Chapter 20: Discolorations

General Treatment of discolorations (Blood):

1. Flush vascular system by varying type, strength, quality of injection chemical 2. Type and strength set so blood will not be further modified to "set" discoloration 3. Quantity that would fill and flush all parts of the vascular system, but not cause rupturing of vascular system which would make it extravascular 4. Alternately raise and lower the prat 5. Manual passage

Decomposition change treatments

-general treatments of discolorations -hypodermic injections of chemicals to bleach and preserve -apply surface compresses saturated with bleaching agent

Importance of pre-embalming removal

-may conceal signs of fluid distribution or diffusion -some are more difficult to remove after tissues have firmed

Decomposition changes

-post mortem discoloration due to action of bacterial or autolytic enzymes on body tissues -progressive color changes in tissues

Examples of embalming chemicals reacting on body contentes

-razor burns or desiccation marks -"formaldehyde gray" -conversion of bilirubin to biliverdin -eye enucleation discoloration

How can you insure vascular filling of injection chemicals?

Increased pressure and limited drainage. Resulting distention of vessels aid in removal of blood

Antemortem Intravascular Blood Discolorations Include

Lividity patterns Carbon monoxide (cherry red) Capillary congestion (solid particles settling to the bottom) Livor mortis

Antemortem

a discoloration that appears on the human body during life. The fact that it may remain after life will not cause change of its classification.

Postmortem

a discoloration, which makes its appearance on the human body only after the death of the body.

Pharmaceutical agents

antemortem discoloration due to pharmaceuticals or chemotherapeutic agents pathological antemortem discolorations occurring during course of diseases

Surface discoloring agents

antemortem or postmortem discolorations occurring prior to or during embalming - adhesive tape -blood -grease -ink -iodine - beta dine -mold -oil -paint -tobacco tars

Skin lesions

any traumatic or pathological change in the structure of the skin

Examples of pustule or ulcerative lesions

boils, carbuncles, furuncles, ulcers, pustules, fever blisters (herpes)

Jaundice

checks whites of eyes for yellow discoloration FHs could make special jaundice fluid some FHs use low index (25 or less)

Poisons

corroding skin effects on liver petechiae on skin mostly autopsied use dye clean and dry areas burned by corrosive poisons

Blood

discolorations resulting from changes in blood composition, content or location. Intravascular blood discolorations either antemortem or postmortem are easily removed by vascular injection and drainage. The extravascular blood discolorations are not substantially reduced and may be permanent.

Exsanguination

excessive blood loss to point of death slightly stronger arterial solution

Drowning

liver, post mortem stain, cyanosis, bruises, lacerations possibility of purge pack orifices use restricted cervical injection

Methods of removing surface discoloring agents

mechanical: soft brush or cloth to remove stain chemical: use proper solvent when stain can't be removed mechanically (both methods can be used to remove blood from hair)

Gunshot

mostly autopsied discoloration not a great concern if wound away from face discoloration on face due to fracture of bones and swelling of eyes use strong arterial fluid

Carbon monoxide

mostly delayed embalming with refrigeration cherry red discoloration is intravascular entire body is red, not just dependent parts

Reaction of embalming chemicals upon body contents

postmortem discoloration that may be present before embalming but becomes more intense due to embalming chemicals

Refrigerated Bodies

practically a non-issue, it's so common body should be allowed to thaw at room temp

Burns

remove all loose skin before arterial injection apply surface area compresses edema and swelling often present use unionalls

Electrocution

restoration of burned area make sure burn is cauterized

Conditions related to discolorations

skin lesions disinfect the lesion in order to prep it for post-embalming restorative treatment

If blood discoloration is localized

use sectional arterial injection and venous drainage

Hanging

very dark discoloration on face no blood present in facial tissues many discolorations clear during arterial injection restricted cervical injection recommended do NOT use pre-injection solution inject head separately

Antemortem Extravascular Blood Discolorations Include

Ecchymosis Petechia Hematoma (blood clot caused by ruptured blood vessel) Hemoglobin decomposition

Examples of antemortem discoloration from pharmaceutical agents

1. Gangrene -moist (wet) -ischemic necrosis (dry) 2. Jaundice 3. Bronzing 4. Addison's Disease 5. Miscellaneous - leukemia -neoplasms (tumors) - meningitis - peritonitis - lupus vulgaris

Additional blood treatments

1. Operative aids during arterial embalming (incise directly or punctured and channeled to reduce direct outflow) 2. Sectional/local hypo injections to bleach and preserve discolored areas 3. Surface compresses saturated with bleaching agent

Treating pustule or ulcerative lesions

1. aspirate bus away from papule/pustule 2. swab pocket with disinfectant 3. sectional embalming 4. use restorative art after

How to treat skin separated from body

1. puncture and drain blisters 2. remove loose skin 3. apply sectional embalming (arterial, hypo, surface compress) 4. use restorative art after

Classifications of skin lesions

1. skin unbroken but discolored 2. skin scaling (exanthematous diseases) 3. skin broken separated from body (abrasions, blisters [vesicles], skin slip)