Embalming II Test 1

Work practice controls

1 be aware of ctting and shapr instruments are laid 2 cover broken or cut bones 3 washed gloved hands or change gloves often 4 avoid use of high water pressure when water is used to flush fluids from table 5 practive continuous aspiration of cavities during arterial injection 6. clamp leaking arteries and small veings 7. run table water continuously to dillute and carry away blood 8 pack external orfices calvarium and the removed portion of the sterneum can be soaked in peseving solution

factors determined in the embalming analysis

1. Vessels for injecrtion and drainange 2. method of mouth closure 3. strength of embalming solution 4. volume of embalming solution 5. injection pressure 6. injection rate of flow

Old Age

Embalmers will have greater numbers of bodies in this age group as the medical profession progresses with its technology. -Arthritic conditions are common and may cause a number of positioning problems in this age group. -Mandibular suturing will be used most often in conjunction with cotton and/or mortuary putty to achieve a comfortable mouth closure. -Arteriosclerosis is very common, resulting in the restricted cervical injection being the first choice for arterial embalming. -enile Purpura or ecchymosis, are extravascular and do not clear with arterial injection. Many older people have these bruises on their hands and arms may require surface compresses or hypodermic injections to lessen the discoloration. -Both local and systemic effects of malignancy have an effect on embalming. Your text will detail some of these effects and remedies.

exploratory autopsy

Exploratory autopsies are rare. This type of an autopsy generally requires that no organ or tissue be removed from the body. In most cases the embalmer can proceed with the embalming as if the body was not autopsied. As needed, vessels at the incisions may have to be clamped off or ligated to prevent leakage. Some hypodermic embalming may also be required before incisions are sutured after the arterial embalming. In the event that bone or tissues were removed, the procedures outlined in the chapter dealing with Organ and Tissue Donations may be followed.

calvarium replace and secure

One or a combination of these methods can be used to secure the calvarium in its original position.. a) Drill a series of holes opposing each other in the calvarium and remaining skull. Insert wires through the holes and tightly twist them together. b) Apply special "calvarium clamps" provided by the mortuary supply outlets. c) Apply special mortuary adhesives to secure the two pieces of the skull together.

Supplemental Embalming Treatments

Surface Embalming, Hypodermic Embalming

Surface Embalming

The direct contact of body tissues with embalming chemicals. Surface embalming may be applied to both external and internal body surfaces. These can be used in combination, such as in the use of gels and powders in the treatment of a gangrenous limb. The three most common types of surface chemicals are: a) liquids (most commonly used) b) gels c) powders

Quadrant or Four Region of the abdominal region

The division of the abdomen into four regions is achieved by means of two imaginary planes, one horizontal or transverse and the other sagittal or vertical.

Nine Region of the abdominal region

The division of the abdomen into nine regions is achieved by means of four imaginary planes, two of which are horizontal or transverse and two sagittal. contains: Right hypochondriac, Epigastric, Left Hypochondriac, Right Lumbar, Umbilical, Left Lumbar, Right Inguinal (illiac), Hypogastric, and Left Inguinal (illiac)

Aspiration Procedures; Cranial Cavities

There are three conditions that may necessitate the aspiration of the cranium. 1) Disease of the brain 2) Cerebral hemorrhage 3) Gas within the cranium -The preferred method of aspiration is use of a small bore trocar introduced into the nostril and then through the cribiform plate of the Ethmoid bone, then inject sufficient undiluted cavity fluid.

Incision Closures

Two accepted methods of incision closure are sutures and super glues.

Coinjection fluids

a supplemental fluid, is used primarily to enhance the action of the arterial solution. Both adolescent and adult bodies can be treated with coinjection and preinjection chemicals.

abdominal minimum vessels that must be used to regional or sectional embalm the body.

a) Common Carotid Arteries - head b) Subclavian Arteries - neck, shoulders, and extremity c) Axillary Arteries - medially and laterally d) Internal Iliac Arteries - gluteal, peroneal areas e) External Iliac Arteries - lower extremity and anterior abdominal wall

thoracic autopsy minimum vessels that must be used to regional or sectional embalm the body.

a) Common Carotid Arteries - head b) Subclavian Arteries - neck, shoulders, and extremity c) Axillary Arteries - medially and laterally d) Internal Iliac Arteries - gluteal, peroneal areas e) External Iliac Arteries - lower extremity and anterior abdominal wall

spianal cord autopsy method of removal

a) Dorsal b) Ventral c) Foramen Magnum/ sample

Adolescent To Adult

age group ranges between 13 to 75 years of age. First Choice; raise both common carotids, using the right internal jugular for drainage Second Choice; raise only the right common carotid, using the right internal jugular for drainage Third Choice; raising the right femoral artery and vein

Foramen Magnum/ sample spinal cord removal

approach is difficult and rarely used. usually through the ventral approach a wedge cut from the vertebral column

Dorsal spinal cord removal

approach requires that the vertebral column be opened from the back of the body.

Ventral spinal cord removal

approach requires that the vertebral column be opened from within the body cavities.

Supplemental fluids

can be employed in the embalming of all bodies. They are designed to enhance the preservative and disinfecting qualities of the preservative fluids.

coroner or medical examiner autopsy reasons

cause of death manner of death time of death recovering identifing and preserving evidence providing factual objectinge infor for legeal athorities separate deaths dute to disease from deaths due to external causes

Hypogastric

center botton portion of the nine abdominal regions contains: bladder in adults if distended, uterus during pregnancy, coils of small intestine, and the greater omentum

Umbilical

center middle region of nine abdominal region Contains: transverse colod, part of body kidneys, part of duodenum, colils of small intestine, greater mentum, bifurcation of the abdominal aorta and inferior vena cava

Preinjection fluids

classified as supplemental fluids. These fluids are injected primarily to prepare the vascular system and body tissues for the injection of the preservative vascular or arterial solutions. These are injected before the preservative solution is injected.

Terminal disinfection

comprises the disinfection practices carried out after the embalming process to protect the environment and includes personal hygiene for the embalmer as well as disinfection of the instruments, equipment, and preparation room

guide for the heart; right side

direct the trocar point along a line from the left anterior-superior iliac spine to the lobe of the right ear; keep the point up against the cavity wall until it has pierced the diaphragm, then dip it downward and insert into the heart

guide for the cecum

direct the trocar point toward a point one-fourth of the distance from the right anterior-superior iliac spine to the pubic symphysis; keep the point of the trocar well up near the abdominal wall until within four inches of the right anterior-superior iliac spine; then dip the point two inches and insert it forward into the colon

guide for the stomach

direct the trocar point toward the intersection of the fifth intercostals space and left mid-axillary line; continue until the trocar enters the stomach

Guide for urinary bladder

direct the trocar point toward the intersection of the median line and pubic bone, keeping it well up toward the abdominal wall until it touches the bone; then withdraw about one-half inch, dip the point slightly and insert into the bladder

autopsy

examination of the organs and tissues of a body to determine cause of death or pathological condition aka necropsy/ post mortem

necropsy

examination of the organs and tissues of a body to determine cause of death or pathological condition aka autopsy/ postmortem

postmortem

examination of the organs and tissues of a body to determine cause of death or pathological condition aka autopsy/necropsy

Child To Young Adult

four thru twelve years of age has some difficulties associated with it. The vessels are generally smaller than that of adults. The axillary arteries are not good primary injection sites. Fluid strengths are determined by the condition of the body. Considerations should be given to the somewhat delicate nature of the skin in this age group. The overall volumes of arterial fluids will be less than that of adults. Positioning and setting of features requires no unique or special procedures.

partial autopsies

generally only one body cavity (cranial thoracic or abdominopelvic) is opened to examine one specific item. This type of autopsy is most frequently performed as the medical or hospital autopsy.

Hypodermic Embalming

injection of embalming chemicals directly into the tissues through the use of a syringe, needle, or trocar. This method can be used to treat tissue areas that cannot be arterially embalmed. The solution used for this process can be standard arterial mixtures, however, it is recommended that the index be raised with cavity fluid or a higher index fluid. Phenol solutions are not to be routinely used for supplemental hypodermic embalming, only localized treatments of discolored areas or when the bleaching of tissue is necessary.

Electric Aspirator

is a device that uses a motor to create a suction for the purpose of aspiration.

Trocar

is a sharply pointed surgical instrument used in cavity embalming to aspirate the cavities and inject cavity fluid. The trocar may be used for supplemental hypodermic embalming.

Hydroaspirator

is the apparatus that is connected to the water supply; when the water is running through the apparatus, a suction is developed and is used to aspirate the contents of the body's cavities.

postembalming period

last of the three periods of embalming. This period includes the treatments of a restorative nature. A delayed cavity treatment is considered to also be in this period.

left inguinal (iliac)

left bottom portion of the nine abdominal regions contains: part of descending colon, sigmoid colon, coils of small intestine, and the greater omentum

Left lumbar

left middle portion of the nine abdominal regions contains, part of the left kidney, descending colon, coils of small intestine, and the greater omentum

Double Intradermal suture

made with two needles threaded with opposite ends of the same thread. The holding ability is slightly better than the single Intradermal type.

Trocar Guides

main guids are to reach the stomach, cecum, urinary bladder, and the heart These four guides all originate from a point of reference two inches to the left and two inches superior to the umbilicus.

spinal cord autopsy

may be preformed in conjunction with a complete autopsy. There are cases when only a spinal autopsy will occur. Most times a partial removal of the spinal cord will be preformed through the ventral approach. A small wedge of the vertebral column, containing the spinal cord, will be removed. Treatment requires a cotton pack saturated with an embalming gel inserted into the open area. Rarely will the entire spinal cord be removed.

cranial sealing the incision

one or a combination of the following methods can be used to secure and seal the scalp incision. a) Baseball Suture b) Whip Suture c) Intradermal or Subcutaneous Suture d) Adhesives

Senile Purpura

or ecchymosis, are extravascular and do not clear with arterial injection. Many older people have these bruises on their hands and arms may require surface compresses or hypodermic injections to lessen the discoloration.

Single Intradermal

or hidden suture is used on the exposed areas of the body. The single stranded stitch is the easiest type to conceal.

Interlocking suture

or lock suture is a very tight leakproof suture. The large ridge it creates in the surrounding tissue is its greatest disadvantage.

Continuous suture

or whip suture is used to close autopsy incisions during the transport of bodies from the hospital to the funeral home.

Inversion suture

or worm suture, is used to gather in and turn under excess tissues. This suture is not visible and easily waxed.

hospital autopsy reason to perform

page 327

complete autopsy

page 330, involves opening of the following body cavities and removal of the following organs 1. cranial cavity and contents 2.eye enucleation or viterous humors of the eye 3. removal of the neck orans 4. Thoracic cavity and contents 5. abdominal cavity and contents 6. pelvic cavity and contents 7. spinal cord testes from scotum tissue samples from any region of the body

autopsy guideline to determine when to perform

pg. 328

Infant To Child

ranges from birth to four years old. The infant period is from birth to eighteen months. The toddler age ranges from eighteen months to forty-eight months. Generally an infant will contain approximately 75% verses the one year and up 60% of total body weight being water. Body fat in a newborn will only be about 12% then increase to 30% at one year of age. This helps to understand why infant embalming requires special attention. A general rule is to use regular arterial and supplemental fluids when embalming this age group.

Reaspiration

repeated treatment of a cavity. Reaspiration may take place a few hours after embalming or just before dressing and casketing. Additional cavity fluid injection is determined by the body conditions as seen by the embalmer. main reasons for reaspiration: -blood infections -advanced decomposition -ascites -pulmonary infections -infectious diseases of the abdominal organs and tissues -obese bodies -excessive gas formation -prior to shipping-

right inguinal (iliac)

right bottom portion of the nine abdominal regions contains: cecum, appendix, part of the ascending colon, coils of small intestine, and the greater omentum

Right lubar

right middle portion of the nine abdominal region contains: lower portion of liver, ascending colon, part of right kidnet, coils of small intestine, greater omentum, right colic ( hepatic) flexure

Tubing

rubber or plastic tubing is needed to connect the trocar to the devise used to create the required suction. It is also used to connect the trocar to a gravity injection device to apply the disinfectant / preservative chemical.

Baseball

sutures are the most common type used. This type is very secure and can be airtight, however, a ridge of tissue adjacent to the incision will result.

crepitation

the crackling sensation produced when gasses trapped in tissue are palpated, as in subcutaneous emphysema.

calvarium

the domelike superior portion of the skull that is removed during a cranial autopsy

Bridge

the individual suture are temporary and used to align tissue during any stage of embalming.

Distension

the state of stretching out or becoming inflated. This can occur anyplace in the body

Epigastric

top center portion of nine abominal region contains: stomachincluding cardiac an pyloric openings, portions of liver, duodenum, pancreas, suprarental glands and part of kidneys, and the greater ometum

left hypochondriac

top left portion of nine abdominal regions contains: part of liver, Stomach (fundus and cardiac regions) spleen, top of pancreas, left colic splenic flexure, part of left kidney, greater omentum

Right Hypochondirac

top right portion of the nine abdominal regions Contains: Part of the liver, part of right kidney, Greater omentum, coils of small intestine, and gall bladder

Aspiration Procedures; Reduction of a Distended Neck

Channel the neck tissues with the trocar after vascular injection but prior to the abdominal treatments. This will allow for the drainage of excess liquids into the body cavity.

Theory Two - Cavity embalming timing

Cavity embalming is delayed an hour or more after vascular embalming has been completed. This method allows the arterial solution to remain in the vascular system longer to take more of an effect on the tissues.

cranial autopsy steps to be followed for following arterial injection of the cranium

1) Clean and dry the interior of the cranium. 2) Cover the base of the skull with a quick-drying sealer and fill the foramen magnum with a mortuary putty. 3) If the brain was returned with the body, remove it from the embalming solution, dry the tissue, apply a hardening compound, and replace the brain. If the brain was not returned, mix a hardening compound with cotton and fill the brain space. 4) Replace and secure the calvarium. One or a combination of these methods can be used to secure the calvarium in its original position.. a) Drill a series of holes opposing each other in the calvarium and remaining skull. Insert wires through the holes and tightly twist them together. b) Apply special "calvarium clamps" provided by the mortuary supply outlets. c) Apply special mortuary adhesives to secure the two pieces of the skull together 5) Carefully fill the line of bone incision with a quality mortuary putty sealing any possible leaks and creating a smooth skull surface. 6) Return the scalp to the original position. 7) Depending on the embalming analysis, one or a combination of the following methods can be used to secure and seal the scalp incision. a) Baseball Suture b) Whip Suture c) Intradermal or Subcutaneous Suture d) Adhesives

Aspiration Procedures; Abdominal, Pelvic, and Thoracic Cavities

1) Prepare the necessary equipment then insert the trocar through the abdominal wall. 2) Thoroughly puncture, drain, and channel all thoracic, abdominal, and pelvic organs. No specific order is required. 3) Generally using gravity pressure, inject sufficient undiluted cavity fluid to saturate all organs and all regions of the cavities. 4) Treatment of the trocar puncture, most commonly results in the application of a plastic threaded "trocar button" being screwed into the puncture. The puncture can also be sutured. A less common treatment is the covering of the open puncture with cotton then covering the cotton with a impermeable material. 5) The throat should be cleared of all purge material using a nasal aspirator.

Thoracic and abdominal autopsy treatments

1) Reopen all cavities and remove sutures or wire staples. 2) If viscera has been returned, remove and clean/sanitize the bag. Carefully open the bag and add a sufficient amount of cavity fluid to preserve the viscera. Reseal the bag, removing the air pockets. Cut off ant excess plastic bag. 3) Carefully examine the damage to the vascular system. 4) Below are the minimum vessels that must be used to regional or sectional embalm the body. a) Common Carotid Arteries - head b) Subclavian Arteries - neck, shoulders, and extremity c) Axillary Arteries - medially and laterally d) Internal Iliac Arteries - gluteal, peroneal areas e) External Iliac Arteries - lower extremity and anterior abdominal wall 5) Keep all body cavities as dry as possible during the injection process. Aspirate all cavity drainage continually during the embalming. 6) Examine and treat unpreserved areas of the trunk using one or both of the following methods. a) Hypodermically Embalm - the injection of en embalming solution directly into the tissues b) Surface Embalm - the direct contact of body tissues with embalming chemicals 7) Viscera remaining in the cavity should be liberally covered with a hardening compound 8) Ligate the rectum and esophagus. Pack and seal the trachea and vagina. 9) If the viscera was returned in a plastic bag, return the bag and chemically treated tissue to the cavity. 10) If the viscera was not returned, mix a hardening compound with cotton and fill the cavity to a normal fullness. 11) Replace and secure the sternum and costal cartilages and close the cavity with sutures.

abdominal and thoracic autopsy treatment

1) Reopen all cavities and remove sutures or wire staples. 2) If viscera has been returned, remove and clean/sanitize the bag. Carefully open the bag and add a sufficient amount of cavity fluid to preserve the viscera. Reseal the bag, removing the air pockets. Cut off ant excess plastic bag. 3) Carefully examine the damage to the vascular system. 4) Below are the minimum vessels that must be used to regional or sectional embalm the body. a) Common Carotid Arteries - head b) Subclavian Arteries - neck, shoulders, and extremity c) Axillary Arteries - medially and laterally d) Internal Iliac Arteries - gluteal, peroneal areas e) External Iliac Arteries - lower extremity and anterior abdominal wall 5) Keep all body cavities as dry as possible during the injection process. Aspirate all cavity drainage continually during the embalming. 6) Examine and treat unpreserved areas of the trunk using one or both of the following methods. a) Hypodermically Embalm - the injection of en embalming solution directly into the tissues b) Surface Embalm - the direct contact of body tissues with embalming chemicals 7) Viscera remaining in the cavity should be liberally covered with a hardening compound 8) Ligate the rectum and esophagus. Pack and seal the trachea and vagina. 9) If the viscera was returned in a plastic bag, return the bag and chemically treated tissue to the cavity. 10) If the viscera was not returned, mix a hardening compound with cotton and fill the cavity to a normal fullness. 11) Replace and secure the sternum and costal cartilages and close the cavity with sutures.

Cranial autopsy steps prior to posing features and injection

1) Thoroughly apply massage cream to the forehead. 2) Completely remove staples, sutures, etc that hold the incision closed. 3) Remove the calvarium 4) If the brain is present, remove it. 5) Immerse the brain in a suitable embalming chemical to be returned after arterial injection. 6) Ligate or clamp the exposed right and left internal carotid arteries. 7) Ligate or clamp the exposed right and left subclavian arteries. (vertebral arteries)

Theory One - cavity embalming timing

Cavity embalming takes place immediately after vascular injection to prevent gas formation and other putrefactive changes from starting or continuing.