MOR 346 Embalming II/Lesson 5.3

What color of skin would a typical person with renal failure show?

Sallow due to urochrome buildup - a pigment in the blood that gives a yellow color.

The term anasarca refers to

Severe generalized edema throughout the body.

Urotropin

A compound formed when formaldehyde reacts with ammonia; this reaction neutralizes the formaldehyde and creates a risk of under-embalming.

How should the embalmer proceed when arterial solution is present in purge and drainage has stopped?

A sectional injection will need to be implemented because a major fluid loss is taking place and distribution is not occurring.

Which of these cases would be best treated with a trocar?

Ascites versus cellular edema, anasarca or intercellular edema.

When making removals we should . . .

Avoid compression of thoracic or abdominal cavities and place a mask on the deceased.

Why is a person with renal failure more challenging to embalm?

Because their high levels of ammonia in their system tends to neutralize formaldehyde/HCHO.

Five minutes into injection, there is no drainage and the abdomen is swelling rapidly. What do you do?

Begin multi-point injection immediately.

A common sign of carbon monoxide poisoning.

Cherry-red discoloration

How should the embalmer proceed if arterial solution is present in purge and drainage is occurring?

Continue injecting until the preservative demand is met.

This type of gas usually stops when tissues are properly embalmed.

Decomposition gases

Which aspects of embalming is usually responsible for formaldehyde gray?

Drainage

Which gas condition is NOT caused by a microbe? Tissue gas, Gas Gangrene or Subcutaneous Emphysema?

Subcutaneous Emphysema

Tissue gas is usually found in what areas of soft tissue?

Eyelids, neck, scrotum, blisters, skin slip.

This is a fatal disease caused by contamination of a wound infection by a toxin-forming, spore-forming anaerobic bacterium.

Gas Gangrene

What case would you expect to find subcutaneous emphysema?

Heart Attack/CPR.

What amounts and strength of solution should you inject into an obese case?

Large amounts with strong index.

What must be done to remove gas for subcutaneous emphysema?

Must lance and channel tissues to release gas - AND kill the microbes that cause the gas or the gas will just come back.

Tissue gas is a antemortem or postmortem condition?

Postmortem condition but may begin prior to death as gas gangrene.

The term used to define the postmortem evacuation of any substance from any external orifice of the body.

Purge

Explain the significance of the external iliac artery when embalming an obese case.

The external iliac artery are more superficial than the femoral artery and arteries in obese bodies are often very small.

What is usually best way to address subcutaneous emphysemia?

Use trocar puncture to release gas. It's usually most effective. Using the restricted cervical injection (RCI) provides two incisions for gas exit points.

What condition is Tissue gas? Antemortem or Postmortem?

Usually postmortem but may be antemortem.

Sallow

a yellowish, sickly color of the complexion.

Gas gangrene is common after

farm accidents, close range gun shot wounds, compound fractures

How would an embalmer create a "barrier" between an extremity exhibiting tissue gas and the rest of the body?

By hypodermically injection undiluted cavity fluid after sectional embalming is complete.

What micro-organism is responsible for the formation of tissue gas and gas gangrene?

Clostridium perfringens

Why is disinfection of instruments so important after treating cases of tissue gas and gas gangrene?

Clostridium perfringens can be passed from one body to another via contaminated instruments.

Can tissue gas bacillus from the intestinal tract be transferred from one body to another via contaminated embalming instruments?

Yes. C. Perfringens are resistant to most disinfectants.

Uremia

a presence of toxic waste products in the bloodstream as a result of a diseased kidney failing to perform its filtering function.

Describe lung purge.

postmortem evacuation of any substance from the lung which appears white, frothy, odorless and usually exits through the nose and/or mouth.

Subcutaneous emphysema

what is commonly caused by a compound fracture of the rib, tracheotomy, lung surgery, or projection of an object into the pleural sac.

What smell would you find with a person who has renal failure?

Strong ammonia smell.

What strength solution should you use on a renal failure case?

Strong solution and employ a restricted cervical injection to avoid over embalming the head. Very slow intermittent injections.

The vessel selection for the neck, shoulders, and upper extremities of an autopsy case.

Subclavian artery

What is the most common form of gas condition? Tissue gas, Gas Gangrene or Subcutaneous Emphysema?

Subcutaneous Emphysema

How does gas gangrene tear tissue apart?

The organism grows in a wound tissue, it releases exotoxins and ferments muscle sugars. Then the pressure and gas tear the tissues apart.

What is a mycotic infection?

Those infections caused by fungus.

Other possible ways to address decomp, gangrene and tissue gas.

1. Restricted cervical injection of large quantities of solution into trunk, 2. Possibly use special purpose fluids such as Triton 28, Omega, etc., 3. Consider sectional injection if gas originates in other extremities - waterless injection, and 4. Hypo specific areas in need.

List some signs of renal failure.

1. Sallow color to the skin, 2. Excoriations on the skin from repetitive scratching due to uremic pruritus, 3. Distinct odor from increased amount of urea, ammonia, etc., 4. Edema - harder to observe, 5. Acidosis, 6. Anemia, and 7. Gastrointestinal bleeding.

What are the five gases that are found in the dead human body and cause distension?

1. Subcutaneous Emphysema, 2. Air from the embalming apparatus, 3. Gas Gangrene, 4. Tissue gas, and 5. Decomposition gas.

What are four ways that pressure responsible for purge can develop?

1. Gas, 2. Visceral expansion, 3. Arterial solution, and 4. Ascites/Hydrothorax

What two factors are needed for purge to occur?

A substance to purge and pressure on an organ to evacuate the material.

Is gas gangrene a postmortem condition or a antemortem condition?

Antemortem condition. Fatal disease caused by contamination - clostridium perfringens.

Gas gangrene

Antemortem formation of gangrene associated with anaerobic gas-forming bacillus, most commonly Clostridium perfringens.

What are the two factors responsible for decomposition gas?

Autolytic enzymes and bacterial enzymes

Distention is greatest in what area of the body?

Soft tissue areas such as eyelids, neck, scrotum, blisters, skin slip

Which gas is usually least intense?

Decomposition gasses

Which gas cannot be spread from body to body by contaminated instruments? Decomposition, Tissue or Gangrene?

Decompostion

Describe subcutaneous emphysema.

Distension of the tissue beneath the skin by gas or air. An antemortem condition brought about by a surgical procedure or trauma - like trauma from a broken rib which punctures the lung allowing air to escape into the body cavity.

What portion of the embalming process would arteritis most likely affect?

Distribution

What is the region of the top center of the 9 region diagram or region #2?

Epigastric region

Which case would be LEAST suited for a pre-injection?

Green discoloration in the lower right quadrant

In which of the following embalming scenarios would urotropin be created?

HCHO combining with ammonia in a case of renal failure.

Another term for Instant Tissue Fixation?

Head freeze.

What ingredient of stomach purge can dry and discolor the skin?

Hydrochloric Acid

What arterly do we raise on a person who is obese instead of the femoral artery?

Iliac artery at the level of the injuinal ligament. More superficial than femoral arterial and common for these arteries to be quite small.

Describe the causes and appearance of brain purge.

In adults brain purge is usually caused by skull fracture, surgery or trauma. It is a creamy white, odorless fluid that exits through the nose and/or ears.

In which method do you open procurement incisions and inject using intact arterial structures?

Internal access

Why do we keep an obese persons head in a raised position?

It helps prevent purge.

When positioning an obese case, why is keeping the head high important?

It's easier to raise vessels and helps prevent purge.

What is uremic pruritis?

Itching sensation. May see this in a decedent that has excoriations on the thighs and groin from scratching.

What is the ONLY effective way to remove gas (with the exception of subcutaneous emphysema) from distended tissues?

Lance and channel the tissues to release gas.

Describe the appearance of stomach purge.

Liquid and has a coffee ground appearance, a sour odor, contains acid, usually exits through the nose and or mouth.

Should you pre-inject a case of renal failure?

No. Tissues will easily swell if circulation is poor.

What would you expect from a body refrigerated less than one hour following death?

Normal drainage upon arterial injection.

Purge

Postmortem evacuation of any substance from an external orifice of the body as a result of pressure.

Tissue gas

Postmortem formation of gas associated with anaerobic gas-forming bacillus, most commonly, Clostridium perfringens.

What is a common cause of subcutaneous emphysema?

Puncture or tear of the pleural sac/lung tissue. Common after CPR has been performed.

When a case has decomp, gangrene or tissue gas what is most important with regard to arterial fluids?

Saturate tissues with strong arterial solution.