MOR 340 Embalming II Lesson 3.1

Describe a partial autopsy.

1. Complete autopsy involves opening of the cranium cavity and its contents, eye enucleation or vitreous humors of the eye, removal of neck organs, thoracic cavity and its content, abdominal cavity pelvic cavity, spinal cord, testes and scrotum, and tissue samples. 2. Partial autopsy involves usually only one body cavity for one specific item. These are performed as medical autopsy's.

List some typical cases that would be reported to a coroner or medical examiner.

1. Sudden deaths not caused by readily recognizable disease or wherein the cause of death cannot be properly certified by a physician on the basis of prior medical attendance, 2. Suspicious death, 3. Violent or traumatic death such as homicide, suicide, accidental, 4. fetal deaths, 5. therapeutic and criminal abortions, 6. When a death is simply unexplainable, 7. When the body is unidentifiable, 8. Any death where there is uncertainty as to whether or not it should be reported to the medical examiners office.

List some ways to secure the calvarium and prevent it from moving.

1. Suture through the temporalis muscle and up across the calvarium, 2. Suture the cut temporalis muscle on either side of the head, 3. Use calvarian "clamps", 4. Wire the calvarium into place, 5. Superglue to help hold calvarium in place, 6. Use plaster of Paris, and 7. Use needle injector wires.

List the main steps in the suggested order of preparation of an autopsied body.

1. Unzip the pouch, 2. disinfect the body, 3. dispose of covering materials, 4. rinse and dry body, 5. relieve any rigor mortis, 6. Remove pathologist stitches and lay back skin flaps and disinfect, 7. Inspect arteries needing injection, 8. Shave and set features, 9. Mix solution, 10. Inject lower extremities, 11. Inject upper extremities, and 12. Inject the head.

What is the Circle of Willis?

An arterial circle at the base of the brain that receives all the blood from the two internal carotid arteries that come up the front of the neck and from the basilar artery formed by the joining (anastomosis) of the two vertebral arteries that come up the back of the neck. All the principal arteries that supply cerebral hemispheres of the brain branch off from the circle of Willis.

How do you stop leakage in the cranial vault when injecting the head of an autopsied case?

Clamp leaking sites with hemostats as they become apparent.

In an autopsied case, what are the ideal vessels to use for injection of the lower extremities?

Common Iliac artery

What are the two types of autopsies?

Medical or Hospital and Medicolegal or Forensic

Is it necessary to insert drainages devices when embalming an autopsied body?

No, it is not necessary to insert drainage devises when embalming an autopsied body.

Describe the saturated packing technique of embalming an organ/tissue donor.

Open all procurement sutures. Legs are packed with absorbent material and the leg is resutured. As packing/suturing proceeds, packing material is saturated with undiluted cavity fluid or strong arterial fluid, creating an internal preservative compress. Larger muscles of the thigh area can be treated hypodermically.

Autopsy

Postmortem examination of the organs and tissues of a body to determine cause of death or pathological condition.

Define an autopsy.

Postmortem examination of the organs and tissues of a body to determine cause of death or pathological condition.

What is the proper technique to use when tightening sutures while closing an autopsy case?

Pull on the thread and not the needle.

Circle of Willis

The circular arterial structure at the base of the brain from which all the principal arteries that supply brain branch.

Anastomosis

The connection of normally separate parts, for example, a connection of two blood vessels.

Define Anastomosis.

The connection of normally separate parts, for example, a connection of two blood vessels.

What distribution problems does one encounter if it becomes necessary to inject the axillary artery rather than the subclavian artery of an autopsied body?

The shoulder, the upper portions of the back, and the deep muscles of the neck do not receive arterial solution distribution.

Describe the Uniform Anatomical Gift Act.

This act allows any person 18 years or older to donate all organs and tissues of their body for transplantation, research or educational purposes after their death.

Bifurcation

To divide into two parts or branches.

After the completion of arterial embalming, what areas are generally injected with a hypo-valve trocar?

Trunk walls with special attention to buttocks, breasts and the shoulder and neck regions or any other tissue lacking preservative fluid.

Generally speaking, with regard to fluid selection, what type of solution should be used on an autopsied case?

Typically use stronger than average arterial solution.

When embalming a thoracic autopsy, where is drainage taken for the lower extremities and abdomen?

Inferior vena cava.

Define viscera.

Internal organs enclosed within a body cavity.

Viscera

Internal organs enclosed within a body cavity.

What is the priority of the next-of-kin who can consent to organ donation?

1. Spouse, 2. Adult son or daughter, 3. Either parent, 4. Adult sibling, 5. Guardian, 6. Any other person authorized or under obligation to dispose of the body.

What are the goals of a coroner/Medical Examiner autopsy?

1. Determine the cause of death, 2. determine the manner of death, 3. establish the time of death, 4. recover, identify and preserve evidence, 5. provide factual objective information for legal authorities, and 6. separate deaths due to disease from deaths due to external causes.

List and describe the two options for the arterial injection of an organ donor.

1. External access where embalming is accomplished by raising vessels at one of the commonly used injection and drainage sites, and 2. Internal access where the embalmer opens the procurement incisions and attempts to inject the body utilizing the arterial structure that remain intact in the areas where organ recovery has taken place.

Give a brief description of the Free Flow method of preparing a long bone donor.

1. Raise the right and left iliac arteries, 2. Prepare strong concentration of high index arterial fluid, 3. Inject each leg using 1/2 gallon of fluid for each leg, 4. Allow solution to saturate the tissue while doing other areas of the body, 5. Puncture the lower leg with a scalpel and insert a drain tube or trocar to drain fluid from leg, 6. Suture and glue with cotton and then place in plastic stockings containing preservative powder or autopsy gel.

List three reasons why it is important to inject the left side of the head first.

1. So that a certain amount of fluid flows to the right side through anastomosis, 2. It gives the embalmer a chance to observe the effects of the fluid and the dyes on the left side before the right or most visible side is done, and 3. It prevents over injection of the right side of the face.

List several reasons why a hospital would perform/require an autopsy.

1. When doctors have not made a firm diagnosis, 2. When death follows unexpected medical complications, 3. When death follows the use of an experimental drug or device, a new procedure, or unusual therapy, 4. When death follows surgical procedure and the case does not come under the jurisdiction of the medical examiner, 5. When death occurs suddenly, unexpectedly, or in a mysterious circumstance, 6. When environmental work place hazards are suspected, 7. When death occurs during or after childbirth, 8. When heredity disease might effect other members of the family, 9. When there are concerns about the possible spread of an infectious disease, 10. When the cause of death could affect insurance settlements, and 11. When death occurs in a hospital and the patient comes from a nursing home and the quality of care is questioned, 12. Confirmation or to verify a diagnosis, 13. Teaching hospitals where they serve as a learning opportunity in explaining a diagnosis technique or disease process.

Regarding an autopsied body, what factors influence the need for a stronger arterial solution?

Refrigeration, time delays, pathological conditions, dehydration of tissues, distension.

Eye enucleation

Removal of the eye for tissue transplantation, research, and education.

In an autopsied case, what are the ideal vessels to use for injection of the upper extremities?

Subclavian arteries

Because refrigeration can cause hemolysis and hardening of tissue, what is the best way to detect actual arterial solution distribution?

Use dye in the arterial solution to see surface distribution and then massage deep tissues to improve distribution.