Lesson 1.2 Study Guide

List some potential areas of leakage cited by the text and the lesson.

Any area of trauma to the face or hands where the skin was broken or torn. Cranial autopsy incisions. Autopsy sutures. Surgical sutures. Sutures at sites where vessels were raised for arterial injection. Areas where edema is present. Intravenous punctures. Punctures used for drawing postmortem blood samples. Any point where the skin has been broken. Undetected point where trocar broken through. Cranial autopsy suture/staples. IV sites. Incisions/autopsy sutures. Skin slip or edema.

What is the most common type of suture?

Baseball sail suture

Direction of suture: Popliteal Artery

Begin the suture at the inferior (or distal) portion of the incision and suture superiorly.

Direction of suture: Anterior and Posterior Tibial Arteries

Begin the sutures distally and suture superiorly.

List several different ways that pitting edema can be moved out of an area

Can be moved by mechanical aids such as gravitation, massage, channeling of the area, and application of pressure (e.g., pneumatic collar, weights, elastic bandage, water collar, digital pressure) to move the moisture to another area. Elevation of the head and firm digital pressure slowly drain pitting edema from the facial tissues. During cavity aspiration, the trocar can be used to channel the neck, which may allow some of the edema to drain from the facial tissues into the thorax.

What types of chemicals are used for surface embalming

Cavity Fluid, Phenol, Gels

Why does a pacemaker have to be removed before cremation?

Certain radioactive powered units must be returned to the manufacturer. A small incision can be made over the device, which is usually located in the upper pectoral region. The wires that lead to the heart are cut. Incision seal powder is placed in the pocket and the incision is sutured.

Why does the text suggest that invasive devices such as IV needles or venous catheters be left in place until after arterial injection?

Considerable swelling and discoloration of the area can occur if the needle or catheter is removed prior to arterial injection. Following arterial embalming, the invasive probe can easily be removed.

Baseball Suture

Considered the most secure and commonly used, the baseball suture can be airtight.

Which suture is normally used by autopsy technicians to close long incisions?

Continuous suture whip stitch

Interlocking Suture

Creates a tight, leak proof closure. It has a disadvantage in that an unsightly ridge appears on the surface of the incision.

List some possible post-embalming problems that may be addressed.

Dehydration of tissues. Purge. Leakage from incisions (embalming or antemortem surgical). Leakage from any antemortem invasive treatments. Softening and discoloring of tissues. Gas formation. Separation of lips or eye lids. Leakage from areas where edema is present. Odors. Maggots. Needed cosmetic changes.

List two different ways embalming powders can be used and compare their effectiveness in relation to gels and liquids

Diapers can be used to contain the powder or the powder can be placed in plastic garments such as stockings, coveralls, or pants after the garments are in position. Powders can also be used to treat the interior walls of the abdomen and thorax in the autopsied body. Powders are not as effective as gels or liquids. Read the label to be certain the powder is a preservative and not just a deodorant or absorbent.

List several steps that the text suggests must be taken before incisions are closed

Do not suture until after cavity aspiration, aspiration relieves pressure on the vascular system and helps to prevent leakage. Be certain all vessels are securely tied, this prevents any further leakage. If there is edema in the surrounding tissues, force as much liquid out of the incision as possible. Dry the incision.

Stoma

Exposed portion of the bowel.

List several different types of sutures

Individual bridge suture. Baseball sail suture. Single intradermal hidden suture. Double intradermal suture. Inversion worm suture. Interlocking lock suture. Continuous suture whip stitch suture.

When should orifices such as the nasal passages, throat, and rectum be packed?

It is the instructor's opinion that these orifices should be left open and any purge allowed to drain during the embalming. This will elimante if from the body during injection and should reduce the chances of it appearing after embalming or even when the body is "in state". Packing of the orifices should, in the instructor's opinion, be done after embalming and cavity treatment is completed as cavity treatment can alleviate any pressure which may be causing the purge in the first place.

How is the single intradermal suture hidden?

Made with one needle and a single thread. It is referred to as the "hidden stitch" because it is used on exposed areas of the body and is directed through the subcutaneous tissue only.

Single Intradermal Suture

Made with one needle and a single thread. Referred to as the "Hidden Stitch" because it is used on exposed areas of the body and is directed through the subcutaneous tissue only.

Double Intradermal Suture

Made with two needles threaded with opposite ends of the same thread. Because this suture is permanently fixed at each end, it has greater holding ability than the single intradermal suture.

Describe a unionall

Plastic garment which covers the arms, trunk (including the shoulders), and legs. The unionall is available up to triple-x size. It is always advised to use a garment slightly larger than necessary.

List several post-embalming treatments that are generally carried out after arterial and cavity embalming

Preservative treatments for areas that did not receive arterial solution or did not receive sufficient arterial solution. Closure of embalming incisions. Removal (and closure of openings) of invasive devices (pacemaker, intravenous needles, surgical drains, colostomy apparatus). Washing of the body.

What will need to be done to a body that has purged after dressing/cosmetics?

Re-aspirate the body. No doubt the body will have to be taken back to the preparation room for this procedure. Not only should the body be thoroughly re-aspirated, but the cavities should also be re-injected with undiluted cavity fluid. If gases were noted when the trocar button was removed, leave the body in the preparation room, if possible, for several hours and repeat the treatments again before redressing the body.

When applying surface preservative gels, what should be done to reduce fumes and prevent evaporation?

Should be covered with plastic to reduce fumes and to prevent evaporation.

Describe the recommended care of the embalming machine after each use

Should be flushed with warm water. Ammonia and lukewarm water should be flushed through the machine to remove residue. Many embalmers prefer to flush the machines with a water softener or the powder used in electric dishwashers. Additives for machine cleaning can be purchased through fluid manufacturers. A final flush with warm water is necessary. It is recommended that the machine be filled with water at this time for the next preparation. This keeps the gaskets moist and allows the water time to release any dissolved gases such as chlorine.

What is a capri garment?

Single unit that combines pants and stockings.

List some ways that wrinkled lips can be corrected

Some firms have a policy of waxing the lips of all bodies to prevent dehydration and/or cover wrinkles and imperfections. It is the instructor's opinion that this is not necessary. Gluing the lips before application of cosmetics will usually create a much more natural appearance and is much less time consuming.

When should a colostomy bag be removed and what type of suture should be used to close the opening?

Something that should definitely be removed at the completion of the autopsy. A purse-string or "N" suture can be used to close the colostomy. Surface glue may be applied to the closure after the body is washed and dried.

Crepitation

Spongy feel of the gas as it moves through the tissues when they are pushed on.

Two types of supplemental methods of embalming?

Surface & Hypodermic Embalming

Direction of suture: Radial and Ulnar

Suture from the distal portion of the incision medially.

Direction of suture: Common Carotid Artery (anterior parallel incision)

Suture from the inferior portion of the incision superiorly.

Direction of suture: Femoral Artery

Suture from the inferior portion of the incision superiorly.

Direction of suture: Axillary Artery

Suture from the medial area of the incision laterally (with arm abducted).

Direction of suture: Brachial Artery

Suture from the medial portion of the incision laterally with the arm abducted.

Direction of suture: (supraclavicular incision)

Suture from the medial portion of the incision laterally.

What are the two common methods of incision closure today?

Sutures & Super Adhesives

What problem can arise in removing edema from the facial tissues or hands?

The skin may become very wrinkled. Tissue preservation must alway be the first concern. The use of an electric spatula may also be used to remove wrinkled eyelids.

Direction of suture: Autopsies (Trunk Standard "Y" incision)

Use bridge sutures to align the skin into position. Begin the trunk suturing at the pubic symphysis and suture superiorly.

Individual Bridge Suture

Used to align tissues into position prior to, during, or after embalming. They are temporary and are later replaced by more permanent sutures.

Continuous Suture

Used to close long incisions. Frequently used by the autopsy technician to close long incisions from the autopsy. The suture prevents leakage of fluids from the body cavities during transfer from the hospital to the funeral home.

Inversion Suture

Used to gather in and turn under excess tissues. The pattern of this suture is the same as that of the single intradermal suture, except that the stitches are made parallel to the incision edges and do not pierce the margins of the incision. The stitches are generally made as close to the markings as possible.

Why should one pull on the thread and not the needle when tightening the suture.

When suturing, one should pull on the thread and not on the needle to tighten the suture. Pulling on the needle weakens the suture cord where it passes through the needles eye. In closing long sutures, as in autopsies, this may cause the cord to break.