EMBALMING II: CHAPT. 20-DISCOLORATIONS
*Factors to consider when embalming a body with postmortem stain:*
*(1) A number of hours (approx. 6 or more) have elapsed since death* *(2) Pressed on skin does not clear* *(3) It is extravascular* *(4) It cannot be removed by arterial injection and blood drainage* *(5) It is caused by hemolysis and is not by blood in tissues*
*CAUSES OF DISCOLORATIONS*
*(1) Blood discolorations* *(2) Drug and therapeutic discolorations* *(3) Pathological discolorations* *(4) Surface discoloring agent discolorations* *(5) Reactions to embalming chemicals on the body* *(6) Decomposition changes*
*Restoration of the visible skin areas to a natural color and acceptable appearance involves the internal use of?*
*(1) Fluid dyes* *(2) Arterial injection and drainage*
*TREATING BLISTERS*
*(1) Lance and drain* *(2) Remove all damaged skin* *(3) Cauterize* *(4) Dry*
*3 Types of Jaundice:*
*(1)Toxic* *(2.) Hemolytic* *(3.) Obstructive.*
*4 Categories of Skin Lesions*
*(1)Unbroken skin but discolored* *(2)Skin scaling* *(3)Broken skin* *(4)pustular or ulcerative lesion.*
*Antemortem EXTRVASCULAR BLOOD discoloration*
*Ecchymosis:* A large bruise caused by escape of blood into the tissues.* *Purpura:* Flat medium-sized hemorrhage beneath the skin surface. *Petehcia:* Small pinpoint skin hemorrhage *Hematoma:* Swollen blood-filled area within the skin
*GANGRENE* *(PATHOLOGICAL DISCOLORATIONS)*
*WET:* Caused by venous obstruction; infected tissues red to black in color *DRY:*Caused by arterial insufficiency; a dark red-brown to black color
*Antemortem INTRVASCULAR BLOOD discolorations*
-*Hypostasis of blood (blue-black discoloration)* -*CO poisoning (result of carbon monoxide) (cherry red color)* -*Capillary congesting (hypostatic, active, or passive*
*Mold is scraped away with what?*
-1% phenol and 1% creoste solution.
*Healthy human blood serum contains approx. how much bile pigment billirubin?*
-1.0-1.5 mg
*How long should you let phenol sit before applying pressure?*
-20-30 minutes.
*ADDISON'S DISEASE* *(PATHOLOGICAL DISCOLORATIONS SPECIFIC DISEASES)*
-A bronze discoloration produced in the skin
*LUPUS ERYTHEMATOSUS* *(PATHOLOGICAL DISCOLORATIONS SPECIFIC DISEASES)*
-A chronic skin disease characterized by scaling, red, macular rash
*Ecchymosis:*
-A large bruise caused by escape of blood into the tissues.
*Excess formaldehyde converts into what?*
-Acid
*Bilirubin and biliverdin is caued by what kind of environment?*
-Acidic
*What level pH is not recommended for jaundice case?*
-Acidic
*The most influential part of skin color is?*
-Amount and distribution of melanin.
*ABRASION*
-An antemortem injury resulting from friction of the skin against a firm object resulting in removal of the epidermis
*Hemorrhage*
-An escape of blood
*Intravascular Blood discoloration respond best to what method?*
-Arterial injection and blood drainage.
*What race is Death Palor not noticeable?*
-Blacks -Suntanned Caucasian
*BULLAE*
-Blisters beneath or in the epidermis.
*ANTEMORTEM DISCOLORATIONS*
-Blood discoloration -Drug discoloration -Pathological discoloration -Surface discoloration agent
*POSTMORTEM DISCOLORATIONS*
-Blood discoloration -Surface discoloration agent -Reaction to embalming chemicals on the body -Decomposition discoloration
*Hanging can result in two very different situations.*
-Blood discoloration and Petechia -No blood discoloration.
*CYANOTIC*
-Blue or purple discoloration
*FURNUCLE*
-Boil
*Which can be removed by arterial injection, Postmortem or Antemortem discoloration?*
-Both
*Should you inject the sides of the head separately or at the same time for a gunshot wound victim?*
-Both (use a Y tube to inject both sides)
*JAUNDICE* *(PATHOLOGICAL DISCOLORATIONS)*
-Caused by many disease processes *EX. Diseases of the liver, a bile problem, or a blood problem*
*If poison effects respiration, what happens to the body?*
-Cyanotic (blue/purple)
*Should a preinjection solution be used to rid the blood vascular sustem of the nitrogenous waste?*
-Depends; if there is good circulation and drainage, yes. If there isn't. No.
*Chronic renal failure is often accompanied by?*
-Diabetes
*MENINGITIS* *(PATHOLOGICAL DISCOLORATIONS SPECIFIC DISEASES)*
-Discolorations can include *cyanosis*- a blotchy erythematous rash (reddening) of the skin. -Petechiae and purpura
*TUMORS* *(PATHOLOGICAL DISCOLORATIONS SPECIFIC DISEASES)*
-Discolorations in and around the tumor itself may be caused by pathological changes
*Flushing*
-Distribute arterial fluids but unable to obtain good drainage.
*What is caused by the capillary breakdown of the drugs?*
-Ecchymosis and purpura.
*BLISTERS*
-Elevations of the epidermis containing watery liquids
*Ecchymosis, purpura, petechia are what kind of blood discoloration? Can they have another classification?*
-Extravascular. -Can be caused by disease.
*What are the hidden point of entries for the upper eyelid and surrounding tissue?*
-Eyebrow -Hairline
*Purpura:*
-Flat medium-sized hemorrhage beneath the skin surface
*Chemicals that can be used for Surface Embalming?*
-Formaldehyde, Phenol, and autopsy gel.
*Biliverdin*
-Green discoloration
*When does Postmortem Stain occur?*
-In tissue where Livor Mortis was present. -Surface tissue where blood could not be drained.
*What are the hidden point of entries for the lower eyelid and surrounding tissue?*
-Inside mouth -Inside nostril -Behind the ear or hairline
*What kind of drainage should you use to clear Livor Mortis?*
-Intermittent or Alternate.
*Is Exsanguination external or internal?*
-It can be either
*Is swelling apart of discoloration?*
-It can be.
*If poisons effect the liver, what happens to the body?*
-Jaundice
*What is a secondary cause of drugs? Why?*
-Jaundice. -Because it effects the liver.
*Exsanguination deaths are characterized by?*
-Lack of color.
*Size of Ecchymosis? Purpura? Petechiae?* *How do you clear these discolorations?*
-Large -Small -Small -Arterial embalming, bleach.
*Postmortem INTRAVASCULAR BLOOD discoloration*
-Livor Mortis
*Refrigeration and blood thinners speed the onset of what?*
-Livor Mortis
*Some (not all of the) factors that you have to look out for in gunshot wounds?*
-Majority will be autopsied. -Fractures of the facial and cranial bone
*The 3 pigments that create skin?*
-Melanin (browns to black) -Cartone (yellow) -Hemoglobin (oxyhemoglobin) (red)
*Which pigments remain in the skin after death?*
-Melanin and carotene.
*When is it okay to use preinjection in the case of Jaundice?*
-Mild Jaundice.
*Can you bleach coinject to clear jaundice?*
-On Mild Jaundice.
*What embalming method should you NOT use on mutilation and blunt force trauma?*
-One point injection
*Could you use cavity fluids to correct jaundice?*
-Only in specific treatments.
*What cosmetic effect do you usually want with women?*
-Ornamental.
*What kind of chemical reaction is the conversion of yellow to green discoloration?*
-Oxidation
*Death pallor*
-Paleness of skin -Pink/Redness is gone from the skin.
*LEUKEMIA* *(PATHOLOGICAL DISCOLORATIONS SPECIFIC DISEASES)*
-Petechiae
*After arterially embalming a gunshot wound, what do you do?*
-Phenol (or cavity) cauterizing with hypodermic needle (use hidden point of entry)
*2 chemicals that can be used for hypodermic treatment?*
-Phenol and Formaldehyde.
*Diabetes Mellitus causes what?*
-Poor circulation.
*Postmortem EXTRAVASCULAR BLOOD discoloration*
-Postmortem Stain -Tardieu Spots
*What should you avoid when working on postmortem bruising?*
-Preinjection
*How common is postmortem bruising?*
-Rare, it occurs if sufficient pressure is applied to tissues to damage the capillaries.
*ERTHEMA*
-Red(ness)
*If poison causes anaphylactic shock, what happens to the body?*
-Redden and swell
*What kind of agent is formaldehyde?*
-Reducing agent
*Nephritis is found in cases of? What does it also do?*
-Renal failure. -Urea in the blood is converted to ammonia.
*What kind of injection is recommended for jaundice?*
-Restricted Cervical.
*Nephritis*
-Sallow yellow color or Bronzing of the skin resulting from the presence of urochrome in the tissues.
*CARBUNCLE*
-Several skin boils.
*Petehcia:*
-Small pinpoint skin hemorrhage
*All races, the color of the skin is defined as?*
-Straw color with pink overtone.
*What do you do when Ecchymosis or Hematoma (of the eye) begin to distend?*
-Stronger solution, smaller volume. -Use cotton to close the eye, place a few drops of cavity fluid on the cotton.
*What strength of arterial solution should you use for Postmortem Stain?*
-Stronger.
*Hematoma:*
-Swollen blood-filled area within the skin
*HEME*
-The Coloring Matter
*What advantage can Livor Mortis give?*
-The breaking and clearing of the Livor Mortis indicates fluid distribution.
*The embalmer should understand what when it comes to discolorations?*
-The cause of discoloration -To know which discolorations can and cannot be reduced by arterial injection -To know which discolorations can be altered or bleached by proper chemicals -To know which discolorations will have to be treated by opaque cosmetics to hide
*For Jaundice cases, do you use weaker or stronger arterial fluids?*
-Use what is recommended or slightly stronger.
*What do you do when you inject phenol around the eyes (because of swollen black eyes)?*
-Wait 20 minutes for the chemicals to cauterize the tissue. -THEN arterially inject.
*How do you remove blood stains ON the skin?*
-Washing with cold water.
*What can happen to ends of fingers cause of dehydration?*
-Wrinkle and darken.
*Bilirubin*
-Yellow discoloration
*Decomposition Discolorations*
-Yellow, green, blue-black, black.
*Can Livor Mortis be gravitated?*
-Yes
*Do you need to align the fractured bones on gunshot victims?*
-Yes
*Is Instant tissue fixation for gunshot wounds recommended?*
-Yes
*Is it okay to surgically reduce if eyelids are grossly distend?*
-Yes
*Is surface discoloration cleared by arterial injection?*
-Yes
*Can Livor Mortis and Postmortem Stain be present on the same spot? Which can be washed away?*
-Yes -Livor can wash away.
*Should you add dye when embalming Postmortem stain? Why?*
-Yes, indicates surface distribution Counterstains formaldehyde gray.
*Hypostasis*
-accumulation of fluid or blood in the lower parts of the body.
*Hemostasis*
-causes bleeding to stop
*What causes scaling skin?*
-diseases such as measles and chicken pox.
*CO poisoning intravascular conditions can become what? because of delay.*
-extravascular
*How strong should the pressure and rate of flow be when working with postemortem bruising?*
-low, to help control swelling.
*Should you apply massage cream on an abrasion to prevent it from turning brown?*
-no. Apply it AROUND the abrasion.
*What are Tardieu Spots?* *Where are Tardieu Spots seen?*
-pinpoint hemorrhages. -In Livor Mortis.
*What technique should you use to inject the face of a gunshot victim?*
-pulse
*Formaldehyde burn can create what?*
-raised rash like appearance.
*Blisters are characteristics of?*
-second-degree burns.
*Hemolysis*
-the rupture or destruction of red blood cells
*SKIN LESION*
-traumatic or pathological change in the structure of the skin.
*Is livor mortis evident in exsanguination?*
-very little
*2 MEANINGS Of DISCOLORATIONS*
1. Color is removed or lost. 2. To change color.
*2 TYPES OF DISCOLORATIONS*
1. Localized (black eye, razor burn) 2. Generalized (dehydration, livor mortis, and jaundice)
*What are the 3 things that can happen when embalming on a Large Ecchymosis on the back of the hand?*
1. Perfuse the area, little distention, good preservation 2.Area will distend 3.Nothing
