FSE2140 Embalming II Chapter Test 21-25 Study Guide

Gas Gangrene

-*Ante-mortem* condition which allows the bacteria to migrate after death. -Caused most commonly by the bacterium *clostridium perfringens*. -Foul odor -Usually found with wounds from outside activities -May spread after embalming

Treatments for edematous cases:

-*Continuous drainage* -High-index special drying fluid -*Adding* epsom salts to the arterial solution to make it hyp*er*tonic -High concentration of Vegetable humectant -Channeling the neck to drain

Responsibilities of the *receiving* funeral home when receiving a ship in:

-*Inspect remains* and report to shipping funeral home -Restorative and cosmetic treatments, dressing

Effects of antibiotics:

-*Membrane permeability is reduced* -Chelating of metallic ions of calcium and magnesium on the outside of cell membranes, thus *reducing ability of fluid able to enter/exit the cell*. *This combination increases the build up of nitrogenous wastes in the body*. To overcome that, you should increase the index, *add supplemental chemicals: surfactants, buffers*.

Diabetes considerations:

-*Poor peripheral circulation* = intermittent drainage + high pressures to promote distribution -Arteriosclerosis -Increase *bacterial and mycotic infections* = *thorough* cavity treatment especially of the lungs -Abnormal pH values = strong solution strength + co-injection fluid + dyes -(Dry) Gangrenous areas = hypodermic injection of cavity fluid -Decubitus ulcers (bed sores) -Strong/high index solutions -Possible multisite injection on distal areas

Tissue gas

-*Post-mortem* condition which may have started out as gas gangrene. -Caused by *C. Perfringens*. -*Blebs* on the surface areas of the dependent parts of the body. -May be spread by instruments because they are very resistant to disinfectants.

Sources of *extra*vascular resistances:

-*Rigor mortis* - should be broken before embalming -*Ascites* - relieved with a trocar during embalming -*Gas in intestines* - relieved with a trocar -*Bandages* - removed before embalming -*Tumors* - remove (with permission) only if it affects distribution -*Visceral weight* - may need to inject above and below the site of visceral weight

Shipping a *casketed* body:

-*Secure* in casket with padding (there are no straps) -Lower bed to lowest position -Place plastics as to prevent leakage -Cover head and hands to prevent make-up damage -Do *NOT completely* tighten the lid (the body will expand at 30 thousand feet if the casket is pressurized) -Place casket in air tray

Factors that increase moisture content (edema):

-Alcoholism -Burns -Cirrhosis of liver -Carbon monoxide poisoning -Congestive heart failure -Allergic reactions -Drug Therapy -Renal failure -Trauma -Lymphatic obstruction -Steroid therapy -Phlebitis -Hepatic failure -Transplant procedures

Preventing postembalming purge:

-Aspirate and inject 3 bottles of cavity fluid -Inject additional bottles in obese -Re-aspirate!! -Remove moist cotton if used -Pack throat and nose -Aspirate cranium -Tie off the trachea

Embalming procedures to maintain a good balance of moisture:

-Avoid hyp*er*tonic solutions -Avoid concurrent drainage -Avoid rapid injection -Delay aspiration -Avoid old or fast acting fluids -Use non-absorbent cotton -Avoid warm water -Use massage cream -Pack the throat and nose -Cover the body after embalming

Decomposition gas

-Caused by bacterial and autolytic enzymes (normal flora) -Gas ceases when the tissues are properly embalmed -These gases are responsible for the odor of decomposition -Can be removed with cavity aspiration and postembalming channeling of the tissues

Problems associated with dehydration:

-Darkening of tissues -Flaking or peeling of skin -Desiccated lips, eyelids and finger tips -Thickened blood

The pressure responsible for purge can develop from (4):

-Gas -Visceral expansion -Arterial solution -Ascites and hydrothorax

Anatomical Embalming:

-Large volume of solution (4-9 gal) -NO ASPIRATION! -Some permit drainage others do not- anatomical board provides instructions -*Major problems*: 1. Mold 2. Desiccation

Storage for Delayed Viewing:

-Lay on plastic with body blocks- reduce contact points -Chemical wetting agent of mold retardant and humectants -Store in cool area -Check on remains regularly

Embalming precautions for radioactive cases:

-Less exposure = *distance* from body whenever practical -Continuous flow of water -Proper terminal disinfection -PPE's plus use of rubber gloves and apron

Chemotherapy concerns:

-Liver problems - filters toxins -Kidney problems - filters toxins -Skin problems -Circulatory system

Effects of tranquilizers and recreational drugs:

-Loss of weight and protein -Liver problems -Kidney problems -Low firming expected *A higher index solution and buffers should be used*.

Responsibilities of the *shipping* funeral home when preparing for ship out:

-Removal -Embalm *for extended period of time* -Legal documents including embalming report -*Communication of Problems w/ receiving FH*: 1. Leakage 2. Poor embalming

Embalming considerations for *delayed* viewing:

-Restricted cervical injection -Intermittent or restricted drainage -Delayed aspiration and cavity treatment after arterial injection -Reduce body surface contact (body blocks) -Hypodermically treat areas of blood discoloration -Apply massage cream -Spray mold inhibitor -Do not store in closed environment (have good air flow) -Inspect remains regularly

Re-Embalming:

-Six point if needed (can use same injection site as first injection) -Waterless (arterial fluid + humectant if they are dehydrated) -May also include hypodermic injection -Supplemental chemicals 1. Humectants 2. Mold retardant

Types of gases that may be found in the tissues of the dead human body:

-Subcutaneous emphysema -Tissue gas -Gas gangrene -Decomposition -Air from embalming machine (rare)

Considerations for cases dead from renal failure:

-Toxic wastes in blood = increases formaldehyde demand. -Sallow color of the skin (yellowish bronze) -Acidosis (excess sugar in the blood) -Gastric ulcerations -Ecchymoses

Embalming treatments for dehydration:

-Use moderate arterial solution 1.5-2.0% -Use an equal amount of co-injection fluids -Use a humectant -Use a large volume of solution (at a slow rate of injection) -Use alternate drainage or intermittent -Avoid *excessive* massage of visual areas -*Apply massage cream*

Classifications of edema:

1. Cellular (Solid) Edema- moisture inside the cell 2. Int*er*cellular (Pitting/Skeletal)- moisture in the skeletal tissue

When can standard embalming procedures be performed on a radioactive case? (*un*autopsied)

30 mCi or below

How many grams of formaldehyde is needed per every 100 grams of protein?

4.4

When can standard embalming procedures be performed on a radioactive case? (autopsied)

5 mCi or below

The average (adult) human body is what percent water?

55-65%

Sources of purge- Anus:

Semisolid liquid

What should be done with radioactive waste materials?

A *certified* radioactive wastes specialist should be contacted for disposal.

That amount of radioactive material in which 37 million atoms disintegrate each second is known as:

A millicurie (mCi)

What kind of solution should you use for a person with severe arteriosclerosis and why?

A stronger solution (high index fluid) with co-injection fluids (surfactants) and dye, because there may be little distribution, so what little bit does get distributed should be enough to meet the formaldehyde demand.

When dealing with pathological conditions, what should be done with the embalming solution?

Additional embalming fluid should be added to the embalming solution.

Which adductor muscle is part of the femoral triangle?

Adductor *longus*

Generalized edema:

Anasarca

What kind of edema would be treated with a hyp*er*tonic solution (verses a trocar)?

Anasarca (generalized edema of the skeletal tissues) Edema in the cavities can be treated with a trocar.

Abdominal edema:

Ascites

Methods of gas removal:

Aspiration with a trocar or needle.

What is the most effective way to remove gas?

Channeling and/or lancing of the tissues.

Radioactive isotopes:

Cobalt 60 Iodine 131 Phosphorous 32 Radium 226 Gold 198 Strontium 89

Sources of purge- Embalming solution Cavity solution

Color of embalming solution injected- as long as there is distribution and no swelling, continue injecting / color of cavity fluid- pack throat

What is the best injection/drainage site for a person dead from congestive heart failure?

Common carotids, internal jugular

The source of infections:

Spores

The term used to describe the condition of having a more than 10% increase in total moisture content.

Edema

How does *localized* edema affect embalming solution?

Edema of the cavities does not affect the solution.

What are the 3 conditions associated with moisture content?

Edematous, dehydrated, & "normal" - which is the goal.

What artery is best to use when embalming the lower extremities of an obese person with extreme visceral weight?

External iliacs

What is the recommended treatment for a person dead from a febrile disease?

Febrile (fever) diseases causes a person to become very dehydrated so a *large volume of solution will be necessary*.

What chemical is responsible for the majority of tissue moisture reduction?

Formaldehyde

Sources of purge- Lungs:

Frothy with little odor.

The product you would use to treat mycotic infections:

Fungicide

What is created when ammonia and formaldehyde mix and formaldehyde is neutralized?

Hexamethylene/urotropin (and water)

What kind of arterial *fluid* should be used to treat an edematous case?

High index arterial fluid.

Edema of the scrotum:

Hydrocele

Edema of the head:

Hydrocephalus

Edema of the sack surrounding the heart:

Hydropericardium

Edema of the chest:

Hydrothorax

What type of *solution* would you use for an edematous case?

Hyp*er*tonic

What kind of embalming solution is used for edematous cases?

Hyp*er*tonic solutions

Order of progression of discolorations:

Hypostasis, livor mortis, postmortem stain, formaldehyde grey.

What rate of flow should be used to embalm a body with arteriosclerosis?

Injection should start with a slow rate of flow then can be increased when distribution has been established.

What are the 3 layers of arteries?

Intima (inner) Media (middle) Adventitia (outer) Lumen (opening or cavity of the artery)

How do nephrotoxic changes affect the body?

It enhances the nitrogenous waste products (ammonia) which neutralizes formaldehyde and turns it into hexamethylene (urotropin) which promotes decomposition.

What should be done with potentially radioactive laundry?

It should be set aside in a bag for several weeks and then laundered.

Subcutaneous emphysema

Most frequently encountered, caused by antemortem SCE. -Result of lung puncture/CPR - breaking of ribs/ puncture the lungs. -Best to remove trapped air *after* embalming. -*Can be removed by channeling*. -*No odor, skin-slip or blebs*. -This condition is *not* caused by a microbe & does not continue to intensify after death. -Moves to dependent areas such as the neck and face.

What kind of person is likely to be affected by arteriosclerosis?

Most likely after 30 years of age.

What is the recommended method of injection for persons dead from cerebrovascular accidents (strokes)?

Multisite injection.

How do you correct cellular (solid) edema?

Only by excision or channeling of tissues.

Evacuation of any substance from any orifice as a result from pressure:

Purge

What is the recommended injection method for second degree burns?

Restricted cervical injection

What is the recommended method of injection for an edematous case?

Restricted cervical injection.

What should you not say is an advantage of having a casket?

That the casket will preserve the body longer.

What does the consumer have a right to expect from an embalming?

That the preservation *will last* until the time of disposition.

What kind of precautions should be given to the family of a chemotherapeutically treated body (if cremated)?

The ashes should not be scattered because they may be radioactive and could be ingested.

How might you be able to tell that a person died as a result of a cerebrovascular accident (stroke)?

The body might shows signs of one side receiving more fluid than the other. One side of the body went into vaso*dilation* and the other went into vaso*constriction*. Multi-site injection is recommended for the constricted side.

How would you treat dry gangrene of the finger tips?

The fingertips are hard to embalm hypodermically, so they would be treated with a *surface pack*.

If a delayed viewing body starts to form mold, how should it be removed?

The mold should be scraped off with a spatula or scalpel blade.

What should be done with the head/hands on an edematous case?

They should be elevated so fluid will drain out of them.

What should be done with the hands of a person exhibiting arteriosclerosis?

They should be lowered off the table to promote distribution via gravity filtration.

What type of body has a higher moisture content - thin or overweight?

Thin.

How do you treat *localized* edema? (ascites, hydrocele, hydrocephalus, etc.)

This type of edema can be drained (and injected) with a trocar.

How do you correct intercellular (pitting/skeletal) edema?

This type of edema can be treated (corrected) with a hyp*er*tonic embalming solution, elevation of the head and/or limbs so gravity can pull it away.

How do you treat anasarca?

This type of edema can be treated (corrected) with a hyp*er*tonic embalming solution.

How do you treat generalized edema? (Pitting, skeletal, anasarca)

This type of edema can be treated (corrected) with a hyp*er*tonic embalming solution.

Other than preservation & disinfection, what is the objective of the embalming process?

To establish or maintain a proper moisture balance in the body.

What are the purposes of long term preservation?

To prepare for final disposition and/or anatomical donation/study.

How long should an embalmed body last?

Until the time of disposition.

Hexamethylene is also known as:

Urotropin

What is the difference between wet and dry gangrene?

Wet gangrene is able to get fluid distribution, dry gangrene does not get fluid to it and will have to be treated hypodermically or surface packed.

When is the only time radioactive isotopes become a problem to the embalmer?

When they are inhaled or ingested.

Sources of purge- Brain:

White semisolid.

How would you treat the remains of a person who was taking corticosteroids?

With a pre-injection and high index fluids.

How would you treat the remains of a woman taking a fertility drugs (progesterone)?

With a stronger than normal arterial solution and co-injection fluids.

How would you treat a dehydrated remains?

With the use of pre-injection fluids and a large volume of mild solution.

Sources of purge- Stomach:

"Coffee grounds" appearance with a foul odor.

Effects of corticosteroids and anti-inflammatory drugs:

(same affects as antibiotics) -*Decrease the permeability of membrane* = liquid maintained in the cell, thus, -Bodies may go bad after embalming (shell embalming)

About how much water will an embalmed body lose each day?

*3 pounds* (*3 pints*) Therefore extra fluid should be added if the service is delayed.

Name the different types of arteriosclerosis:

*Type 1* - inner wall of artery is thickened but can be used for embalming *Type 2* - lumen is reduced but a small arterial tube can be inserted *Type 3* - total blockage and if ischemia or gangrene is not present then canalization has occurred but you cannot inject these arteries, they will have to be hypodermically or surface embalmed or both.