Embalming Theory 2

edema

an increase in 10% of total body water

Slow hemorrhages, febrile diseases, kidney diseases and some cancers can all cause what type of dehydration?

antemortem dehydration

arteriosclerosis

anyone over the age of 30 can have it. the younger the age at death from heart disease, there is generally severe arteriosclerosis. most common in the femoral arteries. CCA is first choice for injection.

vavlular heart disease

aortic semilunar valve- if damaged, aorta is no longer the center of embalming. -this cuases lung purge because fluid is then pushed back into lV then LA then lungs. -aspiration and cavity work eliminated lung purge

true/false: drainage adds moisture

false

true/false: you should low index fluids for edema?

false

true/false: you should use bleaching disinfectants to maintain moisture?

false

true/false: you shouldn't cover the body with a sheet to maintain moisture balance

false

subclavians

features should be set when using these, provide added preservation to back of the neck and shoulders

internal iliacs

feed the buttocks, perineal and anal tissues. this may leak and can be clamped off

external iliacs

feed the legs

What arteries should you avoid if the body is dehydrated?

femoral or iliac

For local treatment what should you raise(edema)

femoral or iliac after embalming

Hypodermic Injection- autopsy

flaps and sidewalls can be channeled with a hypovalve trocar and then injected with arterial solution. Pelvic area should be packed to prevent leaks

medicolegal autopsy

forensic, does not need family consent

what is anasarca?

general edema everywhere

What is edema that is throughout the entire body?

generalized edema

What's included in organ donors?

heart, lungs, liver, kidneys, etc.

In burn bodies or renal failure, what is there a demand for?

high HCHO

medical autopsy

hospital autopsy, need consent from the family

what is edema of the scrotum?

hydrocele

what edema is in the cranial cavity and head?

hydrocephalus

what edema is in the heart, pericardial sac?

hydropericardium

what is edema in the chest and pleural cavity?

hydrothorax

What can happen if you lance or drain after embalming an edemic person?

incisions will leak

case analysis-infant

infant to child- birth to age 4. child to young adult -4 to 12 -size and weight, cause of death, moisture considerations, post mortem changes, discolorations

What type of edema is between the cells?

intercellular (pitting)

what type of edema leaves a pushed down imprint when touched?

intercellular (pitting)

What type of injection should you use for edema?

interrupted and continuous

3 layers of arteries

intimina, media, adventitia

posterior neck incision

leaking is a big problem, pack with phenol or cauterant then embalm as normal autopsy. done to determine if neck was broke or for muscle damage/strangulations. Tight suture

where is localized edema most common on the body?

legs

which methods allow for control over the amount and strength of the fluid entering a particular area

restricted cervical, six point and multipoint

autopsy drainage

restricted, clamp off appropriate veins

What type of injection prevents swelling/helps control to reduce swelling?

restrictive cervical

What is best used for drainage with edemic remains?

right atrium of the heart

what causes little absorption of preservatives?

rigor

vascular system

route of delivery for embalming solutions. should there be a problem, pre injection should be avoided

abdominal autopsy

see page 341 in meyer text

thoracic autopsy

see page 341 in meyer text

infant body mass

significantly reduced in infants compared to children and or adults

embalming to control dehydration

skin is dry and flaky, apply massage cream/lanolin spray, mix 50/50 rectifiant and restorative from dodge to remove cradle cap and flaky skin. use dye to trace fluid as dehydrated skin feels embalmed

what is desquamation?

skin slip

What's included in tissue donors?

skin, bone, connective tissue (fascia, tendons) and corneas

Should you use a quick or slow injection of fluids?

slow

Antemortem Dehydration

slow hemorrhages, febrile diseases, kidney diseases, diabetes, some cancers, 1 degree burns, aids, tb

infant sundry items

small cannulas, infant trocar, dental floss, hypodermic needle and syringes, diapers, baby wash/shampoo/lotions, one piece under garment, bandages

what type of fluid should you use in decomp remains?

specialty or high index fluid (25 index)

closing the cranium- autopsy

spray the reflected scalp with a cauterant. putty can be used to seal off the foramen magnum, vertebral arteries, and internal carotid arteries. cotton and absorbent powder should be placed in cranial vault. begin on right side and use baseball or worm suture

autopsy fluid

stronger than usual, use dyes.

vertebrals

supply the head with some fluid.

Anyuerism

tear or break in the vascular system

diabetes

tend to develop arteriosclerosis. increased bacterial and mycotic infections. stronger solution recommended (first gallon weaker). high pressure, pulsation, massage of extremities. -tissues may have abnormal ph and difficult to firm -use restricted cervical for obesity. -cavity embalming should be thorough. gangrene and decubitus ulcers may be present.

true/false: HCHO is dehydrating as is dries and firms tissue

true

true/false: You should avoid astringent or hypertonic solutions in order to maintain moisture balance?

true

true/false: all bodies dehydrate some

true

true/false: avoid pre injection with decomposed remains

true

true/false: blood clots as blood congeals

true

true/false: dehydrated remains decomposes slower

true

true/false: edema in the cavities doesn't mix with arterial solution to cause secondary dilution

true

true/false: endemic remains decompose quicker

true

true/false: for decomp remains use less pressure in the arms and legs to help distribute fluid

true

true/false: for decomp use strong solution-less volume

true

true/false: its unwise to lance and drain after embalming edemic remains

true

true/false: let the body continue to drain after embalming to pull the edema out

true

true/false: skin slip is more likely with edema

true

true/false: to maintain moisture, you should avoid fast acting fluids

true

true/false: trauma, gangrene and burn victims are predisposing factors of decomposition?

true

true/false: use pulse to reduce risk of swelling

true

true/false: waterless mixture can be used for mild to moderate decomp cases

true

true/false: you can use a humectant to prevent dehydration

true

true/false: you should avoid continuous drainage to maintain moisture balance

true

true/false: you should avoid femoral and iliac arteries because clots can be pushed into CCA's

true

true/false:To prevent dehydration you can use more water

true

what 3 common problems happen during decomposition ?

uneven distribution of chemicals, swelling and increase demand for preservation

injecting the upper extremities-autopsy

use the arch of the aorta if left intact, braciocephalic to the right subclavian. subclavians to inject arms. if arch is gone, raise the axillaries. use the R and L common carotid arteries for the head, the external carotids can be used if the common carotids are severed. Clamp off the internal carotids in the cranial vault

what solution should you use for skin slip?

warm water and STRONG solution

partial cranial autopsy

3 methods to inject. See page 340 in meyer text

viscera-autopsy

32oz of cavity fluid should be the minimum amount used if viscera is in a viscera bag. can be treated in the first few steps. dry packing the viscera is another way to treat the organs.

What volume should you use for edema?

4-5 gallons with 1.5-2.0% strength

A healthy male is roughly what percentage of water?

60%

Humectants

Aid in moisture retention

Dermatone

An instrument used to remove skin

Surface Discoloration

Antemortem and Postmortem discoloratons that occur prior to or during embalming due to the deposit of matter on the body surface. Examples are: Adhesive from tape, Tobacco, Blood & Grease

The meaning of "to change color" is?

Any abnormal color appearing in or on the dead human body

Skin lesions

Any traumatic or pathological change in the structure of the skin. Solution: Disinfect and prepare for post embalming treatment.

Surface Embalming

Application of embalming gels or cavity fluid or arterial fluid externally.

2nd degree burns

Blisters, edema and deep layers of epidermis and dermis are involved

Extravasular Discoloration

Blood that has escaped into the interstitial space. The blood is no longer within the vascular system.

Carbon Monoxide (CO) poisoning

Classified as an intravascular discoloration. However, owing to a delay and discovery or coroner investigations, the discoloration rapidly becomes extravascular.

Antemortem discoloration

Discoloration that are present in life and remain after death - i.e. jaundice, bruise (ecchymosis)

Solution for Skin Slip

Disinfect, pen all vesicles and remove loose skin -Use of cavity fluid compresses aid in arresting condition. -Sectional embalming -Autopsy gels -Powders in non-viewable areas

You should pre-inject if...

Drainage is anticipated to be good

Blisters

Elevations of the epidermis containing a watery liquid.

What should be done if a Intravascular Discoloration IS NOT removed ?

It could be a sign that fluid is not reaching the area or the stain could be EXTRAVASCULAR. (1.) May need multi-point injection (2.) Look for clearing in the nail beds, earlobes as a sign of distribution.

What is the old belief about formaldehyde

It turns bodies green, when in reality, oxidation is what turns bodies green.

PROS & CONS - Method #4 for Jaundice (4-Use some cavity fluids arterially)

PROS: -Use the mild solution so you don't set the stain and create conversion and it'll build the strength later to get better concentration -There are specific bleaching cavities that can be marketed as a bleaching fluid (& won't damage your machine) -Bleaching agent - affects milder cases CONS: -If you don't know what you're using, you'll ruin your machine -Phenol- increases oxidation and can convert to green

Postmortem discoloration

Occur after death - i.e. lividity, PM Stain.

Formaldehyde (HCHO) Gray

Occurs about 6 hours after embalming in areas where the blood was not removed. Blood gravitates to the area where it mixes with HCHO. -Other reason: Too strong of a solution. -SOLUTION: Thorough aspiration & elevation should lessen effects.

Flushing

Occurs where arterial fluid has been distributed but good drainage has not been established. Commonly seen in femoral injections. Solution: Split injection usually alleviates problem

PROS & CONS - Method #1 for Jaundice (1 - Use Jaundice Fluid)

PROS: -Contains buffers to balance PH levels because if you reduce oxidation, the yellow will turn to green. -If there is no jaudice fluid, add water conversion -Has added active dye, which adds color to the tissue CONS: -Low formaldehyde or no formaldehyde, which can lead to complication with pore preservation

PROS & CONS - Method #6 for Jaundice (6 - Counterstaining)

PROS: -Respects the difficulty of the stain and appreciates the stain -Treats the stain rather than disregarding it. -It's the only thing you need to do - besides add extra dye -Then you can embalm appropriately & it's a solid base foundation for any cosmetic work that needs to follow. CONS: -None

PROS & CONS - Method #5 for Jaundice (5 - Bleaching Co-injection)

PROS: -The bleaching agent will bleach out and lighten the discoloration of jaundice -Use your fluids normally CONS: -Only works to reduce interesting or mild cases (NOT FOR severe cases)

Solution for Blisters

Puncture & drain, remove loose skin. -Inject artery close to the site (sectional) or hypo or pack or combination of three. -Hair dryer can be used to speed up process of drying

What is the most usual a problem with Drowning Cases?

Purge (from lung and stomach)

What is the primary problem for the embalmer with skin donors?

Seeping or Leaking

1st degree burns

Skin is red, only surface is involved

Treatment for Green Jaudice

Use opaque cosmetics

arterial/venous coagula

arterial- generally pushed towards legs (preferred) when RCCA is injected, pushed towards head when femoral is injected. usually subclavians clog. venous- can be removed with forceps, can cause distension. intermittent drainage can force out clots. multipoint injection can be used. stronger fluid

what edema is in the peritoneal cavity?

ascites

what causes great preservative demand?

after-rigor

Blood thickens during what period?

agonal period

infant body water

at birth water content is 75% at around age 1 water content declines to 60%

What can cause remains to become desiccated/dehydrated?

being refrigerated for too long

congestive heart failure

blood congested into right side of heart. neck veins are engorged; facial tissue darkened due to congestion. lips, ears and fingers are cyanotic. generalized pitting edema in the legs, feet and there is possible ascites-fluid in the periotenal cavity. -blood is more viscious due to increase in RBC. salt is retained

Definition of Intravascular Discoloration

blood still with in the vascular system

ways to secure the calvaria to the skull

calvaria clamps, ligate, plaster of paris, ca or super glue, drill and wire, needle injector

What does the hands/feet do when remains are edemic?

can become wrinkled and swollen

cavities- auotpsy

cavity walls can be painted with autopsy gel. if viscera isnt returned cavity fluid soaked sheets can be used to fill the area.

What is caused by steroid use and will not respond to arterial embalming?

cellular (solid) edema

what type of edema is hard to press?

cellular (solid) edema

CVA

cerebrovascular accident (stroke), cleared by sufficient drainage.

What removes astringent effects?

co-injections

what are early signs of decomp?

color changes, vascular changes, odor, purges, gases, desquamation

infant embalming

common carotid artery is the largest non-aortic vessel and the most superficial. femoral can be used. can use abdominal aorta. stronger solution

removal-infant

cot, car seat, briefcase, bassinet, arms

What is a form of preservation that is not viewable?

desiccation

Treatment of Intravascular Discoloration

(1) Can be removed best by mild arterial solution first and/or pre-injection (2) "Build" your fluid strength -as discoloration is removed, more arterial solution can be added. This is done to prevent setting of the stain (3) Concurrent drainage should be used (4) Use of Intermittent drainage may be used after discoloration is cleared.

The treatment for Hypo Injection AFTER or DURING arterial injection.

(1) Insert Needle b/w fingers (2) Repeatedly push the needle in and out to create channels (3) Inject phenol or cavity solution to distribute uniformly. Note: Some leaking will occur. (5) Let chemical stand for 15-20 mins, then push out through injection sites (6) Seal the puncture holes with CA glue (super glue, aron alpha)

Treatment of ECCHYMOSIS or HERMATOMA to the eye?

(1) Raise the right and left common carotid artery, Restricted Cervical Injection - RCI (2) Allows for stronger solution with less volume to be injected into head to help prevent swelling. Avoid pre-injection. (3) Cotton soaked in cavity fluid can be used in place of eye caps to help bleach and preserve the eyelid. (4) Cavity fluid can also be injected into the tissue surrounding the eye (5) The use of phenol in the same manner works well for blackened, swollen eyes (6) Surface embalming can also be employed. (7) The eye lid may be incised on the inside to allow for the extravasated blood to be pushed out.

4 types of Internal Access incisions

(1.) Base of neck to bottom of sternum (heart, lungs (2.) Base of sternum to pubic bone (liver, kidney, pancreas, SM bowel (3.) T incision, transverses the inferior portion of the rib cage, and base of sternum to pubic bone. Liver, kidney, pancreas, SM bowel are recovered from this type of incision (4.) Base of the neck to pubic bone-full recovery of all organs

Long Bone Donors - Method 2

(1.) Leave sutures in place and inject the legs via the iliacs (or femorals) (2.) Use = part water with a strong arterial fluid, or use a waterless solution. Inject at least 1/2 gallon in each leg (3.) Let this sit and osmotically embalm the legs while the rest of the body is embalmed (4.) After embalming is complete, small holes are made around the ankles to relive any fluid (5.) Surface glue is applied to sutures and cotton (6.) Stockings can then be placed on the legs with absorbent powders added.

Long Bone Donors - Combo of Method 1 & 2

(1.) Locate both iliac arteries and clamp off (2.) The sutures will need to be opened enough to raise the iliacs (3.) The iliac arteries can be injected. Inject one iliac toward the heart and assess the results. Both arteries should be injected down the embalm the legs (4.) The cervical (RCCA) sites may be used. RCI is another good method to use. The RIJV is raised for drainage (5.) A "Y" can be used to inject down both the R & LCCA to fill the arch and throroughly embalm the body. To prevent fluid from just pouring out the botton be sure to clam off the iliacs. (6.) The reasoning for leaving the sutures closed is to reduce the HCHO exposure and embalm the tissue of the legs osmotically. The legs are opened treated with phenol etc. (same as method 1).

Long Bone Donor - Proximal Humerus

(1.) No reason why arterial supply need be disrupted (2.) It may be possible to inject with out opening the incisions if they are tight (probably should to add hardening compounds and preservative powder) (3.) If vessels are cut the brachials, radials and ulnars can be injected (4.) Good idea to inject both ways - away and towards the heart in as many vessels as possible to ensure preservation (5) Hemostats can be used to clamp off leaks

Internal Access

(1.) Opening procurement sites and locating/injecting vessels that are left, such as aorta (arch, thoracic, abdominal), subclavian, iliacs, etc. (2.) It's very similar to embalming the partial autopsy

Long Bone Donors - Method 1

(1.) Remove sutures & prosthesis. Locate arteries & inject (2.) Trunk, head and arms may be injected by cervical or femoral (iliacs) sites (3.) Hypodermic treatment of muscle tissue is probably necessary (4.) Cauterize tissue (in leg area) with a phenolic spray, such as dryene or phenox (5.) Final Steps: replace prosthesis and suture in place (6.) Add absorbent cotton, preservative powder etc. Suture closed

When are autopsies performed?

*when a death is suspicious *to determine cause of death, if cause is unknown. homicides, deaths in the workplace, sids, intra-and perioperative accidental deaths

Definition of Preinjection

-"Capillary Watch"/"Primary Injection" -Injecting fluid prior to embalming -Expand vascular system -Promote drainage and distribution -Improve distribution (by prepping tissues for the reception of the preservative arterial solution and balancing PH levels).

Heparin

-A blood thinner, prior to the harvest to prevent clots in the transplanted organs. -Most donors are placed on it -Positive: better drainage -Negative: Postmortem stain/livor mortis

Jaudice

-AKA Icterus -Considered a pathological and antemortem discoloration which occurs with certain diseases. -It IS NOT a disease

Livor mortis

-AKA hypostasis -the discoloration of the skin due to the pooling of blood in the dependent parts of the body following death

Solution for Decubitus Ulcer

-Apply cavity fluid pack, gels, phenol -Embalm, hypo area then re-apply packs & cover with plastics and powders

Decubitus Ulcer

-Bed sores -result from constant inadequate blood supply to the tissues overlying a bony part of the body to which prolonged pressures have been applied. -Occur usually in the sacrum, heels, ankles and buttock. -Foul odor -Staph infections often accompany these sites

Treatment for Surface Discoloration

-Blood (soap & water) -Adhesives (ink, betadine and similar can usually be removed with soap and water or "dry wash" (trichloroethylene aceton). Use nitrile or non-latex gloves -Mold can be removed by scraping away and wiping area with 1% phenol, or 1/2 and 1/2 mix of methanol and acetic acid.

DO NOT pre-inject if the following are seen.

-Body is autopsied and/or long bone donor -Arterial clots (blocks circulation channels) -Ischemic gangrene -Delay between death & embalming causes concern for difficulty with circulation

Pustular/Ulcerative

-Boils, carbuncles, fever blisters (herpes) -SOLUTION: Treat the same as blisters or skin slip

Carbon Monoxide (CO) Poisoning

-Bright color owing to carboxyhemoglobin -Few clots if prepared right away -Cherry red discoloration seen where livor mortis is or would be -Most cases are autopsied so there is a delay between death and embalming. This allows for PM stain to occur.

Decomposition

-Brought on by autolysis and hemolysis

Solutions for Road Mapping, Spider Veins, & Mottle

-Can be bleached with phenol packs -Multipoint injection and or hypo injection is all that can be done.

Different ways Surface Embalming can be done.

-Can be done during or after arterial preparation -Coat the area with the embalming gel or make a pack with cotton -Cover with plastic wrap to keep chemical from evaporating -Allow time for chemical to work. Usually 2 or more hours -Remove gel/packs clean and dry

Hangings

-Can be self-inflicted, either accidentally or intentionally, or homocide -Extensive facial discolorations usually occur as a result from jugular being "clamped off" -Eye and tongue may protrude -Many discoloration clear once the restriction is removed ("cut down")

Gunshot Wound (GSW) Solution

-Can fracture the skull -Use instant fixation method (head freeze) -Treat swollen ecchymotic eyes with phenol -If not to the head, try RCCA and if watch for adequate distribution -Abdomen may swell and the decendent will purge -Standard drainage may be significantly decreased.

Mutilations

-Caused by Auto accident, autopsies and murders

Burned Bodies

-Chemical, thermal, electrical or radioactive -Systemic effect is embalmers main concern: (1) infection (2) blood flow to peripheral areas (3) kidney failure -Many live for a period of time -Blistering is rarely seen as the hospital drains and treats areas prior to death -High preservative demand -Circulation may be hard to establish unless death was by electrical shock SOLUTION: Add dye & perform multipoint inject.

What causes death from Poisoning?

-Corrosive agent that are swallowed can burn the mouth, the lining of the esophogus and the stomach causing veins to rupture -Death from shock (anaphylactic) can cause swelling

Dehydration

-Discoloration caused by embalming -Drying of the skin -Yellow, brown and black spots -Many reasons: (razor burns, too strong of fluid & abrasions)

Internal Approach for Middle Ear, or Temporal Bone - tissue donors

-Done after embalming usually -May be done during and after autopsy -Plug cutter is used -If done prior to embalming it shouldn't pose any circulatory problems for the embalmer.

What are some examples of Extravascular Discolorations that DO NOT respond well to arterial injection?

-Ecchymosis -Purpura -Petechia -PM Stain

"Tanning"

-Elevation of the body by use of blocks allows air to move under & around the body, thus drying the area. -Use of a hair dryer will speed up the process

Post Mortem (PM) Stain

-Extravascular in nature.

External Approach for for Middle Ear, or Temporal Bone - tissue donors

-Eyes and upper face don't receive adequate amounts of fluid -Incisions behind ear is made

Other issues with Drowning Cases

-Handle each case differently -In addition to discoloration, objects in the stream may hit the body (i.e. logs, other foreign objects or the body may be dragged by the concurrent and scarp along the bottom) -Marine Life can eat portions of the body -Cool water preserves -Warm water speeds decomposition

How long should you refrigerate bodies?

-Intense liver mortis (6-12 hours) -Prevalent PM Stain (over 12 hours) -Speeds up hemolysis (destruction of RBC)

Drownings

-Intense lividity, cyanotic discoloration (intense blueish/purplish in face & fingertips) -Cool water causes intense lividity (similar to refridgeration) -Blood rapidly settles to dependent part of body -Gas generation causes body to surface & float face down (PM Stain)

Facts about Intravascular Discoloration

-It is a PM physical change -Sped up by refridgeration -Appears in dependent parts of the body -Sometimes begins antemortem and rapidly increases after death. -Cleared by arterial injection/drainage -May be gravitated out of region -Color varies from PINK to DARK BLUE/PURPLE -Discoloration blanches (make white or pale by extracting color) when pressed upon.

Solution to Abrasions

-Let them dry out and turn brown -Let the arterial fluid flow through the area -Massage cream will protect the unaffected areas -Phenol or cavity packs can be applied later if needed.

Solution from Mutilations

-May need to hypo inject if vascular system is too complicated -Multipoint injection -Probably going to be autopsied

Solution for Hangings

-Most cases will be autopsied which aids in draining face and head -Restricted cervical injection is best choice in the event body is not autopsied. -Solution should be 2.0 - 2.5 % -PM stain probable if delay b/w death & embalming -Avoid pre-injection -Strong solution/small volume

How to identify Jaundice

-Normal blood serum is 1.0 - 1.5 mg of bile pigment (bilirubin) per 100 ml -Greater than 1.5 mg causes jaundice -High index fluids convert bilirubin (yellow) to biliverdin (green).

Electrocution

-Occurs at point of contact with source, usually palms of hand -Coronor/M.E. may excise burned tissue -Treat excised area with a cauterant

Facts about PM Stains

-Occurs where Livor Mortis was present (and not removed) -Usually a delay between death and embalming -Caused by the breakdown of RBC -The heme escapes to outside of vessels

Treatment for Burned Bodies

-Paint unseen areas with autopsy gel/ and or cavity packs -Restricted cervical injection-unless neck is the only area involved -Incision sites may be hard to close. Use CA glue, big bites, nail polish

What's the most important aspect of jaundice treatment?

-Preservation -Cosmetics can always be applied and a good base for cosmetics is a well embalmed body. -You have to have preservation...if not, you'll add some degree of decomposition

Pathological Discoloration of Nephrities

-Seen as renal failure, diabetics -Sallow yellow color to the body (urochrome) -Can be mistaken for jaundice -SOLUTION: Calls for strong solution -HCHO is neutralized by urea and nitrogen waste -Use dye to overcome discoloration

Solution to Carbon Monoxide Poisoning

-Solution strength should be based on size, delay, and other PM changes -May use dye -Stronger solution if refrigerated -If head and neck are dependent expect PM stain and HCHO Gray

Cornea Removal cases

-There's little to do in these cases. -Usually water soaked cotton packs should be placed on eyes to prevent swelling.

Vertebral Body Donor

-They can be removed from the poster incisions -They can be taken via autopsy incision or other organ procurement sites -Main Concern: Rigidity of body & leaking

Treatment for Drowning Cases

-Treat with aspiration (4-8 times) -RCCA & RIJV or RCI recommended -Solution strengh depends on extent of decomposition -Thoroughly aspirate and inject 32 to 48 oz. of cavity fluid.

Counterstaining

-Turning yellow discoloration and turning it red. -Creates reddish undertone -Cosmetic effect/ Chaser -Covers easier -You can tone down the red rather than tone down the yellow

How to control swelling in eye enucleation

-Use restricted cervical injection (RCI) -Avoid preinjection -Use strong arterial solution -Avoid accessive manipulation -Allow fluids to run out of eye while embalming -Avoid rapid rates of flow change and high injection pressures

Treatment of PM Stain

-Use strong solution with a minimum amount of volume to avoid distension -Use dye as an indicator and aid in masking gray hue (formaldehyde gray) that will occur. -Avoid preinjection

Poisoning

-Variety of discolorations associated with it -Some poisons act quick and others are cumulative -Some act on the central nervous system causing labored breathing and cyanosis

Long Bone Donors

-Very time consuming -Requires the use of a lot of fluid material -Use strong fluid due to delay in preparation

Exsanguination

-bleeding to death -Lack of color -May be internal (watch for stomach swelling) -In cases of shock, blood congeals in the large veins making good drainage hard to establish

Renal Failure

-common in advanced diabetes, along with poor peripheral circulation. SOLUTION: A good coinjection with string fluid should aid in preservation, distribution and profusion.

infant body fat

-fat is 12% of total body weight -6 months of age is 25% -at 1 year it is 30%

embalming arterioslecrosis

-increase solution strength, co-injections to help distribute solution, dyes. -lower hands to sides, slow rate of flow, multi point injection with higher pressure and pulsation. -femoral artery: find softest spot, avoid cutting into the hardened area. use an appropriate size cannula

aortic aneurysm

-ruptured: causes lots of problems if body is not autopsied. -surgical repair often leads to extreme edema. determine if a 1 point injection is possible

embalming CHF

-use RCCA and RIJV or restricted cervical. -Make 1st gallon mild strength to clear discolorations. any further gallons can be stronger. -tap ascites with trocar -lower arms, massage face and appendages. -raise both jugulars if needed -pressure high enough and rate of flow fast enough to establish good drainage and distribution -USE CONTINUOUS DRAINAGE

for advanced decomp cases, how many gal should be injected?

1 gal of undiluted arterial and 32oz of co-injection then aspirate and inject an additional 48 oz of cavity fluid

How many gallons should you use for edema?

1-1.5

3 Types of Broken Skin

1-Abrasions 2-Blisters 3-Skin slip

What does an Embalmer need to do in total tissue cases?

1-Assess the situation 2-Analyze EMB complications 3-Develop a plan of application of EMB treatment 4-Implement the plan 5-Engage in concurrent EVAL of the effectiveness of EMB treatments & make adjustments if needed

6 Discolorations that can be identified by Cause

1-Blood, both intra and extravascular 2-Drug or therapeutic 3-Pathological 4-Surface coloring agents 5-Reactions to embalming chemicals 6-Decomp discoloration

6 Categories of Discoloration

1-Blood, both intra and extravascular 2-Drug or therapeutic 3-Pathological 4-Surface coloring agents 5-Reactions to embalming chemicals 6-Decomp discolorations

5 Signs of Decomposition

1-Odor 2-Desquamation (skin slip) 3-Gas 4-Purge 5-Color change (progresses from red to black)

3 types of Jaudice

1-Toxic 2-Hemolytic 3-Obstructive

4 Discoloration Groupings

1-Unbroken 2-Scaling skin 3-Broken 4-Pustular

6 Methods to treat Jaudice

1-Use jaundice fluid 2-Use pre-injection solution 3-Use mild arterial solution with dye 4-Use some cavity fluids arterially 5-Bleaching co-injection solution 6-Relative Counterstaining

What should embalmers be looking for when embalming discoloration cases?

1-Vessels for injections and drainage 2-Strength of the embalming solution 3-Volume of the embalming solution 4-Injection pressure 5-Injection rate of flow **These factors vary by the individual body and can vary in different areas of the same body

15 steps to maintain moisture balance

1. avoid astringent or hypertonic solutions 2. avoid continuous drainage 3. avoid rapid injection 4. delay aspiration for a short time 5. cover with a sheet if refrigerated 6. avoid fast acting fluids 7. disinfectants should not dry or bleach tissues 8. use of cotton for feature setting can dehydrate tissue 9. fumes from cavity fluid in the neck can dry tissue 10. short circuting of arterial fluid can dehydrate tissue 11. warm water speeds up HCHO reactoin 12. cover body with a sheet and cream cosmetics 13. don't elevate head too much if there is a long delay 14. tissue build 15. use an emollient during and after embalming

3 types of arteriosclerosis

1. inner walls is hardened and thickened but lumen is open. use an iliac artery in an autopsy case 2. lumen is reduced in size and pushed to one side, need a small tube 3. artery is completely occluded. area may be ischemic, if not, collateral circulation may have increased to supply blood to the limbs (canalization)

What are the 10 steps of Eye Enucleation

1.) Remove packing 2.) Saturate cotton with autopsy gel and loosely pack the eye socket. 3.) Fill to re-create a natural looking appearance & close the eye/Embalm body 4.) Remove autopsy gel & cotton from orbit and thoroughly dry the orbit 5.) Place incision powder, or mortuary putty 6.) Pack the orbital cavity with cotton or putty 7.) Place instrument in eyelid to stretch lids 8.) Insert eye cap over cotton/putty & close eyes 9.) Check height in profile is a straight edge from eyebrow to cheek 10.) Glue eyes

What solution strength should you use to prevent dehydration?

1.5-2%

How much does edema increase the total body water?

10%

How long should you wait before using tissue builders ?

10-15 hours

what minimum solution strength should be used for decomp remains?

2%

Coumadin

A drug that can cause purpura and ecchymosis.

Razor Burn

A form of dehydration. SOLUTION: Apply a think layer of massage cream over areas to ease the darkening. Wax over the areas and cover with cosmetics.

Using IV needle sticks

A method for treating ecchymosis and or senile purpura. For an IV, the area may: (1.) Receive fluid (2) Distent, or "swell" (3) Have nothing occur (even when using bleaching or preservation).

injecting the lower extremities-autopsy

COMMON ILIACS ARE FIRST CHOICE. if all arteries are severed, raise the femorals. 1/2 to 2 gallons can be injected. intermittent drainage may aid in distribution.

Sprays/Massage Creams

Can be applied to hands and face to prevent dehydration. Cover face with plastic wrap or plastic bag & keep from air currents.

3rd degree burns

Charred, epidermis, dermis and epidermal derivatives are involved

Green jaundice

Conversion of bilirubin to biliverdin

What do people who drown die from?

Cyanosis (blue color on skin) from asphyxia (a condition arising when the body is deprived of oxygen, causing unconsciousness or death

Scaling

Example: chicken pox, measles, large amounts of some medication can cause skin to dry and flake. Similar to sunburn pealing. SOLUTION: (1) Remove as much as possible (washing helps), (2) Treat all lesions as infectious & (3) Autopsy gel can be applied if preservation is questioned.

What are the two options when selecting vessels?

External access & Internal acccess

infant feature settings

Eye caps cut down or cotton pads. May be glued with rubber-based glue or superglue. Musculature suture for closing mouth or superglue to close, generally after injection and cavity embalming.

Localized discoloration

For example "black eye" or razor "burn"

Generalized discoloration

For example, livor mortis, dehydration, or jaundice.

Mortuary Putty

Incision Powder

What should you do when embalming the body and employing procedures recommended to prevent swelling in an eye enucleation?

Inject a minimum amount of fluid if swelling starts to occur. Less volume, stronger solution strength.

Treatment for Dehydration

Injection of tissue builder into the finger tips post embalming will help prevent shriveled tips and can also be used for lips (lip drift).

What are the two approaches for Middle Ear or Temporal Bone tissue donors?

Internal Approach and External Approach

Body parts that darken because of dehydration

Lips, finger tips darken and wrinkle

Does cavity fluid bleach work as well as phenol?

No, Basic Dryene by Dodge or Phenox by Hydrol work the best.

Can abrasions be bleached?

No, they darken with time and are generally hard to touch (leather like).

PROS & CONS - Method #3 for Jaundice (3 - Use mild arterial solution with dye)

PROS: -Wash the remains really well which will lighten and reduce the intensity (2-3 times) post embalming too -Be liberal with Massage cream-if they're in good shape, it'll soften skin cells & takes off yellow -Leave lights "on" in prep room, which might reduce intensity of dicoloration CONS: -Poor preservation of tissue & soft tissues won't have a firm base and causes the use of more cosmetic fluid

PROS & CONS - Method #2 for Jaundice (2 - Use Preinjection Solution)

PROS: -The Belief is to attempt to wash out or drain the discoloration but that's misleading. It works best with someone with a mild case of jaundice -Follow with normal solution strength and add dyes CONS: -Doesn't take into consideration other complication (i.e. edema, decomp, etc.) -Resistant & not adequate to someone with mild to severe jaudice

extravascular resistance

Pressure on the outside of an artery or vein that may restrict the flow of arterial solution into a body region or may restrict drainage through a vein. multipoint injection. intermittent injection with concurrent drainage recommended.

What's the most important thing to know about surface embalmings?

Remove surface discolorations prior to completion of embalming. It is easier and the colors are not set.

Body bags

Retain moisture as condensation occurs

Problems with Eye Enucleation

Swelling, ecchymosis & occasional laceration

What should the embalmer recognize in discolorations?

The embalmer should be able to recognize the cause of a discoloration to know which discolorations: -CAN & CANNOT be cleared by arterial injection. -can be altered or bleached by proper chemicals -will have to be treated by OPAQUE COSMETICS to hide them.

What does our book advocate the use of when dealing with long bone donations?

The use of the: -femoral -popliteal & -anterior tibial artery as injections sites and that they are ligated and ready to go.

What should be known about ECCHYMOSIS, PURPURA & PETECHIA?

They CAN be classified as pathological and as drug discolorations, such as, the drug, coumadin. Also, leukemia, a disease, can cause petechia

Facts about Livor Mortis (lividity) and Post Mortem (PM) Stains?

They CAN exist simultaneously. Lividity will be "washed" out and the PM stain will be left behind.

External Access

This is when vessels are raised as in a normal case (probably a multi-point injection).

What should skin donor areas be treated with?

Treat areas where skin is removed with phenol, autopsy gel, cavity fluid, etc.

When is Natural Color removed or lost?

When death occurs and is replaced by "death pallor" (paleness of the skin)

what can be used on the palm of the hands to help pull wrinkles out?

duct tape

What can you use to trace fluid to find the dehydrated tissue?

dye

What factor speeds up the decomposition process?

edema

What is defined at the abnormal collection of fluid in the tissue spaces

edema

what should you do to help gravitate the fluid out of legs or arms?

elevate the affected areas

What is edema that is in one part of the body?

localized edema

pulmonary edema

lung purge

autopsy-liability of the embalmer

make a not of the type of autopsy and whether the viscera was returned or not

what aid is using gravity, massaging, lowering arms, use of compression collars etc.

manual aid

What can you apply to control dehydration?

massage cream/lanolin spray

what aid is the use of drainage tubes, and embalming machines?

mechanical aid

Can desiccated remains be fixed with arterial infection or hypo?

no

lumen

opening or cavity in the vessel -narrowing of this can cause arteriorsclerosis, restricts the flow of fluid, intravascular problems can result in tears or breaks.

what aid is incising/excising tissue and channeling?

operative aid

what is bacteria in the gut that escaped into the vascular system?

peritonitis

closing the torso-autopsy

place viscera bag in cavity, coat sidewalls and breastplate with autopsy compound, use a minimum #5 twist, linen ligate. start at the pubic symphysis for abdominal area. use a baseball stitch. suture from xiphoid process and continue towards shoulder.

autopsy

post mortem examination of the dead. Also called a necropsy, postmortem, post

what can cause postmortem dehydration?

pre-embalming refrigeration

post mortem dehydration

pre-embalming refrigeration, dry cool air moving over the body blood settles into dependant parts

what causes great absorption of preservatives?

pre-rigor

what is edema of the alveolar sacs?

pulmonary

60% water content

what percentage of water is a healthy adult male?

Should you delay aspiration for a short time in order to maintain moisture balance?

yes