Embalming Theory Ch. 24-25 Study Guide

True Tissue Gas

-Anaerobic bacteria (gas gangrene) -Clostridium Perfringens

Pressure causing purge can develop in several ways...

-Gas -Visceral Expansion -Arterial Solution -Ascites and Hydrothorax

Ecchymosis Treatment

-Hypodermically treat areas. -Left untreated, they will turn black. -Use a phenol cautery solution or cavity fluid; this will bleach tissues and ensure good preservation.

The 2 Categories of Blunt Force Facial Trauma

1. Injuries in which the skin is broken (abrasion, laceration) 2. Injuries in which the skin is not broken (contusion, hematoma)

Broken Skin

Abrasion Laceration Incision Compound Fracture

Benign OR Progressive

Acute Disseminated Histoplasmosis

Dessication

An over drying of tissue that causes dehydration or a leathery appearance to the remains.

May be Fatal

Chronic Disseminated Histoplasmosis

Progressive

Chronic Pulmonary Histoplasmosis

Facial Trauma Goal

Maximize tissue preservation with a minimum amount of swelling.

Subcutaneous Emphysema Treatment Options

-Allow gas to escape through incisions -Establish good arterial preservation -Channeling of tissues after arterial injection to release gases

Gas Gangrene

-Anaerobic -Clostridum Perfringens -Foul odor & infection -Strong solutions needed -Localized injection of cavity fluid

Predisposing Conditions to Purge

-Decomp -Delay between death & embalming -Hydrothorax/Ascites -Peritonitis -Bloodstream infections -Esophageal Varices -Drowning/Asphyxia -Tissue Gas -Warm Environment -Recent abdominal, thoracic, or cranial surgery.

Mycotic Infections

-Fungal infections that may have been present as an antemortem condition or occurred as the result of a PM invasion. -Fungi may be Saprophytic or Parasitic.

Esophageal Varices

-Mouth/Nose -Bloody liquid -Arterial solution -Blood

Lung Purge

-Mouth/Nose -Frothy -Blood remains red -Little Odor -Respiratory tract liquids -Residual air from lungs -Blood/arterial solution -Pre/Post Embalming

Conditions Predisposing to Tissue Gas

-Recent abdominal surgery -Presence of gangrene at time of death -Intestinal perforations or ulcerations -Contaminated skin wounds or punctures -Intestinal obstruction or hemorrhage -Unsatisfactory embalming -Contact with contaminated instruments

Brain Purge

-Skull fracture -Nose fracture -Fractured ethmoid -Fractured ear -Temporal bone -Surgical opening -White semisolid -Brain tissue, blood, arterial solution

Treatment for Tissue Gas

-Special tissue gas arterial solutions -Localized hypodermic injection of cavity fluid -Channeling of tissue to facilitate gas removal

Instant Tissue Fixation ("Head Freeze")

-Use a strong arterial fluid. -Pressure gauge 20 psi or higher. -Inject left common carotid. (In the autopsied body, internal carotid may need to be clamped)

Gas Gangrene Incubation Period

1-5 Days

2 Factors Responsible for Decomposition

1. Bacterial Enzymes 2. Autolytic Enzymes

Skin (Not Broken)

Depressed Fractures Swollen Tissues (Hematoma) Ecchymosis Simple Fracture Contusion

100,000, 100

More than ___________ species of fungi are known, of which approximately ______ are human pathogens.

Air Tray

Used for casketed remains, only the bottom is made of wood, top sides and ends are made of heavy grade cardboard.

Zieglar Case

(Liner) A gasket sealed container that can be used as an insert into a casket or a separate shipping container.

Candida albicans

Most common cause of Candidiasis -Causes THRUSH, which affects the oral mucosa and pharynx. -Seen most often in infants/children. -Lesions: white patches on mucosa.

Aspergillosis

-Most species are Saprophytic and Nonpathogenic. -Some found in external auditory canal, nasal sinuses, external genitalia and as secondary invaders in lung abscesses. -Ear: foul moist material spotted with black granules. -Lung: most common site of Series infection. -Characterized by abscesses, necrotic & necrotizing lesions, & sometimes chronic granulomatous inflammation.

Stomach Purge

-Mouth/Nose -Liquid/Semisolid -Coffee grounds -Foul Odor -Stomach contents/Arterial solution -Pre/Post Embalming

Purge

-Postmortem evacuation of any substance from any external body orifice as a result of pressure. -May occur prior to, during, and after embalming.

Chronic Pulmonary Histoplasmosis

-Progressive, forming granulomatous inflammation with caseation necrosis and cavitation. -Frequently misdiagnosed as Pulmonary Tuberculosis, or may occur as secondary complication of TB. -Seen most commonly in otherwise healthy males older than 40 years. -Poor prognosis. -Spreads through blood to other organs.

Subcutaneous Emphysema

-Puncture of the lung or pleural sac (seen after CPR) -Puncture wounds to thorax -Rib fracture -Tracheotomy -No odor, no skin slip, no blebs. -Gas can reach distal points, even toes -Gas can create intense swelling and can rise to higher body parts such as neck and face. -NOT caused by a microbe & does not intensify after death. -Best to remove gas from tissues AFTER body is embalmed.

Signs of Renal Failure

-SALLOW color to skin as a result of UROCHROME buildup. -Uremic pruritus (scratch marks on extremities) -Increase in amount of Urea, Uric acid, Ammonia, & Creatine (Urea and Ammonia can be detected by their odor). -Acidosis -Edema -Anemia -Gastrointestinal bleeding

Positioning of an Obese Body

-Shoulders should be raised High off the table -Body should occupy 3 levels: head is the highest, then chest, then abdomen. -Keeping head high prevents purge. -Keep elbows close to body wall. -Keep head straight and tie feet together. -When body is in casket: tilt the shoulders and head slightly to the right.

Treatment for Decomposition

-Sufficient amounts of the appropriately strong arterial solution must be injected. -Hypodermic & Surface treatments may be indicated. -Channeling to release gases.

Characteristics of True Tissue Gas

-Very strong odor of decomposition -Desquamation; skin blebs -Increase in the intensity and amount of gas -Possible transfer of spore forming bacteria via instruments to other bodies

5 Types of Gases found in the Tissues of a Dead Human Body

1. Subcutaneous Emphysema 2. Air from Embalming Apparatus 3. Gas Gangrene 4. Tissue Gas 5. Decomposition Gas

Combination Case

A transfer container consisting of a particleboard box with a cardboard cover used to ship a remains in place of a casket or air tray.

Asymptomatic OR Symptomatic

Acute Pulmonary Histoplasmosis

Hermetically Sealed

Airtight, impervious to external influence; completely sealed by fusion or soldering.

To Drain Ascites

-Insert trocar or make puncture in the lower left inguinal area of the abdomen (just above inguinal ligament). -Keep trocar just under the abdominal wall (ventral) so you won't pierce any large blood vessels.

Antemortem Subcutaneous Emphysema

-MOST FREQUENTLY encountered gas condition. -Brought about by a puncture or a tear in the pleural sac or the lung tissue. -As the living person gasps for air, more and more air is drawn into the tissues.

Alcoholism

-Many bodies exhibit Jaundice as a result of liver failure. -Liver failure can cause Edema in skeletal tissues or cavities. -Hepatic failure depletes the blood of clotting factors; therefore good drainage can be expected. -Common Carotid & Femoral are good primary injection sites, unless edema is present, then use Restricted Cervical. -Inject at a moderate rate of flow. Purge is common (first bloody, then fluid) -Firming difficult to establish.

Acute Disseminated Histoplasmosis

-May be Benign or Progressive -Acute Progressive Form is rapidly fatal & usually seen in young children or AIDS adults. -Spleen, Lymph Nodes and Liver enlarged. There is a septic type with Anemia and Leukopenia.

Acute Pulmonary Histoplasmosis

-May be asymptomatic or symptomatic. -Basic reaction in lungs & lymph nodes consist of foci of tuberculoid granulomas that tend to heal.

Chronic Disseminated Histoplasmosis

-May occur in elderly & otherwise healthy individuals. -May be fatal. -Clinical features vary according to organ most severely involved. -Involvement of heart valves leads to Endocarditis. -Involvement of Adrenal Glands leads to Addison's Disease. -Other organs that can be affected: GI tract, spleen, liver, lymph nodes, lungs, bone marrow, meninges.

Anal Purge

-Anal orifice -Semisolid/Liquid -Fecal matter/blood/arterial solution

Decomposition

-Bacterial and Autolytic breakdown of body tissues and possible odor, desquamation over time, color changes, and purge.

Histoplasmosis (Reticuloendothelial Cytomycosis)

-Caused by the oval, yeast like organism Histoplasm capsulatum. -Occurs worldwide, but primarily common in Mississippi Valley of the US. -May spread throughout body. -Contracted from soil contaminated with fecal matter of chickens, pigeons, starlings, other birds, bats. -Endemic in many parts of the world, particularily near large rivers, high humidiity warm temperature regions. -Portal of Entry: Lungs -Four Forms: acute pulmonary, chronic pulmonary, acute disseminated, chronic disseminated.

Renal Failure

-Common embalming complication. -It is estimated that 6x more preservative chemical is needed for these bodies.

Candidias (Moniliasis)

-Commonly found in mouth, intestinal tract, vagina of healthy people.

Phycomycosis

-Infection of the Lungs, Ears, Nervous System, Intestinal Tract caused by a fungus commonly encountered as a Saprophyte or a contaminant. -Lesions may display an intense necrotizing and suppurative inflammation process. -Commonly called Mucormycosis, but may be caused by several members of the group Phycomycetes including Mucor, Rhizopus and Absidia. -These fungi invade vessels and cause Thrombosis and Infarction. -Especially seen in patients with uncontrolled Diabetes mellitus, leukemia, AIDS.