EMBALMING 2 FINAL

The "Heart Tap"

- A direct method of inserting a trocar into the right ventricle to release exiting fluids. - If not done properly, damage to the heart will result and multi-point injection will take place as the heart, and arteries supplying embalming solution to the tissues have been damaged.

Basket Weave Suture

- A restorative suture that consists of forming a mesh over an area to serve as a base for wax filling. - BY itself, the basket-weave is not leak proof, but serves the purpose of support. Some embalmers will apply a sealing agent, or mortuary mastic over the area to make it leak proof.

Whip-Stitch

- A temporary suture that functions to get separated tissue to meet while preservative injection is taking place. - Not a leak proof stitch, and NOT ideal for long term restoration.

Bridge Suture

- A temporary suture that functions to get separated tissue to meet while preservative injection is taking place. Less invasive than the whip-stitch. - Not a leak proof stitch, and NOT ideal for long term restoration

Extravascular resistance

- Anything outside the vessels that impedes the flow of fluid within the vascular system. Includes rigor mortis, gas, viscera, tumors, fluid in the tissues (edema), contact pressure, visceral weight, bandages, "skeletal edema" (edema in the extremities).

Intravascular resistance

- Anything within the vessels that impedes the flow of fluid within the vascular system. - Includes plaque, platelets, bodily fluids, and dried blood.

Lacerations

- Are deeper than abrasions and is a jagged tear in the skin. - For deeper lacerations, a "Bridge suture" may be used to adjoin the edges of separated tissue; if there are lacerations in the face, a finer needle and ligature (even dental floss) may be used to keep the tissue edges together so when the arterial solution is injected, the tissues will fixate in place and there is less of a struggle to close separated, fixated tissue. - A "bridge suture" is not a leak-proof suture and only serves as a temporary suture for tissues to meet together.

Abrasions

- Are surfaces where skin has been removed, and can be characterized as dry or moist. - Seal abrasions after the arterial injection.

Surface Embalming

- Can be accomplished by use of autopsy gel, cauterizing agent, or cavity fluid. - Autopsy gel provides fewer fumes & is ideal for areas that are less decomposed. - A good rule of thumb is, if can detect foul odor, use a stronger preservative. - ALWAYS USE PLASTIC WRAP and place over the preservative pack to keep the substance from evaporating so quickly. You want the preservative to linger as long as possible in contact with the area.

Needle injector

A method of mouth closure using wires with a barbed tip (called injector needles) in which they are inserted using a device called a "needle injector". This devices forces the barbed injector needles into both upper and lower jaws (respectively the maxilla and mandible). - The jaws are positioned after the wires are embedded. - The embalmer maintains the position of the jaws, then proceeds to twist the wires together and trims the long ends.

Trocar Button

A plastic, tack-like device that has a circular head and a pointed, threaded end that is inserted into a trocar incision and twisted in a circular motion using an instrument called a "trocar-button applicator". This action is similar to a screw and a screwdriver.

Worm suture

Almost identical to the Hidden suture.

N-Stitch (z-stitch)

Alternative to the purse-string, leak proof, ONLY EFFECTIVE for circular incisions.

Increase Blood Viscosity

Blood thickens further and becomes "sludge-like".

Leakage

Caused by gases or edematous fluid displacement through pores. Clean the remains and place in plastic garments with paraformaldehyde or absorbent.

Odor

Caused by gases, early signs of decomposition. Re-embalm as needed.

Decomposition

Decaying state characterized by intense color change, odor, and distension amongst other unfavorable changes.

Intermittent drainage

Drainage is closed as injection is open, and then drainage is opened for a time then closed.

Alternate drainage

Drainage is open as injection is closed, and when drainage ceases, injection is opened and drainage is closed, then vice versa.

Tissue softening

Due to inadequate preservation , or decomposition; re-embalm if necessary.

Signs of arterial diffusion

Dye in the tissues, firming of tissues, loss of skin elasticity, drying of tissues, the rounding of fingertips, lips and toes, the bleaching of tissues, and finally fluorescent dye observed using a black light.

Postmortem Stain

Extravascular discoloration that is constant even when pressure is applied to the area, and will not completely be removed by arterial injection.

Ecchymosis and purpura

Extravascular discolorations that cannot be removed at all and must be hypodermically bleached by using a syringe & needle filled with a bleaching agent (usually a cauterant).

Tissue gas

Gas buildup within tissue ; Usually requires re-embalming as condition will get progressively worse and spread throughout body; also implement hypodermic AND surface preservation.

Gluing the mouth

Ideal for infants and small children, not for adults due to the mass of the jaws.

Purse-string Suture

Leak proof, ONLY EFFECTIVE for circular incisions

Inter-locking Stitch

Leak proof, but VERY unsightly.

Baseball Stitch

Leak proof, but unsightly.

Femoral veins

Located along the femoral artery and external iliac arteries.

Axillary veins

Located in both shoulder areas.

Common carotids

Located in the cervical area.

Axillary

Located in the shoulder/"arm-pit" area (under-arm)

Femoral

Located in the top, inner thigh area of the leg.

Subclavian

Located in the upper chest below the clavicle.

Brachial

Located on the lateral interior (inner-side) side of the bicep belly.

Basilic veins

Located parallel to the brachial arteries.

External iliac

Located past the inguinal ligament, high in the origin of the thigh

Hidden Suture (Single-Intradermal)

Not leak proof, IDEAL for restoration.

PPE

PERSONAL PROTECTIVE EQUIPMENT must always be worn to minimize hazards

CHAPTERS 16-25

READ OVER OUTLINES!

Ventilation

Removes the fumes from the preservative chemicals from the embalming room.

Jugular veins

Runs along the carotid.

Dehydration

The loss of moisture due to very strong embalming solution, or due to atmospheric conditions (i.e. gusting air condition vent). Solution: Use a liberal amount of emollient and remove with rubbing alcohol prior to dressing & casketing.

Dehydration

The loss of moisture; Blood thickens during this time.

Lymph system

The lymph system receives fluid in the tissue and empties into the veins.

Diffusion

The net movement of substances based on concentration differences. The flow is from high to low concentration.

Ideal pressure

The pressure needed to overcome vascular resistance and distribute to all body areas.

Mouth Closure

The raising and holding the lower jaw into position.

Restricted cervical injection

The right and left common carotids are used for injection. - ACTUAL TECHNIQUE: You raise the right and left common carotids, inject down to ward the heart through the right common carotid artery, tie-off (ligate) the lower portion of the left common carotid and snip ¼" - ½" inch above the ligated piece. - This allows solution to reach the areas below the neck, and for the embalmer to inject the head separately (insert the arterial tube into the head and inject both sides).

The center of venous drainage

The right atrium of the heart.

Post-mortem caloricity

The rise in body temperature due to cellular metabolism by microbes.

UNIVERSAL PRECAUTIONS

The safe assumption that ALL bodies and their bodily fluids are possibly contaminated with pathogens (disease-causing microbes) and you take every precaution to minimize unsafe contact.

Hypostasis

The settling of blood and/or other fluids to lower portions of the body.

Rigor Mortis

The stiffening of the body muscles by natural processes.

Split injection/drainage

Two sites are used, one for injection and another for drainage.

Cranial Aspiration

Using an infant trocar, the brain is accessible by inserting the trocar through the nostril and breaking through the softer bone of the skull in a portion called the CRIBRIFORM PLATE. - This can be done if "brain purge" is observed.

Dental tie

Using suture to close the mouth by tying ligature to teeth-not very secure, but an option for mouth closure none-the-less.

Signs of arterial distribution

Visibility of arterial dye in body areas, distension of superficial vessels, blood drainage, leakage from i.v. punctures, and clearing of blood discoloration.

Common iliac

located in the lower abdominal area, superior to the inguinal ligament.

Resistance

esistance is necessary when trying to facilitate arterial fluid into the extra vascular spaces. - The absence of resistance would result in fluids flowing through the vascular system without leaching into the extravascular spaces, whereas the other extreme would be great resistance, where fluid is not passing through the vessel and is directed into the extravascular spaces. - The ideal resistance is called "Moveable resistance" where arterial travels through the vascular system and also leaches into the extravascular spaces.

Plastic mouth formers

- Can be used as a substitute for natural teeth or dentures by giving both support and curvature to the mouth. - This prevents the "sunken mouth" appearance in the cases of people with missing teeth. For those that had missing teeth for several years or never wore dentures, it may not be necessary to build the mouth. View photos if available or ask the NOK by opening the conversation with "Did your loved one have dentures that you would want us to use?". Many times families will bring up the topic of the dentures if the decedent ALWAYS wore dentures in life- "DON'T FORGET THE DENTURES".

Sealing the surgical incisions (stoma) of these tubes

- If the incision is circular, utilize a purse-string suture, or a trocar button. Remember, if a trocar button is applied, and there is little resistance as it is turned, that indicates that internal fluid could leak out - so use a purse-string suture. - In the case of scar tissue surrounding the stoma, apply a purse string suture to bunch the tissue as close together as possible, and if a gap remains, insert a trocar button. - Incision sealer is ideal to use, however, the stoma may be so small that it cannot be inserted. In such cases, you may spray a cauterizing agent into the area, close the stoma, and place a sealing agent (glue) with absorbent cotton on top. - If the incision is linear or oblong, a baseball suture will suffice instead of the purse-string.

Injection

- Insertion of arterial solution at a set rate of flow and pressure from the machine. - You ALWAYS inject into the arteries.

Livor Mortis

- Intracellular discoloration that can physically be observed to clear when pressure is applied to the area. - Removal of livor mortis is usually accomplished with arterial injection.

Pacemakers

- MUST be removed if the body is to be CREMATED. This is due to the fact that a pacemaker can discharge and ruin the crematory tort. - This is done by making an incision above the pacemaker, separating the tissue, snipping the wire leads, pulling out the device, then suturing the incision after placing incision sealing powder into the area. - These medical devices may be returned to medical supply companies, or biohazard waste companies for disposal. Contact these companies in your area.

Embalming Authorization

- Prior to embalming, authorization from the NOK must be obtained. IF given verbally, documentation should be done indicating the NOK name, date, and time permission was granted. It would still be ideal to obtain written permission from the NOK once they arrive to make arrangements at the funeral home. - The FTC states that it is illegal to tell families that embalming must be done according to state law, when in fact no law exists. - The NOK/Family must be given alternatives to embalming, such as refrigeration. - It is illegal to guarantee that an embalming will last for a specified amount of time; rather, the funeral home may only tell the NOK that the embalming will delay decomposition until disposition has been completed-this is reasonable.

Tubes, Catheters, and Drains

- Remove these prior to embalming if they are in the facial area as they can leave indentions during the arterial injection (Recall that formaldehyde fixates tissues, and skin can act similar to clay or wax in this sense). - Monitor for swelling in the face - If you see this happening, it could be the case that since the blood coagulated in death, it is not freely running through the tubing-remove the tubing. - If distribution of arterial fluid is hampered, it could be due to the fact that the tubing is blocking the draining of blood and arterial fluid is being backed up.

Algor Mortis

- The cooling of the body to the surrounding temperature. - The slow onset of rigor mortis , decomposition; Blood is still in liquid state.

Differential pressure

- The drop in pressure when the flow of the embalming machine is opened. - Initially, when the rate of flow is closed, pressure easily builds as no fluid is emitted, yet, when the flow is opened and fluid is released, the pressure drops.

Nasal Tube Aspirator

- The embalming instrument designed to aspirate the throat via the nostrils. - Designed for aspiration of the nasal and oral/pharyngeal cavities.

Diffusion

- The embalming solution in the capillaries, in the cells and the tissues. - When fluid travels from the internal to the external areas (skin surfaces) you are Witnessing the diffusion of the embalming arterial solution. - Tissue space > tissue fluid*(crossroads into cell or lymph system)> cell > protoplasm > embalmed tissue

Distribution

- The embalming solution through the vascular system (network). - Artery > aortic semilunar valve > arch of the aorta > arterial system > arteriole>capillary( crossroads into tissue space and venule)

Drainage

- The fluids exiting the vein (includes bodily fluids and embalming fluid). -This is sometimes referred to as "the return" when the embalming fluid you injected is exiting the vein. - You ALWAYS drain out from the veins. - Venule > veins > venous system > drainage instrument /external environment

3/8" Needles

- These are smaller, less thick needles that are ideal for restoration. They are less invasive and minimize the disturbance of surrounding tissue . - Use these needle when suturing tissue in a viewable area.

Identification of Remains

- Visually check the identification of remains prior to embalming. If there is a discrepancy alert management or do what is necessary to verify the remains. - If possible, note any issue as well as resolution of identification on the embalming case report.

Hypodermic Embalming

- When preserving large areas of tissue, a hypovalve trocar is used. - When preserving portions of the face or hands (visible areas), a needle-syringe filled with preservative fluid is used to offer the embalmer better control & the minimal invasion of viewable areas.

ACCESSORY CHEMICALS (FLUIDS USED IN ADDITION TO VASCULAR AND CAVITY EMBALMING)

1). Autopsy Gels - A low index gel preservative used in topical application. 2). Powders A). Paraformaldehyde - Sometimes called "hardening compound" it is formaldehyde in solid form. B). Incision Sealer - Contains amounts of preservative powder and a liquid absorbing powder as well. 3). Cauterizing Agents - Mostly phenol that dry, preserve and bleach quickly and superficially. 4). Sealing Agents - Any glue 5). Mastics - Any moldable clay, wax or putty substance. 6). Tissue Builder - AKA "Feature Builder" is a liquid that gels and builds up skin for restorative effect.

CAVITY FLUID (CONCENTRATED PRESERVATIVE CHEMICAL)

1). Cavity Fluids - Dye-less, high preservative concentration fluids that penetrate and preserve tissues.

SPECIAL PURPOSE FLUIDS (FLUIDS FOR SPECIAL BODY CONDITIONS)

1). Jaundice Fluids - Used for jaundice cases and typically have a low preservative index and higher dye content. 2). "Difficult Cases" - Used for delayed embalming cases and have high preservative index and other additives. 3). Edema Elimination Fluids - A non-preservative that aims to remove excess water from tissues.

SUPPLEMENTAL FLUID( FLUIDS FOR PURPOSES OTHER THAN PRESERVATION AND DISINFECTION)

1). Pre-injection - *A non-preservative fluid injected before the preservative embalming solution. 2). Co-injection - *A non-preservative mixed with the preservative embalming solution. 3). Water Corrective - Minimizes the interference from minerals found in tap water.

ARTERIAL FLUIDS(PRE-PACKAGED 16 oz. BOTTLES THAT ARE USED IN EMBALMING SOLUTION PREPARATION)

1). Preservatives - Formaldehyde and or glutaraldehyde containing fluids 2). Disinfectants - Germicidal, anti-microbial fluids 3). Dyes- Coloring agents 4). Vehicles -The major solvent that a compound is dissolved in 5). Perfuming Agents- Odor control fluids 6). Modifying Agents -A generic term for chemicals that "enhance" or "improve" other chemicals. A). Buffers- Adjust pH and keeps a solution from being too acidic or too basic. B). Anticoagulants - Aims to dissolve clots and/or remove clots C). Surfactants -Allows a compound to absorb deeper into tissues D). Humectants - Promotes water retention in tissue and discourage dehydration.

Continuous drainage

Injection and drainage are both "open" and taking place.

Multi-point injection

Injection at two or more sites.

Six-point injection

Injection of both carotids, any two arteries that reach the arms, and any two arteries that reach the legs.

The 9 Region Method

Is an organized method of using linear guides to section the torso into 9 divisions allowing for the embalmer to know which organs are accessible at certain areas during the aspiration process of cavity embalming. - *Know the abbreviations: H,U, E, RI, RL, RH, LI, LL, & RH as well as the organs that are accessible in these regions

Post-mortem Stain AKA "PM Stain"

Is the extravascular color stain.

Livor Mortis AKA "CADAVERIC LIVITY"

Is the intravascular red-blue discoloration resulting from hypostasis of blood.

Osmosis

Simple movement of solvent through a semipermeable membrane based on concentration differences between solvent and solute. The flow is from high to low concentration.

Double-Intradermal Stitch

Somewhat leak proof, IDEAL for restoration, requires more coordination and skill as two needles and ligature strands are needed.

Translocation of Microbes

Speeds up decomposition in various body regions.

Embalming Analysis AKA "Case Analysis"

That consideration given to the dead body prior to, during, and after the embalming procedure is completed. Documentation is recommended.

Adsorption

The adhesion of molecules to the surface of cells.

Flow

The amount of solution (volume) being emitted.

The center of arterial solution distribution

The arch of the aorta.

Double-Curved Autopsy Needle

The are larger, thicker needles ideal to suturing embalming incisions in areas that will not be viewed. They offer the embalmer better control while suturing.

Cavity Fluid

The concentrated embalming chemicals which are injected into the cavities of the body following aspiration in cavity embalming, These fluids can be used for surface and hypodermic embalming of the problem areas.

Cavity Embalming

The direct treatment other than arterial injection of the contents of the body cavities and lumina of the hollow viscera; usually accomplished by aspiration & injection of chemicals using a trocar.

Drill and wire

The drilling of holes into both the maxilla and mandible then running wire through to maintain secure mouth closure-this is useful when there jaw(s) is fractured.

Gravitation

The filtration done under the influence of gravity.

Ideal rate of flow

The flow rate needed to achieve uniform distribution without distension of the tissues.

Pressure

The force with which the amount of solution is being forced out.

Tissue fixation

The higher the concentration of the preservative solution, the more intense the firming (and dehydration will be) - Use a topical emollient to minimize dehydration of tissues that will be visible.

One-point injection

The injection and drainage from one site (a "site" is the incision you make to raise vessels").

Dialysis

The travel of crystalloids (small solutes) through a semi-permeable membrane that blocks colloids (large solutes). Essentially, the passage of smaller solutes instead of larger solutes.

Lip closure

The union and holding together in place of the two mucous membranes.

Mandibular suture

The use of a suturing needle and ligature for the purpose of securing the jaws in place by making a loop through the base of the mouth and around the nasal septum.

Muscular Suture

The use of a suturing needle and ligature for the purpose of securing the jaws in place by making a loop through the mucous membrane tissue of both the mandible and maxilla while also including the nasal septum

Filtration

The use of external pressure to force arterial solution from the capillaries into tissue fluid.

Aspiration

The withdrawal of gas, fluids, and semi-solids from body cavities & hollow viscera by means of suction with an aspirator & a trocar.

Skin slip, pustules, and ulcers

These may be treated at the end of arterial injection. - An embalmer may use autopsy gel, a cauterizing agent, or cavity fluid depending on the severity of the area. - Remember, it is better to have an odor of chemical than an odor of decomposition.

Purge

This is leakage through the mouth and/or nose that may be due to gas buildup. Solution: Re-aspirate ALL cavities and re-embalm if this is due to decomposition.