Embalming 2 Chapter 16

Stillborn

Dies prior to delivery from uterus.

You can start with a weaker solution to establish what?

Distribution. Then work it stronger later.

Lanugo

(facial hair)

Embalming the Premature Infant Aspirate and inject cavities.

External compresses are the easiest treatment. Wrap in saturated cotton. (Unviewable case) Hypodermic injection is also a possibility. Surface compresses can supplement hypodermic injection.

Pre-injection is

injected prior to preservative chemical and usually done usually only on unautopsied bodies. You either do pre-injection or you do not. Co-injection is used with arterial preservative fluid. When you use only co-injections with no water as a diluent, you have a waterless solution.

If you inject with a high rate of flow to establish arterial side pressure:

it is best to use concurrent drainage to prevent distention.

Cachexia and emaciation

may cause mouth closure problems, be aware of techniques to fix this.

Atrophy of bones

may cause needle injectors to fracture bone so care must be given or use of a suture method of closure.

If the temporalis muscle has been removed,

putty will need to be applied as tissue building will not work.

Embalming the Infant • Blood Vessels

Abdominal Aorta • Rests on the anterior spine • Make incision just left of the midline (2-3 inches) • You must open the greater omentum and pull out some of the intestines. • Inject distally. • You may need to cut into the viscera during injection due to expansion.

Young Adult to Adult

Age 12 - Mid 70s

Child to Young Adult

Age 4-Age 12

Age

Age is one of the many factors that you will need to take into consideration when performing an embalming analysis.

4-12 yrs

Arm position tends to be more relaxed and straighter than that of an adult.

old Embalming the 4-12 year

• Trauma to the face will cause swelling (your book states this like it's something new), so restricted cervical injection should be utilized in trauma cases. • You should not have sclerotic arteries in this age group.

Embalming the Infant Cavity Treatment

• Use an infant trocar • Standard point of entry can be used or inguinal abdominal area. • Use normal cavity fluid. • Close with Trocar button or suture. • Reaspiration is recommended.

diabetic embalming:

• Use carotids • Use strong solutions • Use dyes as tracers • Massage limbs to stimulate distribution • Disinfect respiratory tract due to fungal infections • Hypo and Surface pack areas where distribution not adequate. • Cavity embalm immediately following arterial injection and ensure injection in the liver and lungs.

Embalming the Autopsied Infant

• Viscera may or may not be returned with the body. • Vessel Selection will be a result of what is left. Use the largest arteries possible. Ligation may not be possible, use hemostats to clamp off areas. • Place cavity fluid soaked cotton inside the mouth and under eyelids if necessary.

Embalming the Infant Blood Vessels

Ascending Aorta • Drainage is usually taking from the heart using this technique • Make incision down the midline of the sternum - bone ossification has not occurred so the sternum should be easily to cut through. There is a 2nd incision you should review, as well. • Must use retractors or another tool to hold open incision • Once the chest is open, you will need to cut open the pericardium to access the heart and vessels. You may need to clamp off • This technique may result in people wondering if an autopsy was done, ensure you get permission for this type of technique and explain the situation.

3 Categories of Body

Autopsied Partial Autopsy Unautopsied

Embalming the Elderly

Average life expectancy is 75.2 years for men and 80.4 years for women as of the printing of this text. Drug therapy, as we've seen, can cause complications outside typical conditions associated with the aged.

Embalming the Infant Blood Vessels

Axillary Not recommended Use subclavian, if necessary.

Infant Age Bracket

Birth to 18 months

old Embalming the 4-12 year

Body size may cause complications, but there are, generally, no special techniques to be considered like that of the infant/toddler. • Carotids and Femorals are two main injection sites. • Axillary is not recommended due to size problems.

Premature

Born prior to 37th Week of Gestation OR less than 5.5 lbs

Embalming the Adolescent and Adult Recommended Injection sites

Restricted cervical, carotid, and femoral. This is so that coagula can be pushed toward the legs.

Initial rate of flow should be ______ to prevent coagula from loosening and blocking arteries.

Slow

Embalming the Infant

Start normally with topical disinfection, etc. Leave IV tubess in place like an adult Any tube that affects nose or mouth closure is removed prior to embalming for obvious reasons.

Infants Specific Conditions

• Skin is Fragile • Can easily distend or wrinkle • Vessels are small, usually free of sclerosis • Usually autopsied • Disease can bring about buildup of waste in tissues (hepatic/renal failure)

Carefully suture area with ligature or dental floss.

• Start on the right and end on the left, a worm (inversion) suture works well. Superglue or a baseball stitch using dental floss are other options.

Ideal rate of flow in a 'normal' case is:

10-15 minutes per gallon. Pressure settings between 5-20lbs are common. Rate of flow can be adjusted according to pressure.

Toddler Age Bracket

18 Months to 48 Months

Pressure settings between ____ and _____ are common.

5-20lbs

Infants Body composition

75% Body Water at birth 60% Body Water at 1 year 12% Body Fat at Birth 30% Body Fat at 1 year

Embalming the Premature Infant

• Start with typical procedures. • Use the carotid or aorta for injection.

Embalming the Infant Blood Vessels

Common carotid • Placing Support under shoulders helps in raising • Drop head backwards to raise vessels • Turn head in opposite direction of vessel being raised. • Place incision in neck wrinkle

Embalming the Autopsied Infant Type of Autopsies:

Complete Partial Special/Local Autopsy Organ Donor Tissue Donor

Embalming the Infant • Blood Vessels

Femoral • Same incision is used as in adult. • Inject distal leg first • Use femoral vein or jugular vein

Principle manifestations of diabetes include

Hyperglycemia • Excess sugar in the blood Glycosuria • Sugar in the urine Ketosis • Acidosis characterized by the presence of ketones in the bloof and body tissues

· Old Age

Mid 70s to late 90s

Use of massage cream can also assist in:

Mouth closure! Wax restoration to ensure a proper line of closure may be required.

Embalming the Infant Positioning

Positioning varies from funeral home to funeral home. Generally, arms are at side, forearms and hands are over the trunk barely touching as if holding a toy or blanket. Head can be placed on the right cheek or head slightly turned. Legs are usually viewed, use strips of sheeting to straighten then during embalming as infant remains can firm very solid.

Infants Techniques

Pre-injection is NOT recommended due to water composition • Do not require as much volume of solution, but require the same strength as adults.

4-12 year olds

This age group is more susceptible to bacterial and viral diseases, so insure disinfection and cavity treatment is thorough. Don't be afraid to Reaspirate and re-inject.

T/F Age alone cannot be the single factor in determine solution strength and volume.

True

T/F Diabetes and diabetes drugs cause plenty of complications

True

• Arthritis can cause positioning and distribution problems.

Use of blocks and ties will assist in proper positing. It is possible to tear tendons and muscle if rough massage is used. It is usually impossible to open arthritic fingers.

Pathologic changes due to diabetes

Use of high index fluids is common along with restricted cervical injection.

Embalming the Autopsied Infant

Usually time consuming. Areas not embalmed arterially need to be hypodermically injected and surface treatments applied.

Embalming the Autopsied Infant - Viscera

Viscera can be treated just like the adult. Clip viscera to relieve gasses. Place viscera inside before adding embalming fluid. Additional cutting in viscera will allow better diffusion of cavity chemical.

Embalming the 4-12 year

You can either use one fluid mix throughout the whole embalming, or to start "weaker" and get stronger as you go once discolorations are removed. Supplemental chemicals can be used but dyes should be minimally used to produce a natural appearance.

You increase the solution by either:

adding more of the same chemical or adding a stronger chemical.

If there is ossification in the cranium and the calvarium has been removed,

adult procedures can be utilized.

The biggest concerns with malignancy are

any buildup of wastes in the tissues to counteract preservative and any circulation issues. Cause of death is usually not attributed directly to the malignancy but due to complications involving it.

Suturing of the abdomen starts where?

at the bottom and works upward.

Compresses

can be used for surface embalming. Cover with plastic.

Calvarium clamps

can be used or you can drill small holes in the bone and wire then closed.

Inlays

can be used to pack abdomen. Inlays are surface packs made of sheeting or cotton strips.

Malignancy

can cause any variety of problems; cachexia, distribution, clotting, etc.

Sclerosis of the arteries

can sometimes be felt in an emaciated person. Be prepared to sectionally embalm remains.

Senile purpura

cannot be cleared with vascular injection. Surface packs and hypo injection may be required. Skin is fragile so be care not to tear during massage. Purpura may swell during injection since the purpura is due to the rupture of capillaries.

Embalming the 4-12 year old

• The amount of solution is greater that infants, but lower than adults.

Generally, pre-injection is used to

clear out some jaundice or discoloration. For all other cases, you run the risk of tissue distension which is why it is not performed on decomposed or other complicated bodies.

Pathologic changes due to _____ can also cause problems (gangrene).

diabetes

Age presents not only certain embalming difficulties, but also:

difficulties specific to age groups regarding positioning, feature setting, etc. • Hands and Head of an infant are presented differently than that of an adult • Positions of an elderly arthritic body is different than that of an adult.

If using cotton to pack the cranium:

ensure that cotton does not come into contact with skin unless it has been coated with massage cream as it will wick away moisture and cause complications.

For all the body types -

following manufacturers recommendation with textbook practices and personal experience should result adequate preservation.

Cardiac death can result in what?

severe edema, utilizing edema practices (channeling, gravity, edema fluids, etc.) will maximize preservation

• Gels

should be painted on inside walls of all open areas. Cover painted areas with plastic.

Loose / broken skin

should be removed at the beginning of the embalming. Surface packs should be applied and cosmetic treatment performed.

Poor circulation can lead to

sores and lesions which need to be properly disinfected.

In the event of renal/hepatic failure,

use of appropriate solutions is permitted.

Supplemental fluids are used based on

your embalming analysis.

Embalming the Autopsied Infant hypo'd areas

• All normally hypo'd areas (Trunk walls, etc.) should be hypo'd just like an adult.

Infant to Child

• Birth to Age 4

Embalming the Autopsied Infant

• Chemicals need to be of standard strength. Use of supplemental chemicals to relieve harshness may be required. • A small amount of dye for coloration is recommended. • Embalm legs before anything else to test fluid

Embalming the Elderly

• Common carotid is preferred site for injection. Sclerosis may rule out a femoral so you may have to try a popliteal. As a last resort, hypodermic injection of legs may be necessary.

Embalming the Autopsied Infant

• Generally, .5 to .75 gallon of solution should be injected with 6 to 10oz of arterial fluid ranging from 18 to 25 index. • Hypo from inside openings or from hidden points whenever possible. Close punctures with super glue in hidden areas. Inject from inside the elbow (antecubital fossa) for upper and lower arms or within the open abdomen or knee area for the legs.

Embalming the Autopsied Infant

• If you must hypo with an arterial fluid, use a fluid with as little dye as possible • Infant Arterial tubes should be cleaned after each use due to clogging issues. • A small venous catheter can serve as an arterial tube.

Embalming the 4-12 year Index

• Medium Index chemicals are recommended (18-25 index) as skin is more delicate than an adult.

Embalming the Infant

• Muscular suture can be used. Needle injector is not recommended. Some embalmers prefer using glue only and some communities prefer the mouth to be open naturally. Check with local practice to conform to norms. • If mouth is to be left open, massage cream inside cheeks and tongue. Corner of mouth may be glued.

Embalming the Infant

• Place infant on a towel to help with positioning. Towel remains in place throughout embalming. • Use cut-down eye caps for eye closure during embalming, use glue after embalming is due to seal them. You can cover eye caps with massage cream, if desired. Ensure that cream is away from eyelid margins prior to gluing.

Embalming the 4-12 old year

• Since many children at this age are autopsied, use of adult autopsy protocols are standard. • Some argue that the femoral is the best choice simply due to types of clothing for children where a carotid incision would be visible.