Embalming II final study guide (FSE2140)

Contents of Drainage

-Blood -Interstitial fluid -Arterial solution (*up to 50%*)

Method for humerus bone donors

-Try and find the *brachial artery* to inject. -If done in the funeral home, ask the technician to leave incision site open, for post-embalming restoration. -Use an autopsy gel or hardening compound and suture.

When embalming a decomp. body:

-Use *waterless* chemicals -Best method of embalming is: *Arterial -> Hypodermic -> Surface* (arteries are one of the last structures to break down, always try to arterially inject first) -Try not to tear pouch when moving the body. Roll the body onto a sheet and then move it. - Add dye to trace fluid. - Use a *high index* fluid.

How are discolorations classified?

Antemortem or postmortem

Concurrent Drainage

Arterial injection and drainage ARE going at the same time

Alternate Drainage

Arterial injection and drainage are NOT going on at the same time

When is the best time to embalm a body?

Before rigor mortis sets in. (pre-rigor)

*Tissues* that can be donated:

Bone Eyes (cornea, sclera) Skin Heart Valves Tendons Veins

Restricted cervical

Both the right and left common carotid are raised so that the head can be separately injected.

Which artery is larger, carotid or femoral?

Carotid

Where is the best site for injection for a person with severe arthritis (in fetal position, etc.)?

Common carotids- which ever one is exposed- can be right or left.

*Organs* that can be donated:

Kidneys Liver Heart Lungs Pancreas (person must have died at the hospital, on a machine)

What should be done with loose skin?

Loose skin should be removed prior to the start of embalming.

Instant tissue fixation (head freeze)

Low volume of a high index (often waterless) solution is used for the head, for the purpose of maximum preservation with minimum distention of tissue.

Sectional injection

Multi-point injection where direct injection of the body region is made

Different temperatures will not effect what postmortem change?

Postmortem stain

Why does rigor leave the body?

Proteins are breaking down, beginning decomposition. (*great preservative demand*)

If you're injecting the common carotid artery on an autopsy case, what artery needs to be clamped off in the head so fluid is not lost?

The *internal common carotid* artery. (this will be closer to the sella turcica, which is more superficial)

If you're injecting the subclavian artery on an autopsy case, what artery needs to be clamped off in the head so fluid is not lost?

The *vertebral* artery. (this will be closer to the foramen magnum where the spinal cord passes through to the head)

The act that allows people to harvest organs/tissues

The Uniform Anatomical Gift Act

After embalming, what area should be checked for supplemental treatments?

The body should be turned to *the posterior side* and be checked for any cuts, etc.

What area of an autopsy incision is most likely to leak?

The shoulder area because it is the lowest part of the incision.

Volume and strength of solution for Autopsy cases

There is no set volume or strength. Pathological and postmortem conditions will determine that.

How can you create infant eye caps if there are none available in the prep room in which you work?

Trim down adult eye caps.

Split injection

injection and drainage from different locations

1 gallon of arterial solution should be injected for:

Every 50lbs of body weight.

For cavity treatment on an infant, instead of inserting "2 up 2 over" where would you insert your trocar?

In *either* the right or left inguinal (iliac) area. A point that can reach everywhere.

One-point injection

Injection and drainage from one location

Multi-point injection

Injection from two or more locations

Intermittent Drainage

Injection of solution is continuous, while drainage is cut off intermittently for selected short periods.

Diffusion of retained fluid

-Capillary -Interstitial space -Interstitial fluid/Lymph system/Veins -Cell -Cytoplasm -Embalmed tissue

Order of Drainage:

-Venule -Veins -Venous system -Drainage instrument -Drainage

Stages of Rigor Mortis

Pre-rigor (*best absorption* of preservative) Rigor (little absorption of preservative) Post-rigor (high preservation demand)

What type of solution would you use to embalm an infant?

*A normal index solution or higher* because they contain a lot of moisture. The secondary dilution of your solution will be even less when it mixes with the fluid in the baby, weakening your solutions strength.

Method 2 for long bone donors

*Leave the sutures in place* from the procurement team (only if they are tight and the body is not being shipped out), *hypodermically inject the limb* and leave the fluid in there to work, then use a trocar to aspirate the fluid out and seal incisions.

In instances of severe arteriosclerosis, what is the best method of injection?

*Restricted cervical injection* using the common carotid arteries. (In some cases, you may be able to palpate the femoral arteries to feel whether arteriosclerosis is present *before* making that incision) This way, you can use a strong solution for the body, and a lesser strength solution for the head.

Considerations for Autopsied Infants:

-*Closure methods*. Bones of the skull that have not ossified will be in pieces which will have to be glued together or sutured. -Cotton will have to be added to the cranial cavity as well, otherwise it will cave in. -Dental floss is a good substitution for ligature when closing incisions. (or a very strong superglue) -You should ask the family to bring something to cover the head (bonnet, hat, etc).

Considerations for arthritic conditions in the elderly

-*DO NOT* break arthritic conditions (bones, tendons, etc.) These conditions develop over time and the family is used to seeing them this way. This will also cause breakage of capillary beds and cause swelling. -If you choose to break arthritic conditions, *get permission from the family first*, as this is a major reconstruction and not part of the normal embalming process.

How should you adjust the rate of flow for delayed cases?

-*The rate of flow should be slower* to try and prevent abdominal distention -Pressure may be increased for sectional embalming -Use *pulse injection*

What kind of solution should be used for delayed embalming?

-A strong solution; *25 index or higher*. -Dyes should be used to trace the fluid. -Pre-injection should *not* be used because too much water will speed decomposition -Volume will depend on the size of the body.

Considerations for diabetes

-Acidosis condition, will cause *poor peripheral circulation and break down capillary beds*. -*Renal & liver problems* -Causes *fungal infections* which are harder to kill than bacterial infections. -Elevated glucose levels will lead to *damage of blood vessels*, you may have to *use a more distal site for arterial embalming*. -*Use higher index solution & supplemental chemicals* due to acidic conditions.

When is the restricted cervical injection recommended?

-Bodies with facial trauma -Facial distension is anticipated -Eye enucleation -Generalized edema -Difficult to firm -Distribution problems -Purge is expected -Instant tissue fixation is wanted

Calvarium treatment

-Calvarium clamps -Wiring and drilling holes -Sutures (use *temporalis muscle*) -Needle injector -Adhesives (bone must be completely dry) -Fill bone incision with mortuary putty -Suture the scalp (*right to left*)

How does cooler temperature effect delayed embalming?

-Cooler temperatures will keep the blood thinner, which will make hypostasis and livor mortis much more vivid. -Decomposition will be slower. -Immediate cooling after death will stop the onset of rigor mortis. - A *cold, dry environment* will hinder gas formation, bloating, & swelling.

What 4 processes are going on at the same time during the normal embalming procedure?

-Delivery (injection) -Distribution -Diffusion -Drainage

General working order for an autopsy case:

-Disinfect, Position. -Treat calvarium. -Shave/set features. -Open cavities/remove and treat viscera -Inject vessels using a high strength solution since you will lose most of it. (start with the legs) -A higher rate of flow can be used on the body but a slower rate of flow should be used on the head. -Use dyes to trace fluid. -Drainage is taken with an autopsy aspirator. -Supplemental treatments. -Return viscera and suture.

In what instances would you employ instant tissue fixation?

-Early decomposition, when facial swelling is anticipated. -When facial trauma is present. -When facial tissues must be dried and firm for restorative treatments. -When facial excisions are necessary (tumors, etc.) -Re-embalming of the face.

Methods to control swelling:

-Elevation devices -Weights -Compresses and pneumatic collars -Pulsation injection -Drain tubes, to control drainage

For cornea removal:

-Embalm like normal -After arterial injection, check for leakage -If so, aspirate using large needle -Repack and return to normal using an eye cap and glue

To embalm a heart/lung donor:

-Embalm the lower half of the body using the abdominal aorta. -*Inject the rest of the body using the arch of the aorta*. -Aspirate the lower half and inject cavity fluid. -Treat the top like an autopsy using a hardening compound.

Considerations for malignancies

-Evaluate the local and systemic effects of the malignancy. (coagulations, hormones, tumors, anemia, cachexia) -Use a solution strength of 2% or greater -Co-injection recommended.

How should you embalm a person between the ages of 4 and 12?

-Fluid strength is determined by condition of the body. -Volume of fluid would be less than adult but greater than an infant. -Will have more delicate skin than adults -Injection sites would be the same as an adult (common carotid/jugular vein and femoral artery/vein) -Intermittent drainage recommended -Positioning is similar to adult - can be a little more "relaxed".

What is the best way to embalm a delayed case?

-High index solution (25 or higher.) -use dyes for distribution signs. -The first 1/2 gallon may be milder to help clear up discoloration. Volume depends on size of body *No pre-injections*

Problems with long-term refrigeration:

-Increased capillary permeability; easy rupture of capillaries during injection which can cause swelling -Tissue breakdown because of autolysis -Intense livor mortis (causes postmortem stain) -Skin-slip due to plastic wrapped tissue -Decomposition -Hemolysis easily occurs causing *post-mortem stain* (gives a false pink color) -Dehydration if not properly wrapped - Frozen bodies (from refrigeration) should be treated via restricted cervical injection with a *low volume of high index solution*

Order of Distribution of Arterial Solution:

-Injection Machine -Delivery hose -Arterial tube -Injection artery -Aortic semilunar valve -Arch of Aorta -Arterial system -Arterioles -capillaries

Purposes of drainage

-Make room for arterial solution -reduce secondary dilution of arterial fluid -remove intravascular blood discolorations -remove elements that speed decomp -remove bacteria -prevent discolorations -reduce swollen tissue

*Intravascular* resistance

-Narrowing/obstruction of the lumen -Blood -Arteriosclerosis -Coagula -Emboli, thrombi

Treatment for skin donors

-Paint the affected area with a cauterant. -Put plastic over the affected area after drying. -Use plastic undergarments.

Work Practice controls

-Proper ventilation and exhaust -Prevent spillage of chemicals -Keep embalming machines in good repair -Rinse fluid bottles -Cap all chemical bottles -Keep a lid on the embalming machine -Use continuous aspiration and clamp leaking vessels on autopsied bodies -Restrict drainage as much as possible (after discolorations have cleared) -Use closed drainage -Avoid splashing -Use moving water to remove drainage from table.

Best injection methods for bodies that are delayed, refrigerated or decomposing:

-Restricted cervical -Sectional -One point injection is *not* recommended because of lack of control of amount of embalming solution entering the head

*Extravascular* resistance

-Rigor Mortis -Gas Pressure -Tumors -Ascites -Contact Pressure -Visceral weight -Bandages -Edema

For total eye enucleation:

-Saturate cotton with autopsy gel -Fill out to recreate normal appearance -Embalm slow to avoid swelling -Remove packing -Use incision sealer -Repack, insert eye cap and glue eyelids shut

Problems encountered embalming a case with rigor mortis:

-Setting features- the jaw could be locked closed -Distribution of fluid because of pressure of the contracted muscles -Drainage of fluid because of constriction of veins due to muscle contraction -Tissue swelling -pH is not ideal for fluid reaction -Firmness gives false sign of embalmed tissue

Good drainage can be expected when:

-Short interval between death and embalming -Livor mortis very early -Skeletal edema is present -jaundiced, -carbon monoxide poison -refrigerated early after death -treated with heparin or dicumar

Advantages of short-term refrigeration:

-Slowed rigor cycle -Decomposition is slowed -Low viscosity of blood is maintained

Method 1 for femoral bone donors

-The donor technician's *sutures are removed* and areas are arterial injected. -Try and find the *femoral artery* to inject. -Treat the tissue with dryene. -Use a prosthesis. -Use an autopsy gel or hardening compound and suture.

How does warmer temperature effect delayed embalming?

-The warmer the temperature, the faster rigor mortis will set in. -Decomposition will be faster.

Considerations when embalming an infant

-Their skin is very delicate and can distend and/or wrinkle very easily. -They have a very high moisture content- NO pre-injection fluid. -Use regular index fluids and supplemental fluids. -Renal & liver failure- use a moderate to strong solution.

Preservative considerations for a body in full rigor

-There is little absorption of preservative. -the index should be higher -the solution should be stronger (*great preservative demand*)

When positioning an infant, what should be considered?

-They should be more relaxed than adult positioning, with arms to the sides or holding a toy (positioning will differ per funeral home). -Their whole body should be considered because infant caskets are usually full couch. -Ask the family to bring in an infant diaper.

Considerations for cardiac disease

-Use common carotids for injection site. -Use a moderate to strong solution.

Treatment of the viscera (autopsy)

-Viscera should be treated in cavity fluid during embalming. -Intestines should be cut to let fluid in and let gases out. -Replace in cavity after arterial embalming. -Use a hardening compound.

Age groups to consider

Infant to child - birth to age 4 Child to young adult - age 4 to 12 Young adult to adult - age 12 to 70's Old age - 70's to late 90's

A strong solution can wall off capillary beds, how would you avoid this?

Inject a mild 1/2 gallon solution first, this will also help clear discolorations, and then add stronger fluids after the first 1/2 gallon has been injected.

Mouth closure for the elderly

Suture is recommended

What is the recommended method of mouth closure for an infant? Why?

Suture, because they don't have teeth and their bones haven't ossified yet.

How much cavity fluid should you use on an infant?

The amount of cavity fluid will depend on the size of the individual.

A rule of thumb when embalming the adolescent:

The younger the person, the more skin that could be showing at a viewing- maybe use femoral or axillary arteries as your primary injection site so incisions can be hidden more easily. If carotids are used, consider using an intradermal stitch and cosmetics.

Shell Embalming

When the solution follows the direct connections between arterioles and venules, resulting in only the surface receiving embalming solution.

How would you treat an area with senile purpura?

With a bleaching agent and cosmetics. A slower rate of injection should be used to prevent further rupture of the capillaries.

How would you embalm a dehydrated case?

With a large volume of normal strength solution.

How should areas that did not receive solution during arterial embalming be treated?

With hypodermic or surface embalming.

When selecting a vessel to use on an infant, what should you consider?

You should choose the largest vessel; common carotid or if they are very small (3-5lbs), you could use the ascending or abdominal aorta. (The arch of the aorta is the largest)

What is the average body fat percentage in an infant?

12%

How much arterial solution should be retained in a 200lb case?

2 gallons - because half will come out as drainage.

What is the average body fat percentage in an person over the age of 1?

25-30%

An infant (up to the age of 1) is what percent water?

75%

How much does 1 gallon of water weigh?

8lbs

When a baby is embalmed, what should he/she smell like?

A baby should not smell like chemicals in the prep room - they should be rubbed with baby power or baby oil so they smell like a baby.

If you do not have access to an infant trocar, what could you use instead?

A regular adult trocar, you just won't insert it as far.

What kind of solution should you use on a delayed case (post-rigor)?

A stronger solution should be used because there is great preservative demand.

Why is resistance valuable to drainage?

Resistance helps slow the embalming solution and hold it within the capillaries, allowing for better diffusion. It helps the tissues retain solution and reduces short-circuiting.

Center of drainage

Right atrium of the heart

When closing an autopsy incision you should:

Start by joining all three "flaps" together and work distally.

How is positioning a baby different than positioning an adult?

Use towels, etc to soften the contour of their back because babies are more likely to be picked up by their parents, and their backs should not be flat or red from contact with the embalming table.

When is the only time you should worry about a tumor?

When it cuts off circulation. Then you would have to get the family's permission to excise it.

All drainage instruments are inserted towards:

the heart

Primary drainage

the location which drainage is first taken.

Senile purpura

An extravascular discoloration that can *not* be cleared by arterial embalming.

Specific areas that should be hypodermically injected after arterial embalming the autopsy case:

Buttocks, breast, chest "flaps", shoulders, neck, plus any untreated areas that did not receive arterial solution.