Embalming II Chapter 24 SPCollege Review

injuries in which the skin is not broken

(contusion, hematoma).

Renal Failure - Embalming Protocol

- Restricted Cervical recommended -Preparation of the body affected by renal failure calls for the use of strong arterial solutions. Preinjection fluid should be avoided, because if circulation is impaired, tissues can easily swell. Begin with at least a 2.0% formaldehyde-based arterial solution. The use of a 30- to 35-index fluid is advised. -When both edema and renal failure are present (in addition to side effects of drug therapy, effects of the immediate cause of death, and postmortem changes that have occurred if embalming was delayed), - saturate these tissues with a strong preservative arterial solution. If this is not done the body will soften in a few hours, blebs can form, desquamation can develop, and the body can discolor and show signs of decomposition within a day or so. - To inject these strong solutions without over embalming the facial tissues, restricted cervical injection is advised. A large volume of very strong arterial solution can be injected into the trunk, and later a milder solution can be used to embalm the facial tissues. The cavities should be thoroughly aspirated. Inject a minimum of one bottle of concentrated cavity fluid into each cavity. During arterial injection purge is possible from gastrointestinal ulcerations, so a large amount of blood and arterial solution may be present in the contents aspirated from the abdominal cavity. These bodies should be aspirated immediately after arterial injection. It is also advised that these bodies be reaspirated and reinjected. Some of the dependent areas press against the embalming table. These pressure point areas often do not receive sufficient arterial solution. These dependent areas are high in moisture, and so hydrolytic changes occur and the putrefactive bacteria flourish. Coveralls and possibly a union all may be needed to prevent leakage if pitting edema is present. Preservative-deodorant powder should always be sprinkled inside the plastic goods.

Decomposition - Gases Distension (Treatment ?)

- arterial injection of sufficient amount of the appropriate strong chemical - hypodermic and surface treatments - channeling to release gases

Decomposition - Gases Distension (Source ?)

- bacterial breakdown of body tissues - autolytic breakdown of body tissues

Air from embalming apparatus - Gases Distension (Characteristics ?)

- first evidence in eyelids - no odors - no skin slip - amount depends on injection time

Gas Gangrene - Gases Distension (Characteristics ?)

- foul odor - infection

Subcutaneous Emphysema - Gases Distension (Treatment ?)

- gas escapes through incisions - establishment of good arterial preservation - channeling of tissues after arterial injection to release gases

Subcutaneous Emphysema - Gases Distension (Characteristics ?)

- no odor - no skin-slip - no blebs - gas can reach distal points - even toes - can create intense swelling - rises to the highest body areas

Decomposition - Gases Distension (Characteristics ?)

- possible odor - skin-slip in time - color changes - purging

Subcutaneous Emphysema - Gases Distension (Source ?)

- puncture of lung or pleural sac - seen after CPR - puncture wounds to thorax - rib fractures - tracheotomy

"True" Tissue Gas - Gases Distension (Treatment ?)

- special "tissue gas" - arterial solutions - localized hypodermic injection of cavity fluid - channeling of tissues to release gases

Gas Gangrene - Gases Distension (Treatment ?)

- strong arterial solutions - local hypodermic injection of cavity chemical

"True" Tissue Gas - Gases Distension (Characteristics ?)

- very strong odor of decomposition - skin slip - skin blebs - increase in intensity and amount of gas - possible transfer of spore-forming bacterium via cutting instruments to other bodies

Renal Failures signs and symtoms

-Sallow color to the skin as a result of urochrome buildup. -Uremic pruritus (scratch marks on the extremities). -Increase in the amount of urea, uric acid, ammonia, and creatine (urea and ammonia can be detected by their odor). -Acidosis. -Edema (retention of sodium by the kidneys leads to increased retention of water). -Anemia. -Gastrointestinal bleeding (blood in the gastrointestinal tract and purging). The importance of this disease to the embalmer lies in the fact that these bodies rapidly decompose.

Candidiasis aka (Moniliasis)

Candida species are commonly found in the mouth, intestinal tract, and vagina of healthy individuals.

Mycotic infections - fungal infections

Candidiasis Aspergillosis Histoplasmosis Embalmers should never handle cases with bare hands most fungal infections are saprophytic topical disinfection before handling

Mycotic infections - fungal infections - Preventions

Embalmers should never handle cases with bare hands most fungal infections are saprophytic topical disinfection before handling

Pressure can develop from:

Gas Visceral expansion Arterial injection Ascites

Histoplasmosis - (Reticuloendothelial Cytomycosis)

Histoplasmosis is caused by the oval, yeast-like organism occurs worldwide, although infection is particularly common in the Mississippi Valley of the United States. Positive diagnosis depends on the identification of the organisms in cultures of sputum, blood, or bone marrow or in biopsied tissue from the lymph nodes. This infection may spread throughout the body. Histoplasmosis is not generally spread between individuals. It appears to be contracted from soil contaminated with fecal material of chickens, pigeons, starlings, other birds, and bats. Mayer, Robert. Embalming: History, Theory, and Practice, Fifth Edition (Kindle Locations 13036-13041). McGraw-Hill Education. Kindle Edition.

Aspergillosis

Most species are saprophytic and nonpathogenic. Some are found as harmless invaders of the external auditory canal, nasal sinuses, and external genitalia and as secondary invaders in lung abscesses. In involvement of the ear, the external auditory canal may be partially filled with foul moist material spotted with black granules. The lung appears to be the most common site of serious infection.

Significance of Mycotic Infections to Embalming

Mycotic infections are frequently encountered, especially in those with debilitating or immunosuppressive diseases and diabetes mellitus. The widespread use of immunosuppressive drugs, combined with modern medical advances that keep patients alive but debilitated, has led to a considerable increase in the incidence of fungal infections.

MYCOTIC INFECTIONS

Mycotic infections are fungal infections that may have been present as an antemortem condition or occurred as the result of a postmortem invasion. Fungi may be saprophytic or parasitic; that is, they obtain their nourishment from a dead organic material or from a living organism. Fungal infections are not rare in humans and frequently are serious. Often, skin and mucous membranes are affected by the fungal infection, as in athlete's foot and thrush. The more destructive parasitic fungi produce widespread chronic lesions.

Phycomycosis

Phycomycosis is an infection of the lungs, the ears, the nervous system, and the intestinal tract caused by a fungus commonly encountered as a saprophyte or a contaminant.

Facial Trauma

Restricted Cervical Instant tissue fixation Use pulsation injection low volume high index solution Maybe use waterless Left side first injection side

Removal of Gases from Tissues (what areas)

Trunk Neck and Face Facial Important to disinfect instruments if gas gangrene was present

Air from embalming apparatus - Gases Distension (Source ?)

air injected by embalming machine (air pressure machines and hand pumps are in limited use today)

Gas Gangrene - Gases Distension (Source ?)

anaerobic bacteria c perfringens

"True" Tissue Gas - Gases Distension (Source ?)

anaerobic bacteria (gas gangrene) c. perfringens

Air from embalming apparatus - Gases Distension (Treatment ?)

if distension is present, channeling after arterial injection to release gases

Candidiasis (oropharyngeal)

is a specific complication of AIDS, because individuals with AIDS are immunosuppressed. Mouth lesions can spread down the trachea and the esophagus and produce extensive gastrointestinal infections. Oral candidiasis can occur at any age during the course of a debilitating disease. It can also occur under dentures and orthodontic appliances and can complicate other erosive mucosal diseases (e.g., pemphigus vulgaris). The moist folds at the corners of the mouth provide a friendly environment for a troublesome candidal infection.

Candida albicans

is the most common cause of candidiasis. A common form of the disease known as thrush affects the oral mucosa (tongue, gums, lips, and cheeks) and the pharynx and is seen most often in debilitated infants (especially premature) and children. The lesions, white patches on the mucosa, comprise an overgrowth of yeast cells and hyphae and a nonspecific acute or subacute inflammation of the underlying tissue. Similar lesions occur on the vulvovaginal mucosa, particularly in diabetic and pregnant women and women on birth control pills.

When arterial solution is present in purge during injection and drainage is occurring do what?

keep injecting

Purge

postmortem evacuation of any substance from any external orifice

When arterial solution is present in purge during injection and drainage is stopped

sectional injection method is used

RENAL FAILURE - during embalming another way to suspect this failure

Also, during and after embalming, if tissues fail to respond (by firming), the embalmer may suspect renal failure. It has been estimated that six times more preservative chemical is needed to preserve tissues of bodies dead from the complications of renal failure.