Selected Conditions

aspects of renal failure?

-sallow color -uremic pruritis and excoriations -Increased levels of ammonia (definite smell) -Edema

How to treat facial trauma?

1. Align any fractures 2. Align lacerated or incised skin areas a. Can be done with super adhesive or dental floss bridge sutures 3. Apply surface preservative and/or bleaching compresses 4. Instant tissue fixation should be used when embalming the head a. This technique utilizes a waterless solution (i.e. "no water added.")

How to embalm an obesity case?

1. Angular forceps are easier to use than drain tube as the neck is usually short 2. Varicose veins may indicate that large clots will be present 3. If legs do not receive proper distribution, raise the iliac artery at the level of the inguinal ligament a. More superficial than the femoral artery b. Arteries in obese bodies are often very small 4. Weight of viscera pushing against stomach can cause purge

3 ways to detect gas

1. Distends weak unsupported tissue such as eyelids, orbit, neck and back of hands 2. Distinction of veins in firmly embalmed body 3. Pushing on tissues and noticing crepitation

What are the causes of pressure?

1. Gas - can create sufficient pressure on the stomach to force contents through the mouth or nose; or on the diaphragm to force lung contents out 2. Visceral expansion - Viscera can expand if rate of flow is too high causing pressure on the stomach and lungs 3. Arterial solution - Leakage through an ulceration in bowel, stomach, esophagus or lungs 4. Ascites (peritoneal edema) and Hydrothorax (edema of thoracic cavity)

considerations for embalming renal failure

1. Pre-injection should be avoided! a. Circulation is usually impaired; swelling can occur 2. Use a 30-35 index arterial fluid 3. Use a restricted cervical injection to inject a strong solution to the body without over-embalming the head

post embalming purge

1. Repack nostrils with cotton 2. Replace moist cotton in mouth 3. Re-aspirate prior to dressing if possible 4. If purge develops after dressing/casketing: a. Remove trocar button to temporarily relieve pressure b. Pass trocar through abdomen to relieve pressure c. Re-aspirate and re-inject if possible

What causes sallow color in renal failure?

Sallow color to skin due to urochrome buildup: (A pigmented blood product that gives urine its yellowish color)

Subcutaneous emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues

Urotropin

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

alcoholism considerations

A. Many of these bodies exhibit jaundice due to liver failure B. Purge is common C. Firming of the tissue may be difficult due to long-term effects of alcohol abuse on body tissues.

Ways to treat facial trauma?

Align fractures, lacerated skin areas (superglue or removing dermis to create a "channel") -Instant tissue fixation

Embalming Protocol: Decomposition gas, Gas gangrene, Tissue gas

All have bacterial origin Important to saturate tissues with strong arterial solution RCI allows injection of large quantities of solution into trunk (Why?) Special-purpose fluids (e.g. Triton 28, Omega, etc.) Sectional injection if gas originates in extremities Waterless Use hypodermic to create barrier of cavity fluid

Gas gangrene

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

Two factors responsible for decomposition:

Autolytic enzymes Bacterial enzymes

Embalming Protocol Subcutaneous Emphysema

Does not involve microbes No odor, skin slip, etc. Only need to remove gas from body Trocar puncture will usually be effective Using an RCI provides two incisions for exit points

anal purge

Should be forced from the body by applying pressure to the lower abdomen Allow it to continue during embalming as fecal matter is difficult to aspirate from the body When cleaning the body, turn it on its side so the buttocks, backs of the legs and table can be cleaned Use plastic garments (with powder to control any odor.)

What happens with gas gangrene?

Skin becomes dark red, then green and finally black Considerable swelling that extends rapidly over the body Tissue tends to "crackle" when touched - CREPITATION May not be visible right away if death occurs quickly after injury; totally internal May not show up for hours after embalming

Blunt force trauma can be divided into two general categories:

Skin is broken (abrasion, laceration) Skin is not broken (contusion, hematoma)

pre-embalming purge includes?

Stomach purge Lung purge Anal purge Brain purge

Protecting skin from purge

Stomach purge contains hydrochloric acid which can dry or discolor the skin If arterial solution is present in purge, the dye in the fluid can also stain the skin Apply massage cream to areas affected by purge

Five types of gas in dead human body:

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

How much embalming demand for renal failure?

Estimates say that six times more preservative chemical is needed to preserve bodies dead from complications of renal (kidney) failure

things that could cause gas gangrene?

Farm or car accidents Close-range gunshot wounds Compound fractures

Gas Gangrene(Antemortem condition)

Fatal disease caused by contamination of a wound infection by a toxin-producing, spore-forming anaerobic bacterium, Clostridium perfringens. Organism grows in wound tissue (especially muscle); releases exotoxins and ferments muscle sugars. The pressure and gas tear the tissue apart. Common after severe trauma (contact w/filth, manure, surface soil)

lung purge

Frothy (due to air trapped in lungs) May be red (due to presence of blood) Usually little odor

Considerations of renal failure?

High levels of ammonia neutralize HCHO Edema promotes hydrolytic decomposition DO NOT PRE-INJECT cases of renal failure Tissues will easily swell if circulation is poor Use a very strong solution and employ a restricted cervical injection to avoid over-embalming the head

considerations with obesity

Inject large amounts of strong solution Tissue firmness makes dressing easier -Visceral weight can cause stomach purge

positioning with obesity

Keep shoulders high off table 3 levels: head is highest, chest, then abdomen Keeping head high helps with raising vessels and helps prevent purge Use cloth straps for arms

Tissue Gas (Postmortem condition)

May begin prior to death as gas gangrene Postmortem by translocation of the gas bacillus from the intestinal tract Can be transferred from one body to another via contaminated embalming instruments, hypodermic needles, autopsy instruments C. perfringens are very resistant to most disinfectants Condition can occur after embalming if all tissues have not been properly treated Distension is greatest in soft tissue areas Eyelids, neck, scrotum; causes blisters and skin slip

Subcutaneous emphysema

Most frequently encountered gas condition Caused by antemortem subcutaneous emphysema Brought about by a tear or puncture of the pleural sac or lung tissue Common in compound rib fractures, tracheotomies, lung surgery, CPR NOT caused by a microbe and DOES NOT intensify after death Can escape through incisions, channeling of tissue

air from the embalming apparatus

Not common Automatic shutoff Most common when using an air pressure machine or hand pump

Sallow

Of a sickly, pale-yellowish complexion

Purge

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

purge

Postmortem evacuation of any substance from any 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

embalming solutions for purge

Remember that you have to replace the loss of embalming solution that has purged by injecting a sufficient total amount of solution When arterial solution is present in purge during injection and drainage IS occurring, continue injection until a sufficient amount of solution to satisfy preservative demand. When arterial solution is present in purge during injection and drainage is NOT occurring, major loss of solution is occurring somewhere and there is not distribution Begin a sectional (six-point) injection where needed

decomp gases

Responsible for the odor of decomposition Not usually as intense as gas gangrene or tissue gas Cannot be spread from body to body by contaminated instruments Generation of gas ceases when tissues are properly embalmed Can be removed by aspiration and channeling

treatments for gas?

Restricted cervical injection Inject a VERY strong solution Both incisions can provide an escape route for gas If gas appears to have originated in an extremity, a sectional embalming should be performed. Create a barrier (if gas is in an extremity) by hypodermically injecting cavity fluid

general treatments for gas

The ONLY effective way to remove gas from distended tissues is to lance and channel the tissues to release the gas With the exception of subcutaneous emphysema, just releasing the gas won't stop regeneration; the microbe must be killed Triton 28 is a sporicidal arterial fluid that is effective against these microbes Soak instruments in strong disinfectant for several hours afterwards; discard scalpel blade

prevention of post-embalming purge

Thorough aspiration Inject additional cavity fluid Hypodermic injection of areas not receiving fluid Reaspiration! Especially bodies coming from other FH's Some FH's have a policy to reaspirate before dressing Pack nose and throat with cotton Tie off or sever trachea and esophagus

mycotic infections

Those infections caused by a fungus Avoid compressions of thoracic/abdominal cavities when making removals Fungal organisms can be expelled into the air Place a mask on the deceased Watch for open superficial lesions and do not touch without gloves

brain purge

Usually a result of skull fracture, surgery or trauma Possible for gas to build up inside cranium Brain purge from the nose is rare; can also come from ear

stomach purge

Usually consists of stomach contents and possibly blood if esophageal vessels have ruptured. Stomach contains hydrochloric acid which makes contents brown in color and can dehydrate or discolor the skin "Coffee ground" appearance

How can arterial solution create pressure?

a. Fast rate of flow b. Leak through ulcerated vessels c. Esophageal varices (dilated veins) can break d. Gastrointestinal bleeding can result in anal purge e. Aneurysm f. Recent surgical incisions

how to drain ascites?

a. Insert a trocar w/hose into the lower left inguinal area b. Some of the liquid should gravitate from the cavity c. Use a nasal tube aspirator to remove purge from the upper areas of trachea and esophagus

uremia

presence of urinary waste in the blood, or urine in the blood

If legs need injected:

raise the iliac arteries at the level of the inguinal ligament More superficial than the femoral arteries - common for arteries to be quite small

Excoriations

scratches or scratch marks on the skin from itching

Uremic pruritis

what is the name for the itchy skin caused by renal failure

embalming protocol for gas

1. Restricted cervical injected recommended for all cases; the two incisions required can serve as exit points for the tissue gas 2. Decomposition, gangrene and tissue gases all require "special purpose" arterial fluids (e.g., Pierce's Triton 28 is sporicidal and can be effective in cases such as this.) 3. If gas has originated at an extremity, a sectional embalming should be done to treat the area as thoroughly as possible. a. If gas is advanced, use 100% fluid solution 4. Often times, tissue gas is not noticeable at the time of death a. Anaerobic organisms will thrive in this medium b. Create a barrier between the afflicted extremity or area by hypodermically injecting undiluted cavity fluid after sectional embalming is completed. 5. Only effective way of removing gas from distended tissues is to lance and channel the tissues to release the gas. a. Incisions to raise vessels are escape routes for gas b. Release of gas from the tissues DOES NOT stop its generation; the microbe must be killed. c. The text lists various ways to lance and channel different areas that are often affected by gas 6. The spore-forming bacillus (C. perfringens) that causes gas can be passed from one body to another via contaminated instruments. a. After treating a case of gas, instruments should be soaked in a very strong disinfectant solution for several hours.

What are signs of renal failure?

1. Sallow color to the skin 2. Increase in amount of urea, ammonia, etc. a. The deceased may even be a exhibit a distinct odor of ammonia. a. Ammonia neutralizes formaldehyde! 1) The reaction of formaldehyde and ammonia forms a new compound called urotropin. b. This creates a MARKED INCREASE in the formaldehyde (preservative) demand! 4. Edema 5. Gastrointestinal bleeding