Embalming 2: preparation of the autopsied body

general guidelines for autopsy

- any child with evidence of injury without explanation - suspected drug overdose - motor vehicle accidents - death in the workplace - pedestrian accidents - suspected poisoning - unexplained death - prison fatalities - homicide - trauma - SIDS

cranial treatment

- before reflecting the scalp through cream and lubricate the face the 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 - injecting the head using the subclavian arteries will insure distribution to the neck and back of t he head via the vertebral arteries

securing the calvarium

- calvarium clamps - needle injector wires - adhesives (superglue) - wiring b/t drilled holes - suturing through the temporalis muscle

sectional embalming

- common carotid arteries to embalm the face and head - subclavian arteries, the proximal end, to embalm the neck - subclavian arteries, distal end, to embalm the shoulder and upper extremites - axillary arteries to embalm the distal arms and hands - internal iliac arteries to embalm the gluteal, pelvic, and perineal areas - external iliac arteries to embalm the lower extremities and distal parts of the leg

safety and work practice controls for the embalmer

- continuous aspiration - cover broken or cut bones - wash gloved hands frequently - clamp leaking arteries and veins - run water on table continuously at low pressure - be aware of where sharp instruments are laid during embalming

medico-legal autopsy performed when

- death of the mother during an abortion, legal or not - fetal death or death w/in 24 hours of birth - spontaneous abortions and miscarriages - operative and peri-operative death - un-identified or un-claimed body - violent or traumatic death - suspicious death - sudden death - uncertainity

problems with the dorsal spinal autopsy

- disfigurement - discoloration - distension

wiring b/t drilled holes

- drill opposing holes in the calvarium and the temporal bone and wire the calvarium in position - criscross the wires

materials for filling the abdominal cavity

- excelsior - cedar chips - clean sheets - clean sawdust - padding and upholstery

after the calvarium is secure

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

notes on replacing the calvarium

- in a proper autopsy there are notches in the area of the temporal bone - these notches keep the calvarium from moving - if the notches are not present, extra care must be taken to secure the calvarium

types of autopsy

- medical (hospital) autopsy - medico-legal (forensic) autopsy - contract autopsy (private autopsy) - complete or partial autopsy

medical, hospital autopsy 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 abut heredity disease - environmental or work place hazards - new or unusual or experimental treatment - death not under the jurisdiction of the medical examiner

packing and ligation or orifices

- pack the vagina - ligate the rectum - ligate the trachea - pack the nose, mouth, and trachea - pack the neck area to conform to natural contours - a cavity pack in the mouth is crucial if the tongue is missing

general recommendations for autopsy

- preparation of autopsied bodies are usually delayed - use a stronger than average arterial so lution - use plenty of active dye - embalm the head slowly, avoid distention

spinal autopsy, dorsal removal

- removal of the spine from an incision made on the back - the body is placed in a prone position for ventral removal - the incision on the back presents the potential for leakage - the incision must be tightly sutured - coveralls are recommended

spinal autopsy, ventral removal

- removal of the spine from the normal autopsy incision, through the front - this type of removal should present no additional problems for the embalming

calvarium clamps

- several varieties are available - this is the most method of attachment - small notches must be made to prevent a gap from forming

suturing through the temporalis muscle

- suture through the 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

exploratory or partial autopsy

- the removal of a single organ, or sometimes multiple organs, from the body organs that may be removed: - brain - heart - lungs - kidneys - stomach - the embalmer must use their knowledge of anatomy to develop a custom for this type of autopsy

needle injector wires

- use four wires - 2 wires on each side - 2 attached to the calvarium - 2 attached to the temporal bone - the wires should be crisscrossed

things to remember

- using a hypo-valve trocar, thoroughly inject all areas that appear un-treated to maintain air quality in the prep room: - if viscera are treated with cavity fluid during the embalming make sure the container has a tight fitting lid - viscera must be stripped or sectional, especially if not bag is removed - continuously aspirate all drainage during injection - when suturing pull on the thread not the needle

recommended methods for closing the cranial incision

- whip stitch - worm suture - intradermal suture - surgical adhesives - baseball suture - worm sutures and intradermal sutures for those who have bald heads

after arterial injection of the heads

be sure to clean and dry the interior of the cranium, and cover the base of the skull with quick drying sealer

complete autopsy:

includes the removal of: cranial cavity and its contents: - removal of the brain - removal of the pituitary gland - possible removal of the temporal bone and iner ear removal of the organs and glands of the neck: - thyroid gland, larynx, esophagus, trachea - possible removal of carotid arteries - possible removal of the tongue thoracic cavity and its contents abdominal cavity and tis contents pelvic cavity and its contents possible removal of the spinal cord may include eye enucleation

before closing the incision

replace and secure the sternum and costal cartilage

treatment of viscera

the embalming report should note the treatment and disposition of viscera: - was the viscera present - was the viscera stripped or sectioned - did u return the viscera to the body - was the viscera treated with fluid or powder or both - was the visceral placed in separate or bag outside the body - it may appear easier to "find room" for the viscera, if fluid is not added until the bag is in position - if the viscera is not present what was used to fill the body - the materials you use to fill the body cavity should not be mistaken for refuse or trash

adhesives

use superglue to help hold the calvarium in position

autopsy, necropsy, port-mortem

words used to describe examination of the body after deat

suggested order for preparation

1. primary disinfection of the body 2. position of the body using block and bridges as needed 3. open the cavities and remove all viscera 4. decide on treatment method for viscera 5. 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 6. prepare arterial solution according to proper analysis: - cause of death - size and weight of body - moisture content, or lack of moisture - time interval b/t death and preparation 7. begin sectional embalming: - legs - arms - head; left side first 8. supplemental hypodermic injections: - trunk and ribs - shoulders and neck - buttocks and perineal area 9. drain all liquids from body cavities 10. treat all internal surfaces with hardening compound or gel 11. return visceral, in sections or in bag 12. suture thoracic and abdominal cavities 13. dry cranial and treat with powder or gel 14. suture the scalp 15. perform terminal disinfection 16. glue thoracic and abdominal incisions 17. cress in coveralls or union-alls