of Jurisdiction entry of remains permission documentation (allows body to be admitted to other country when shipped)

What are the 3 main factors that affect the degree and length of preservation?

1. Condition of the body at the time of the preparation. 2. Embalming thoroughness and chemical formulations 3. Aftercare

Describe treatment for decubitus ulcers.

1. Disinfect topically and tissue around the ulcers using cavity fluid or phenol cautery solution. 2. Apply necrotic surface tissues with surface compresses of autopsy gel, cavity fluid or phenol cautery.

Describe the procedure for safely removing and disposing of narcotic transdermal patches.

1. Do not touch the patch. 2. Remove with forceps. 3. Place in sharps container so no one else will touch it.

List 5 considerations for preparation of remains for delayed viewing and disposition.

1. Edema 2. Kidney or Liver failure, Trauma 3. Infectious diseases 4. Obesity 5. Signs and/or degree of decomposition present

Discuss the complications encountered in embalming bodies dead from renal failure. (8)

1. Firming difficulty 2. 6X more preservative chemical 3. Rapid decomposition (acidity cuases rupture of lysosomes) 4. Edema (provides moisture for enzymes to activate 5. Blood in Intestinal Tract 6. Abundant Ammonia presence 7. Gradual solution strength increases 8. If edema present, preservative deodorant powder and coveralls are needed

Provide an overview of the preparing the deceased for shipment. Hint- see page 344 and discuss the preparation of the casket and/or shipping container.

1. Inter/Intrastate casket and/or shipping container requires either the combination air tray container (all sides made of wood (fiber board or plywood) & outer covering made of cardboard) or the air tray container (bottom made of wood/ tops & sides made of cardboard). 2. International casket and/or shipping container requirements: o Sealing casket or wood casket with sealing Ziegler case inside o All-wood shipping container possibly lined with zinc and soldered closed. o Exact dimensions of the outer shipping box and the material of composition o Bottom of the casket be filled with sawdust (Egypt)

Mucormycosis common locations (1) & decedent types 6)

1. Invades vessels appears as intense necrotizing and suppurative inflammation 2. uncontrolled diabetes mellitus, leukemia, AIDS, and other debilitating diseases, chemotherapeutic agents, and irradiation

Atheroma

Fatty degeneration or thickening of the walls of the larger arteries occurring in atherosclerosis

Cytotoxic drugs

A substance that kills cells, including cancer cells. These agents may stop cancer cells from dividing and growing and may cause tumors to shrink in size.

What are the regulations for shipping and traveling with cremated remains?

For inter/intra-state shipping only the USPS will accept cremated remains within small package cargo systems.

List 5 factors that may contribute to the continuance of decomposition and may require re-embalming.

1. Fluid was not distributed to all areas. 2. Too little solution was injected. 3. The concentration of the fluid was too low to meet the preservative demands of the body. 3. The injected solution was neutralized by the body chemistry (often seen in bodies dead fromrenal failure or edema) 4. Rigor mortis was mistaken for embalming fluid tissue fixation.

Diabetics embalming complications (5):

1. Arteriosclerosis 2. Mycotic infection 3. Restricted Cervical Injection 4. Ulcers, Gangrene, and Lesions disinfection using phenol and/or autopsy gel 5. Cover infected areas with surface compress and/or gangrene areas with plastic stockings

Postmortem Dehydration causations (4):

1. Refrigeration 2. Un-Refrigeration (exposure to heating and air conditioning) 3. Coagula 4. Emboli

Nephrotoxic

damaging or destructive to the kidneys.

Thrombosis

local coagulation or clotting of the blood in a part of the circulatory system

Uremic pruritus

lso called chronic kidney disease-associated pruritus (CKD-aP), refers to itching related to CKD and end-stage renal disease (ESRD). It is commonly defined as the daily or near-daily experience of itch in the absence of a primary dermatologic finding.

Vasoconstriction

the constriction of blood vessels, which increases blood pressure.

List three functions of the proteins in the body.

1. Physical structure formation 2. Give body form. 3. Physicochemical structures which cause catalytic activity.

It has been estimated that ____ times more preservative chemical is needed to preserve tissues of bodies dead from complications of renal failure.

6

Edema of the abdominal or peritoneal cavity and surrounds abdominal viscera

Ascites

Known Shipper Program

Identifies all shippers of cargo (including funeral homes/services) and freight. Each individual airline is responsible to approve cargo shippers including funeral homes as a "known" shipper through their inspection and approval process. As of August 2010, all remains must be inspected just as carry-ons would be inspected.

What is the best practice for removing a transdermal opioid patch from a decedent?

Remove the patch with an instrument such as forceps

The most frequently encountered gas condition is caused by:

Subcutaneous Emphysema

Tunica media

The middle layer, composed of muscle cells and elastic tissue

Outline the embalming of a body with tissue gas isolated to the tissues of the right leg. (5)

cervical injection --> rt. femoral artery raised (injected via pulsation and high pressure) --> hypodermic injection (mid. rt. thigh) --> cavity fluid via embalming machine (above knee) --> deep tissues of lower leg are injected

Chemotherapeutic agents may include all of the following except:

corticosteroids

Discuss the challenges encountered in preparation of the obese dead human body.

1. Positioning (raised high off the table) 2. Arms close to body wall (may need straps) 3. Movement (if clothed or on a sheet easier; if unclothed body is easier to move when wet) 4. Casket placement (when moving body into casket tilt shoulders and head slightly to the right) 5. Restricted Cervical Injection (Rt. Jugular vein is the largest vein to drain on a unautopsied body using drainage forceps) 6. Diabetic obese (leave hands over sides of the table, massage hands, radial and ulnar arteries) 7. Solution: large volumes and increased strength- Fluid Distribution aid: manipulation, massage, intermittent drainage 8. Insufficient Leg Distribution (use external iliac artery, instead of femoral artery) 9. Purge (embalm using restricted cervical injection for trunk to be embalmed first then, aspirate, set features, and embalm the head.) *This method prevents feature set twice

What are sources of extravascular resistance that may be encountered during embalming?

1. Rigor mortis (manipulation prior to injection) 2. Ascites (abdominal draning prior to injection) 3. Cavity gas (puncture abdomen prior to injection) 4. Bandages (remove tight bandages prior to injection) 5. Contact pressure (massage areas) 6. Tumors (excise w/ permission if absolutely necessary; sectional injection may be necessary) 7. Lymph Nodes (sectional injection may be necessary) 8. Hydrothorax (drainage may be possible but difficult before injection) 9. Visceral Weight (above and below heart injection and drainage points)

If renal failure is not listed on death certificate look for the following signs:

1. Sallow color (e.g., yellow color, urochrome buildup) 2. Uremic pruritus (scratch marks on extremities) 3. Increased in amt of urea, uric acid, ammonia, and creatine (can be detected by their odor) 4. Acidosis 5. Edema (retention of Na by kidneys leads to increased H2O) 6. Anemia 7. Gastrointestinal bleeding (blood in the gastrointestinal tract and purging)

List some mycotic infections encountered by the embalmer. (2)

1. Saprophytic (living off dead material) i.e., aspergillus, mucor, candida (mostly found in diabetic, leukemia and AIDS decedents) 2. Parasitic (living off living organisms) i.e., Athletes foot, Thrush, Chronic Lesions

Describe embalming considerations for a ruptured aortic aneurysm (3)

1. Try single site injection (either right carotid common artery or restricted cervical injection). When doing so utilize dye and strong arterial solution 2. If abdomen begins to swell stop injection 3. Use multipoint injection. *Trunk walls may need to have cavity fluid injected using infant trocar

Antemortem dehydration causations (8) from decedents who didn't seek medical attention or withdrawn threatment under physician care (e.g., Hospice)

1. hemorrhage 2. febrile diseases 3. kidney diseases 4. diabetes 5. some cancers 6. localized neoplasms 7. some first-degree burns 8. tuberculosis

Discuss the measures that can be taken to prevent post-embalming purge.

1. thourough aspiration 2. Additional cavity fluid for obese w/ ascities, recent abdominal surgery, and/or decomposition presence 3. Hydodermic injection for parts that didn't receive sufficient fluid (abdominal trunk and buttock walls) 4. Reaspirate bodies w/ abdominal gas (detect by trocar button removal) 5. Reaspirate funeral home transfers 6. Pack autopy gel nonabsorbent cotton to throat and nose 7. Remove moist cotton (be certain mouth is completely dry) 8. Brain purge present (cavity inject small amt of fluid anteriorly via trocar of hypodermic through the cribiform plate, surgical opening, or body fracture) 9. "Tissue gas" presence reapirate several times before dressing 10. Tie off & sever trachea and esophagus, through incition used to raise the carotid artery

Caused by an overproduction of acid that builds up in the blood or an excessive lossof bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis).

Acidosis

Chemotherapy

Application of chemical reagents in the treatment of disease in humans. May cause an elevated preservation demand.

What is the impact of ascites upon arterial fluid and cavity fluid?

Ascites dilutes cavity fluid due to fluid accumulation in the abdominal cavity, but does not dilute arterial fluid.

Abnormal collection of fluid in tissue spaces, serous cavities, or both.

Edema

Proteolytic enzymes

Enzymes that break down protein. These enzymes are made by animals, plants, fungi, and bacteria.

True or False: When embalming a decedent who passed due to complications of alcoholism, the embalmer should expect poor drainage, even within a reasonable time of death.

False

Tissue Gas (Source, Characteristics, and Treatment)

Source: Anaerobic bacteria (gas gangrene), C. perfringens Characteristics: very strong odor of decomposition; skin slip; skin bleeds; increase in intensity and amount of gas possible transfer of spore forming bacterium via cut instruments to other bodies. Treatment: special tissue gas arterial solutions; localized hypodermic injection of cavity fluid; channeling their tissue to release gases

What institution should be contacted when shipping remains internationally?

The consulate of jurisdiction. Other words, each foreign government embassy for where the remains will be shipped has an office in Washington, D.C.

Identification viewing

Viewing human remains for the purpose of identifying the remains, regardless of whether the remains have been washed or otherwise prepared.