Embalming II Lesson 5.2 Delayed & Discoloration

21. Describe the classic discoloration associated with carbon monoxide poisoning and its cause.

Cherry red color; bright color of blood due to carboxyhemoglobin

12. List several signs of decomposition.

Color changes, odors, purge, gases, desquamation

Jaundice

Condition characterized by excessive concentrations of bilirubin in the skin and tissues and deposition of excessive bile pigment in the skin, cornea, body fluids, and mucous membranes with the resulting yellow appearance of the patient.

Dry gangrene

Condition that results when the body part that dies had little blood and remains aseptic; the arteries (but not the veins) are obstructed.

19. This term describes the separation of skin layers and subsequent weakening of the superficial layer of skin.

Desquamation

20. What is another term for skin slip?

Desquamation

Hemolysis

Destruction of red blood cells that liberates the red pigment called heme; also, the process of plasmoptysis when applied to a red blood cell.

12. List some examples of extra-vascular blood discolorations.

Ecchymosis, purpura, petechia, hematoma, postmortem stain & tardieu spots

21. List four factors which speed the onset of decomposition.

Elevated environmental heat Elevated & retained body heat High moisture content within the body Translocation of intestinal bateria

Blister

Elevation of the epidermis containing a water liquid.

Instant tissue fixation (Head freeze)

Embalming technique that uses a very strong arterial solution (often waterless); the solution is injected under high pressure in spurts into a body area; very little solution is injected as the technique attempts to limit swelling; effective in cases with facial trauma or decomposition.

1. List three common problems exhibited by bodies in which there has been a discernable time delay between death and embalming.

Even distribution Swelling Increased preservative demand

7. Define Exsanguination

Excessive blood loss to the point of death

Exsanguination

Excessive blood loss to the point of death.

Ecchymosis

Extravasation of blood into a tissue; a bruise.

Postmortem stain

Extravascular color change that occurs when heme, released by hemolysis of red blood cells, seeps through the vessel walls and into the body tissues.

24. Describe how Formaldehyde Gray occurs.

Failure to remove as much blood out of the body as possible; remaining blood mixes with preservative fluids and makes a dark gray color

16. According to the lesson, what is one problem an embalmer may encounter with a refrigerated body?

False signs of embalming (Firmness from swollen tissues, Pink coloration from hemolysis, Firmness from solidified subcutaneous body fats); Frozen Tissues (Ice crystals that form when tissue freezes will tear the tissue if manipulated)

23. Describe the conditions that favor and hinder the formation of gas in the body tissues and cavities.

Favor - heat & humidity Hinder - cold & dry

5. List the false signs of embalming in a refrigerated case.

Firmness from swollen tissues, pink coloration from hemolysis, firmness from solidified subcutaneous body fats

Hypostasis

Settling of blood and/or other fluids to dependent portions of the body.

Desquamation (Skin slip)

Sloughing off of the epidermis, wherein there is a separation of the epidermis form the underlying dermis.

Purpura

Purplish discoloration of the tissues due to widespread hemorrhage into the skin or mucous membranes.

8. What are the best injection choices for unautopsied bodies dead for long periods of time?

Restricted cervical or 6 point injection

2. List several causes of uneven fluid distribution.

Rigor mortis, post-mortem coagula, increased viscosity of blood, breakdown of portions of capillary system

15. List some advantages of short-term refrigeration.

Slows progress of rigor, slows decomp and maintains blood in liquid state

9. Give a detailed description of how jaundice occurs.

The conversion of bilirubin to biliverdin in presence of strong acidic environment

11. What is the first "tell-tale" sign of decomposition?

green discoloration in lower right quadrant of abdomen

Biliverdin

green pigment created by the oxidation of bilirubin; can occur when formaldehyde reacts with bilirubin and can cause a generalized permanent green discoloration of the skin.

28. What are the "warm" areas of the hands and face?

lips, cheeks, base of chin, nose, ears, joints on back of hands, fingertips & sides of thumb

5. List and describe the three categories of burns.

1. 1st degree; skin surface is red, only surface epithelium involved 2. 2nd degree; skin blisters & edema present, destruction of deep layers of epidermis & upper layers of dermis 3. 3rd degree; tissues charred, epidermis, dermis and epidermal derivatives destroyed

1. Describe the three meanings of discoloration as it pertains to embalmers.

1. Color is removed or lost 2. Any abnormal color appearance 3. To change color

2. What are the three general types of jaundice?

1. Toxic 2. Hemolytic 3. Obstructive

18. What are the four categories of skin lesions?

1. Unbroken skin but discolored 2. skin scaling 3. skin that is broken or separated from the body 4. Pustular or ulcerative lesions

24. List five ways to deal with a tongue that is swollen or protruding.

1. attempt to force tongue back into mouth by using firm digital pressure to arterial injection 2. cover protruding tongue w/cloth & apply firm pressure to cloth 3. when teeth or dentures are present, try to force tongue behind them & then secure jaw shut 4.excision of tongue (get family permission first) 5. make flap incision & lance tongue & apply digital pressure

26. List five embalming complications generally encountered in bodies with early signs of decomposition.

1. color changes 2. dehydration 3. odors 4. chemical changes 5. gases

26. List four examples of pathological discolorations.

1. gangrene 2. jaundice 3. addison's leukemia 4. meningitis 5. tumors 6. lupus

22. Describe how to prepare a solution which will reduce odors on a decomposed body.

2 pints of hydrogen peroxide, half cup of baking soda and 1 tablespoon of liquid soap

7. In cases of delayed embalming or decomposition, what is the recommended arterial fluid index?

25 or higher

6 Define/describe cyanosis.

A bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood

Cyanosis

A bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

Marbling

A greenish-black coloration along the vessels (veins) produced by hemolysis of the blood in the vessels; Hemoglobin mixes with hydrogen sulfide to produce the discoloration observed on the skin when decomposition is present.

Formaldehyde burn

A raised, rash-like appearance caused when embalming fluid escapes directly into tissues through broken capillaries; common in cases of delayed embalming.

19. What is meant by the term "exanthematous" or "exanthema?"

A skin eruption accompanying certain infectious diseases; or a disease, such as measles or scarlet fever, accompanied by a skin eruption.

Exanthema

A skin eruption accompanying certain infectious diseases; or a disease, such as measles or scarlet fever, accompanied by a skin eruption.

Hematoma

A swelling or mass of clotted blood confined to an organ or space caused by a ruptured blood vessel.

Bilirubin

A yellow bile pigment formed in the liver by the breakdown of hemoglobin; excreted in the bile.

10. What is meant by the term "reaction controlled fluids?"

Able to be distributed throughout body & diffuse into tissues spaces before chemical reaction with proteins of the body

13. Describe the process of warming a body exhibiting frozen tissues.

Allow to warm gradually by letting body sit in prep room for several hours

Preservative (formaldehyde) demand

Amount of preservative (formaldehyde) required to effectively preserve and disinfect remains; depends on the condition of the tissues as determined in the embalming analysis.

16. Define a Skin Lesion.

Any traumatic or pathological change in the structure of the skin

4. This is defined as an elevation of the epidermis containing a watery liquid.

Blister

17. Describe the term "Marbling."

Blood in superficial vessel breaks down & becomes greenish-black taking on a spider web appearance

25. List some examples of surface discolorations and when they should be cleaned (and why).

Blood, betadine, adhesive tape marks, gentin violet, paint, tobacco tars; cleaned prior to arterial injection because pores of skin are easier to clean at that time

3. Regarding delayed embalming, what main factor brings about the body's increased fluid need?

Breakdown of tissues

14. How can livor mortis be an advantage to the embalmer?

Breaking & clearing of livor mortis indicates that fluid has been distributed into those tissues

Discoloration

Any abnormal color in or upon the human body.

Lesion

Any change in structure produced during the course of a disease or injury.

Abrasion

Antemortem injuries resulting from friction of the skin against a firm object resulting in the removal of the epidermis; i.e. "skin rubbed off."

Petechia

Antemortem, pinpoint, extravascular blood discoloration visible as purplish hemorrhages of the skin.

Formaldehyde gray

Gray discoloration of the body caused by the reaction of formaldehyde from the embalming process with hemoglobin in the blood to form methyl-hemoglobin; can occur as a result of poor drainage.

20. What is the significance of nitrogenous products created during the decomposition process?

Greatly increase the preservative demand of body & shifts body pH to alkaline

18. Why should manipulation of a body exhibiting frozen tissue be kept to a minimum?

Ice crystals that form when tissue freeze will tear the tissue if manipulated

Waterless embalming

Injection of an arterial solution composed of a preservative fluid which is diluted with supplemental chemicals such as humectants, water conditioners, and other coinjection fluids (instead of water.)

29. What are some causes of dehydration?

Internally; injection of too much arterial solution, use of arterial solution that is too strong & continuous or concurrent drainage Externally; passage of air over body

9. What is the main purpose behind using a six-point injection on a delayed/decomposed embalming?

It reduces the amount of coagula that may move into the smaller arteries and block distribution

6. List five manual aids that can assist in distribution of arterial solution.

Lowering the arms, firm massage, squeezing sides of fingers & nail beds, bending, rotating & flexing limbs, massaging areas which contact with the table

10. What is the main reason rigor mortis should be relieved before embalming begins?

Proteins of muscles are "locked" together & it is difficult for preservative to attach to proteins

11. Describe Tardieu spots.

Minute petechial hemorrhages caused by rupture of minute vessels as blood settles into dependent areas of organs & tissues

Tardieu spots

Minute petechial hemorrhages caused by the rupture of minute vessels as blood settles into the dependent areas of organs and tissues (i.e. hypostasis); found in areas of advanced livor mortis.

25. Why might an embalmer wait until after embalming is completed to close the mouth of a body in which decomposition is evident?

Mouth area may swell during embalming, it may be easier to obtain a proper closure after injection

Gangrene

Necrosis, death, of tissues of part of the body usually due to deficient or absent blood supply.

Wet gangrene

Necrotic tissue that is moist as a result of inadequate venous drainage; may be accompanied by bacterial infection.

23. Describe the theory behind the conversion of yellow jaundice to green jaundice. Include the chemical process and compounds involved.

Oxidation reaction; the conversion of bilirubin (yellow) to biliverdin (green) in presence of strong acidic environment

Death pallor

Paleness of the skin that occurs after death.

27. What is one way to prevent a body pouch from tearing when being lifted?

Place sheet under it, pouch can be lifted & moved with the sheet

17. What is one of the major problems encountered by the embalmer in preparing a body with diabetes mellitus?

Poor peripheral circulation

Rigor mortis

Postmortem stiffening of the body muscles by natural body processes.

Livor mortis (Cadaveric lividity)

Postmortem, intravascular, red-blue discoloration resulting from hypostasis of blood.

3. When embalming the jaundiced body, what factor takes precedence over all others?

Preservation

4. What are the three general stages of Rigor Mortis?

Primary flaccidity Period of rigor Secondary flaccidity

Postmortem caloricity

The rise in temperature after death due to continued cellular metabolism.

Decubitus ulcer

The technical term for a bedsore; a sore developed by an invalid due to pressure caused by lying in bed in one position; the weight of the body causes a lack of blood flow to that area.

14. When there has been a delay between death and embalming, describe why a slow rate of flow/slow injection is necessary.

To avoid distention or dislodged coagula

13. Why should the head and shoulders of the dead human body always be elevated?

To help drain blood from upper tissues

15. In a case of renal failure/jaundice, how is ammonia formed and what is its significance to the embalmer?

Urea in blood system converted to ammonia; ammonia neutralized formaldehyde

22. On a casketed body, what is a good way to detract from eye problems which may have occurred?

Use of glasses

8. List several different embalming for treating the jaundiced body.

Use of: jaundice fluid, preinjection fluid, mild arterial solution, cavity fluid as arterial fluid

27. What are the classic colors of dehydration?

Yellow, brown & black