FSE embalming II lecture 21 & 22

edema

- is defined as the abnormal collection of fluid in tissue spaces, serous cavities, or both. - can be localized, for example, when surgery has involved the heart or repair of the aorta. Following these surgeries, the head and the face can be severely swollen with fluid, while the body trunk and the limbs display no trace of edema. Localized edema is generally named for the region affected.

What is the innermost layer of an artery?

Tunica intima

Which type of arteriosclerosis prevents the use of the artery for arterial injection?

Type 3

Which of the following is an extravascular restriction?

Visceral weight

Dehydration Examples When the Skin Layer is Removed:

When the epidermis is removed and the area is allowed to dry or force dried, the affected area will turn dark brown in color and appear quite firm to the touch. - This type of discoloration does not respond to bleaching by preservative surface compresses. Opaque cosmetic treatment is necessary when this occurs in a visible body area. Massage cream should not be applied to these areas, because it slows the drying of tissues.

Problems From Edema:

1. Affected tissues are swollen with fluid. 2. When edema gravitates or moves from a region, the skin can wrinkle and appear distorted. 3. "Weeping" or "Seeping" of edematous fluid through the skin can saturate clothing and casket interiors. 4. Fluid can leak from intravenous or invasive punctures through the skin surface by gravitation, through hypodermic needle punctures, through surgical incisions, and through incisions made for embalming purposes. 5. Arterial fluid is diluted (secondary dilution). 6. Decomposition is speeded. 7. The possibility of separation of the skin layers (skin-slip) is increased.

The following techniques can help to maintain a good balance of moisture in the body:

1. Avoid the use of astringent or hypertonic arterial solutions unless case analysis indicates strong solutions. 2. Avoid the use of concurrent or continuous drainage after surface discolorations have cleared. Intermittent or alternate drainage helps to distribute and diffuse the arterial solution. 3. Avoid rapid arterial injection and drainage. A slower injection rate reduces short-circuiting of fluids. 4. Delay cavity aspiration for a brief time, 20-30 minutes, to promote deeper diffusion of arterial solution into the tissues.

Problems From Edema: Renal Failure and Burns

1. Generalized edema could be the result of renal failure. 2. Renal failure creates a buildup of nitrogenous wastes in the tissues. 3. The nitrogenous wastes can neutralize the preservative solution, rendering it ineffective. The use of strong astringent solutions should be used to overcome neutralization. 4. Edema also coexists with nitrogenous wastes in deaths from second- degree burns and exacerbated when death occurs after an extended period.

After death, several factors bring about dehydration.

1. Mortuary refrigeration is a leading cause of postmortem loss of moisture. Dry, cool, or warm air moving across the body promotes dehydration. 2. Between death and embalming, the blood and the tissue fluids begin to gravitate into dependent body regions, increasing the moisture levels in the dependent tissues but reducing the moisture in the elevated body areas. 3. The embalming process itself can either add or greatly reduce moisture. The primary ingredient in almost all embalming fluids is formaldehyde, and formaldehyde dries tissues.

Cellular Embalming

1. Must leave the artery/capillary. 2. Pass through the interstitial spaces. 3. Pass through the cell membrane 4. Diffuse within each cell to denature and cross-link the proteins.

Three conditions characterize the various tissues of the dead human body with regard to moisture:

1. Normal tissue moisture, 2. Dehydration 3. Edema - excess tissue fluid accumulation

Embalming protocols for blood clots include:

1. Pre-injection with an anticoagulant. 2. Restricted cervical injection or use of the common carotids to move clots away from the viewing areas. 3. Use the right internal jugular for drainage as it is close to the right atrium of the heart. 4. Use angular spring forceps to remove clots and to establish drainage. Then you can replace with a venous drain tube. 5. Enough rate of flow and injection pressure to overcome intravascular resistances, but not too much as to dislodge them an occlude (block) the lumen of the vessels. 6. Multi-point injections may be necessary. 7. Supplemental hypodermic and surface embalming enhance the areas that do not receive sufficient arterial solution.

Jose Patel is embalming a case with dehydration. Jose plans to use 30 ozs. of preservation chemical in two gallons of total solution. Jose plans to use a humectant as a co-injection. Based on this information, what would the maximum amount of humectant that should be used?

30 ounces

Ideal body water percentage for females is

45-60%.

Ideal body water percentage for males is

50-65%

acidosis

Chronic renal failure accumulates toxic wastes (urea, uric acid, ammonia, and creatine) in the blood and the tissues of the body. Retention of waste products in the tissues

Reduced drainage

Coagula in the veins hinders drainage.

What is the outermost layer of an artery or vein composed of?

Connective tissue

An infant comes in with hydrocephalus with purge from the ears. What bone would you need to insert a needle through to aspirate and treat the cranial cavity?

Cribriform plate of ethmoid bone

What color will dehydrated skin turn?

Dark brown

Reduced distribution

Dehydration causes the viscosity of the blood to increase. Postmortem emboli in the arteries prevents good arterial solution distribution.

Extravascular Resistances Affecting Blood Vessels

External pressure upon an artery or a vein causes the lumen to narrow or collapse, creating resistance within the vessel. This is called extravascular resistance. Extravascular resistance restricts flow within the vessel.

The process of embalming should

add moisture to the body to retain natural appearance.

Pauline Smith died in the hospital from heart disease and pneumonia. Her face was slightly swollen and had livor mortis. Which of the following types of edema would you expect?

Hydrothorax

Which of the following is a common complication of heart valve defects?

Lung purge

What is the leading cause of dehydration in the deceased body?

Mortuary Refrigeration

What is the corrective embalming treatment when you notice the discoloration down the midline and on one side of the body due to vasodilation and vasoconstriction?

Muli-point injection

Embalming Protocols for Vasodilation and Vasoconstriction:

Multi-site injection may be necessary with injection of a sufficient quantity of solution to remedy the discoloration. ** this are both to do with strokes

Which of the following is a major concern when embalming cases with diabetes?

Mycotic infections

Which of the following are common embalming complications in a case that has a ruptured abdominal aorta?

No distribution and ascites.

Arteriosclerosis

Pathological condition causing the arterial walls to thicken, harden, and lose elasticity

Stacy Sorrells dies and is brought into your care. Mrs. Sorrells arrives and has severe anasarca and severe jaundice. Which of the following would be the best arterial solution to use on this case?

Special purpose, high index fluids in a strong arterial solution. - use restricted cervical injection

Flaky skin

The skin of a dehydrated body appears dry and can also be flaky.

Generalized, body-wide edema is called

anasarca.

type 3 arteriosclerosis

canalization: unusable for arterial injection

Pitting, or intercellular edema

ccurs when fluids accumulate between the cells of the body. Digital pressure applied to the edematous area causes an indentation, or pit to remain in the tissues. Pitting edema responds well to embalming treatments. It can be drained from the tissues into the circulatory system and removed along with the blood drainage. This edema may be localized as is frequently seen in bodies dead from cardiac diseases where only the legs are distended, and pulmonary edema (edema of the alveolar spaces in the lung tissue). Or, it may be generalized as is frequently encountered after death from liver or renal failure. Generalized edema is referred to as anasarca. - Pitting edema can be gravitated - means that you can reduce the edema by elevation and compresses.

Vasoconstriction

constriction or narrowing of the lumen of blood vessels.

Bodies with renal failure rapidly

decompose

Vasodilation

dilation or expansion of the lumen of the blood vessels

Normal causes for vasodilation and vasoconstriction

disease conditions like cerebrovascular accident or a stroke when alive.

If there is to be a long delay between embalming and viewing of the body do not excessively

elevate the head during storage of the body; elevation will cause gravitation of liquids from the facial tissues resulting in dehydrated features.

Interstitial or tissue fluids

enter and leave the bloodstream (in a similar manner to embalming fluids) through the walls and the pores of the capillaries, the small vessels connecting the smallest arteries (arterioles), and the smallest veins (venules).

atheroma

fatty deposit within the wall of an artery

Warm water solutions increase

fluid reaction

Loose skin

if not removed from facial areas will interfere with cosmetic application. Massage cream can be applied liberally, allowed to remain several minutes, then gently wiped away. The remainder of loose skin is removed with a mildly abrasive pad, saturated with solvent.

Ascites

in the abdomen

Hydrothorax

in the chest cavity

Hydrocephalus

in the cranial cavity.

Hydrocele

in the male scrotum

Tunica intima

inner lining composed of endothelial cells.

Uremic pruritus

is a chronic itching of the skin affecting up to 50% of patients with advanced and end-stage renal failure. Also called chronic kidney disease-associated pruritus

Lymphedema or lymphatic

is a long-term condition caused by the collection of excess fluid in tissues. The obstruction prevents lymph fluid from draining from the area; fluid buildup leads to swelling and hardened tissues. Tissues become necrotic in the advanced stages of the condition. This condition commonly affects the limbs. Post-embalming treatment includes hypodermic injection of the affected area and surface chemical compresses. Plastic garments are recommended

tunica media

middle layer composed of muscle cells and elastic tissue.

type 1 arteriosclerosis

normal arterial tube with care

Cellular (Solid) Edema

occurs when an abnormal amount of interstitial fluid passes into, and is retained by the cell (intracellular). The tissues are swollen and firm to the touch. Solid edema does not respond to embalming treatments. When facial tissues are affected, excision of the deep tissues after completion of arterial treatment is an optional restorative method. - Solid edema cannot be gravitated - means that you cannot "push" it out and it will not gravitate to lower area if the edema area is elevated.

Tunica externa or adventitia

outer layer composed mostly of connective tissue.

Strong alkaline or acid fluids can alter the reaction between

protein and preservative.

what injection method is recommended for edema renal failure

restricted cervical injection

Cool solutions

slow the formaldehyde reaction allowing better distribution and diffusion of the arterial solution throughout the entire body.

type 2 arteriosclerosis

smaller diameter arterial tube with high degree of care

Edema may be localized in a

specific area or generalized throughout the body.

If more fluid leaves the blood vascular system and enters the tissues than is absorbed from the tissues into the blood,

the tissues become saturated and swell.

Edema of the cavities (ascites) does not mix with or dilute the arterial solution. Ascites will dilute the cavity fluid

true

Formaldehyde has a drying effect on the tissues.

true

Fumes from the injection of cavity fluids into the neck area can dehydrate the mouth and the nose

true

Moisture extremes can be localized (in an area) or generalized within most of the body.

true

The primary objective for renal failure is thorough preservation.

true

Tissue building of the cheeks, lips, temples and fingertips, etc. after embalming prevents dehydration of these areas.

true

water is used to dilute arterial fluid.

true

urochrome

turns the skin to yellow or brown in tone

valves are only in the

veins

Examples frequently encountered for skin layer removed

• Abrasions, - Razor burn (abrasion), nicking of the face during shaving of the body, - Skin-slip, where the dermis has dried, - Epidermis removed for transplant.

The following are common problems with the vascular system:

• Arteriosclerosis (and atherosclerosis) • Aortic aneurysm • Valvular heart diseases • Congestive heart failure • Vasodilation and vasoconstriction • Blood vessel clots (Thrombi) • Diabetes • Extravascular resistances

Postmortem Causes of Dehydration Prior to Embalming:

• Mortuary refrigeration. Short-term refrigeration for a few hours actually keeps blood in a liquid state and aids with drainage. • Surface evaporation caused by hypostasis. Hypostasis removes moisture from the upper, non- dependent areas of the body such as the face and the neck. The dry, cool air draws moisture gradually from the tissues into the surrounding air.

Problems From Edema: Jaundice and Edema

• The jaundice discoloration is secondary. • Restricted Cervical Injection method with a waterless solution is recommended. • A jaundice fluid is selected to embalm the head and large volumes of strong arterial solution is used for the trunk.

Embalmed Tissues Help Prevent Dehydration:

• The well-embalmed body should not show signs of wrinkled, dark dehydrated tissue during the funeral. • Thoroughly embalmed tissues dehydrate LESS than under-embalmed tissues. • Changes in the appearance of the body during the interval between embalming and final disposition should be minimal. • Continued care of the deceased on a periodic basis ensures the body remains stable.

Specific Diseases Causing Edema:

■ Alcoholism■ Burns■ Cirrhosis of the liver■ Carbon monoxide poisoning■ Congestive heart failure■ Allergic or inflammatory reactions ■ Extended drug therapy■ Steroid therapy■ Renal failure ■ Trauma■ Lymphatic obstruction■ Venous obstruction■ Phlebitis■ Malnutrition■ Hepatic failure and/or obstruction ■ Surgical and transplant procedures

The objectives of the embalmer are to

(1) Inject an arterial solution of sufficient strength and volume to counteract the secondary dilution that occurs in the edematous tissues, (2) Remove as much of the edema from the tissues as possible, and (3) Establish tissue drying and satisfactory preservation.

Special purpose high-index fluids are recommended to address the following embalming concerns:

(1) edema further dilutes the arterial solution; (2) waste products in the bloodstream and the tissues neutralize the formaldehyde; (3) altered proteins inhibit tissue firming.

Hydrocephalus

- Abnormal accumulation of cerebrospinal fluids in the ventricles of the brain. - This condition can happen at any age; more commonly infants and adults over sixty. - Causes include bacterial meningitis, lesions, tumors, stroke or other traumatic brain injury. Infant hydrocephalus is usually congenital (present from birth). - The head presents as severely distended. Infants may survive after birth and live many years with this condition. - In adults and un-autopsied infants, it is necessary to drain some of this fluid. Rapid decomposition of the brain and fluids of the cranial cavity can occur. - After embalming, drainage is established using a long hypodermic needle and syringe. Pass the needle through the nostril and direct it through the anterior portion of the cribriform plate of the ethmoid bone. The fluid is aspirated from the cranial cavity by drawing back on the plunger of the syringe. - Several ounces of undiluted cavity fluid or phenol solution can be injected in the same manner as the fluid was aspirated. The nostrils should be tightly packed with cotton to prevent leakage.

Causes, Problems, and Concerns with Diabetes:

- Arteriosclerosis, cardiovascular disease, hyperlipidemia (fats in the blood), obesity, and poor peripheral circulation are common comorbidities with diabetes. - Increased bacterial and mycotic infections, including the lungs. - Abnormal pH values may prevent embalmed tissues from adequately firming. - Abscesses, necrosis, and gangrene of the pancreas and the liver. - Decubitus ulcers - Gangrene may also be present in distal tissues such as the fingers and the toes. - Poor circulation (distribution of embalming solution) is to be expected.

Blood Clots:

- Causes the lumen to narrow or collapse, creating resistance within the vessel. This is called intravascular resistance. - Intravascular resistance restricts flow within the vessel. - Blockages caused by clot formation are commonly encountered during embalming. - Remember, the clots you see coming out in drainage are venous clots coming from the veins. Arterial clots cannot exit the body in blood drainage due to the small capillary system.

Protocols for Embalming Dehydration:

- Dehydration occurs to some extent in all embalmed bodies; the process of embalming removes a great amount of tissue moisture through blood drainage. And, formaldehyde is inherently dehydrating - Arterial injection from the right common carotid artery or restricted cervical injection pushes arterial coagula toward the legs. Injection from the femoral or external iliac arteries, when clots are present, may force arterial clots into the carotid arteries and affect distribution to the face. - A secondary injection point may be necessary. - Blood should be drained from the largest vein; the right internal jugular vein.

Hydrocele

- Edema in the male scrotum. - Insufficient arterial solution reaches the tissues of the scrotum, which can be a site for decomposition. - This condition is treated during aspiration and injection of the body cavities, after arterial injection. - During aspiration pass the trocar over the pubic symphysis and pubic bone and enter both sides of the scrotum. - Place a towel around the scrotum and apply pressure. This forces the edematous fluid through the channels that have been made with the trocar and into the pelvic cavity. - The scrotal sac is filled with undiluted cavity fluid to ensure preservation. - Care should be taken not to puncture the scrotum with the trocar. If the scrotum is punctured, use the wicking method to remove as much fluid as possible

What Can The Embalmer Do Regarding Defective Heart Valves:

- Nothing! You cannot go in and repair the heart valves. - If there is arterial solution purge from the lungs that exit the nose and mouth of the deceased, coat the face with massage cream to protect viewing areas of the face. - Be careful not to inject too fast but enough to create intravascular pressure to distribute your arterial solution. - Watch for swelling of other tissues. - Monitor for proper distribution and diffusion, especially to distal areas of the body. - Multi-point injections where necessary. - Hypodermic and surface treatments when required.

Edema in the Legs Only

- Raise the femoral vessels and separately inject the legs. - If the edema is severe, after arterial injection use the trocar to pierce the upper thighs beneath the inguinal ligaments while embalming the cavities. - Elevate the legs and, if desired, wrap them with an elastic bandage beginning at the foot and moving up the leg. This pushes some of the edema into the pelvic cavity from which it can later be aspirated. The legs should be elevated several hours to make this treatment effective. - Inject with cavity fluid or a high-index arterial fluid using an infant or hypovalve trocar. This is done after the arterial injection of the legs. The fluid is placed in the injection machine, and the delivery tube is attached to an infant trocar. Saturate the leg with the fluid and close the entry point with a trocar button. - The leg can also be coated with autopsy gel and placed into a plastic stocking. - Embalming powder can also be placed inside the stocking. The powder and the gel assist in the preservation of the leg. - When edema is more extensive and affects the hips and the buttocks, plastic coveralls or pants should also be used. - When shoulders and trunk walls are affected in addition to the legs and arms, a plastic unionall is recommended to fully cover these areas.

Problems From Edema: Renal Failure

- Renal failure, acidosis, and anemia may not be recognized during pre-embalming analysis. - Conversations with next-of-kin or review of documents from the releasing institution may yield information about cause of death, or the presence of underlying conditions. - Kidney dialysis indicates a potential for renal failure. Pungent and persistent odors of ammonia or urine can indicate renal failure. Uremic pruritus is a chronic itching of the skin affecting up to 50% of patients with advanced and end-stage renal failure. Also called chronic kidney disease-associated pruritus (CKD-ap). - Kidney disease and renal failure do not occur in a vacuum; simultaneous disease processes called comorbidities, can occur. - The proximity of the kidney to the liver, for example, means both organs can be affected by jaundice; a common complication of liver disease. - Chronic renal failure accumulates toxic wastes (urea, uric acid, ammonia, and creatine) in the blood and the tissues of the body. Retention of waste products in the tissues causes acidosis. - The presence of urochrome turns the skin to yellow or brown in tone. Loss of natural complexion color is referred to as sallow. - Anemia, gastric ulcerations and gastrointestinal bleeding are common. - Over time, a decrease in cardiac function can lead to congestive heart failure and pulmonary edema.

Embalming Protocols:

- Restricted cervical injection be employed. - Drainage from the internal jugular vein (close to the center of drainage - the right atrium of the heart). - Begin at a slow rate of flow. Once distribution is established, increase the rate of flow to ensure good distribution to distal body areas. - "It is very important when removing edematous fluids from the tissue spaces to allow the injected embalming fluid time to bring about osmotic exchange; wherein the edematous fluids move into the capillaries and the preservatives move from the capillaries into the tissue spaces. Best practice is to periodically stop injection to allow these physical exchanges to occur. Massage and squeeze the limbs from their distal portion toward the heart to encourage drainage of the edematous fluids from the veins into the blood drainage. Elevation of the arms and the legs also encourages the edematous fluids to move into the large veins. The injection of additional arterial solution after a rest period helps to force edematous fluid out of the vascular system into the drainage

Embalming Protocols for Ruptured Abdominal Aortic Aneurysms:

- Ruptured abdominal aortic aneurysm can significantly impair arterial solution distribution. - Restricted cervical injection is a recommended best practice. - A single-site injection is improbable after severe aortic rupture. If no drainage appears and the abdomen immediately swells, stop the injection. - This indicates a loss of embalming solution from the ruptured aorta into the thoracic and abdominal cavities. - Begin multi-point injection to sectionally embalm each of the body areas. - The trunk walls may require supplemental injection using a hypodermic or infant trocar. - Extreme facial edema and sclerotic femoral arteries can be anticipated. - Use a strong arterial solution with additional dye to trace distribution. Inject slowly. Continue to inject if drainage is established.

Embalming Protocols for Arteriosclerosis:

- Sclerotic arteries are less flexible and may not tolerate being stretched and raised from the incision. Secure arterial tubes in place with an arterial hemostat or thick cotton ligature. Thin linen ligatures may tear the vessel. - Common carotid artery less frequently exhibits arteriosclerosis and is a good choice when vascular problems are anticipated. - Begin injection at low pressure and slow rate of flow; increase as solution distribution is evidenced. - When distribution is mediocre, the strength of the arterial solution can be increased. - A stronger solution supports sufficient preservation when a large volume cannot be distributed. - Multi-site injection allows for higher pressures and pulsation to establish local distribution. Once circulation is established, the pressure and the rate of flow can be reduced. - Co-injection chemicals aid in both fluid distribution and diffusion. - Dye is added to indicate which tissues have and have not received solution. - Firm massage helps to move the solution to the affected area. Lowering the hands or feet below the sides of the table increases distribution by gravity. - When the femoral vessel has arteriosclerosis, avoid forcing the arterial tube into the artery as it can cause the lining to slough (shed) and block the lumen. - Choose an area of the artery to incise that is not thickened by fatty deposits inside the lumen, called atheroma. The vessel wall is weakened in this area and can easily rupture. Make the incision in an unaffected portion of the artery.

Edema in the Trunk

- Sectional arterial injection of the trunk is not possible. - When edema is present in the dependent trunk areas (e.g., shoulders, buttocks, lateral walls), direct hypodermic injection will serve best to increase the preservation of these regions. An infant or hypovalve trocar can be inserted into the lateral walls on each side of the body. The point of entry can be along the midaxillary line in the soft tissues inferior to the rib cage. From this point of entry, the trocar should be able to reach as far up as the axilla and also as far down as the buttocks. - Cavity fluid or very concentrated arterial solution can be injected through the embalming machine. This added embalming measure, of course, is done after arterial injection of the body. - Coveralls or a unionall can be placed on the body, and a liberal amount of preservative powder can be sprinkled into the plastic garment. - Eventually this edema will pass through the skin of the back and the dependent trunk walls. This exit of fluid can occur even before the disposition of the body. - It is essential to protect the clothing and the interior of the casket by use of the plastic garments.

Desiccation

- extreme dehydration from the lack of moisture and water - is a form of preservation because water is withdrawn to such a degree that enzymatic cellular destruction is fully arrested. - Moisture cannot be restored to desiccated tissues. - Areas of thin tissue, such as the ears, nose, lips, and eyelids become desiccated after long-term refrigerated or frozen storage. Desiccated lips appear black, severely wrinkled, and shrunken. Desiccated fingertips are commonly observed; the skin becomes parchment-like and turns a yellowish brown. - Minor areas of desiccation, may be removed and restored using restorative treatments. Arterial injection or hypodermic injection is ineffective. - Widespread facial desiccation can severely impact viewability.

Edema in the Arms Only

- The arm can be separately injected after the body has been embalmed. - The hand and the arm can be elevated to gravitate some of the edema into the upper arm. - "Wrinkling of the back of the hand now becomes a problem. If distal areas such as the fingers become badly wrinkled, a small amount of tissue builder can be injected into each finger. Some wrinkling may be removed by the injection of tissue builder; good points of needle entry would be between the fingers. If there are intravenous or needle punctures on the back of the hand, the embalmer can remove a considerable amount of edema through these openings by squeezing and then sealing the openings with a drop or two of super adhesive." - Wicking the edema is possible—time permitting. - Cavity fluid can be injected into the edema areas by use of an infant or hypo valve trocar.

Edema in the Abdomen

- The edematous fluid is located within the cavity and around the visceral organs. - Ascites is unaffected by arterial fluid treatment or blood drainage. - Ascites will not dilute arterial fluid, because the arterial solution and the edema in the abdominal cavity do not come into contact. - Ascites will dilute cavity fluid. - When ascites is present and the abdomen is very tense prior to arterial embalming, the pressure in the abdominal cavity may be sufficient to interfere with arterial distribution and blood drainage.

Hydrothorax (in the plural cavity by lungs)

- This condition is not easy to recognize because the rib cage cannot expand like the abdomen when edema is present. - This condition can be expected in deaths from heart disease or pneumonia. - Distension of the neck is common. - Both the face and the neck can exhibit intense livor mortis after death. - Aspiration after embalming removes the fluid. Direct the trocar into the posterior portions of the thorax, where the fluid has gravitated. Often large volumes of fluid can be aspirated from the thorax when this condition is present. - If it is necessary to relieve some of this pressure prior to or during arterial injection, a trocar can be introduced from the standard point of trocar entry and guided along the lateral wall of the abdomen into the thoracic cavity. This provides a drainage outlet for the fluid, but does not rupture any large arteries or veins. - When hydrothorax is suspected, use the common carotid artery for injection and drain from the right internal jugular vein. This is the best location from which to drain the head and the arms. - Aspiration should immediately follow arterial injection. - Very often distension of the neck will diminish and any swelling that may have occurred in the facial tissues will be reduced.

protocols for embalming dehydration continued

- Use a moderate arterial solution with an overall strength of 2.0% or above. - Use a co-injection fluid with the arterial solution. The co-injection fluid helps to reduce the astringency of the arterial solution and also adds moisture to the tissues. It is recommended that equal amounts of co-injection and preservative arterial fluids be used. - Use a humectant co-injection fluid along with the arterial solution. These fluids are designed to maintain or add body moisture. Excessive use of humectants will have the opposite effect and instead will cause tissues to dehydrate. - Inject large volumes of fluid to replenish the lost moisture. - Intermittent or alternate drainage can be used to help the tissues retain the arterial solution and also to reduce short-circuiting of fluids to achieve more uniform embalming. - Very slow injection of the arterial solution will help to fill the vascular system without causing arterial emboli to block small arterial branches. - Avoid excessive massage of the hands, neck, and face. - Hypodermic and surface treatment of the legs can be used to establish preservation. - Apply massage cream, stone oil, or lanolin spray to exposed skin surfaces of the face and the hands to act as a barrier to retard moisture loss. - Do not expose bodies to direct air currents. Maintain body coverings.

Problems From Edema: Burns

- When an individual initially survives a burn trauma, edema will occur, especially in second-degree burns. - Blistering of the skin is characteristic of second-degree burns. - Death commonly results from renal failure. Preservation is the primary objective and demand for preservative is high. - Restricted cervical injection of hypertonic or waterless solutions is recommended. - Fluid dye can be added to the arterial solution to trace distribution. - Areas not reached by the arterial solution are treated by hypodermic injection of cavity fluid or a very strong arterial solution. - Denuded skin surfaces can be thoroughly dried after embalming by allowing air exposure and by force-drying with a hair dryer. - Select a suitable plastic garment that covers all affected areas. - Coat the affected surfaces of the body with autopsy gel and liberally apply embalming powder. - Place embalming powder into the garment as well.

bleb or belle

- contains edematous fluid that has seeped from the deeper tissues into the superficial layer. Lance the bleb and cauterize the moist tissues with phenol or cavity fluid. Apply surface chemical compresses and wrap the affected area - are only seen when tissues are decomposing, and when tissues begin to decompose following under-embalming of tissues.

Embalming Protocols for Diabetes:

1. Proper fluid selection and thorough distribution are primary embalming concerns. 2. Restricted cervical injection is suggested and drainage from the right internal jugular vein. 3. A moderate to strong solution strength accompanied by a co-injection fluid and dye to trace the distribution of solution in the tissues. 4. Moderate to high pressure to distribute the solution. High pressure and pulsation promote flow to the peripheral tissues (fingers, toes, ears, nose, and lips). 5. Massaging the extremities and using intermittent drainage also facilitates fluid distribution. 6. Cavity embalming must be thorough to arrest mycotic infections that may be present in the lungs. Arterial solution does not treat the visceral organs. Abscesses, necrosis, and gangrene of the pancreas and the liver is treated by a sufficient amount of cavity fluid. Cavity fluid is injected into each major body cavity: thoracic, abdominal, and pelvic for a recommended total volume of 32-48 ounces. Based on embalming analysis, additional volumes may be necessary. 7. Hypodermically and surface treat any areas that have not received arterial preservation, including gangrene areas. 8. Treat decubitus ulcers as previously covered in lectures. 9. Plastic garments to control odors of gangrene, etc.

Embalming Protocols for Congestive Heart Failure:

1. Right common carotid and right internal jugular vein or, restricted cervical injection is recommended as they are both close to the right atrium. 2. The first gallon of arterial solution is prepared as a mild solution to clear blood congestion and discolorations. When edema is present, subsequent solutions are mixed stronger to meet the preservative demands of the tissues. 3. Severe ascites and intestinal gases create pressure upon the inferior vena cava that can prevent adequate drainage from the lower portions of the body. Edematous fluids can be drained using a trocar or drain tube. Incise the skin at the point of entry with a scalpel; this allows insertion of the trocar with minimal effort. Insert the instrument into the ventral portion of the abdominal cavity to prevent puncturing any of the major trunk vessels. 4. Lower the arms over the table at the onset of arterial injection to promote capillary expansion; this helps to clear discolorations from the hands and fingers. 5. Massage facial tissues to clear discolorations. Drain from both the right and left internal jugular veins when extensive discoloration of the face is present. Use continuous drainage until congestion has cleared. 6. Pressure and rate of flow may be increased as the embalming progresses; the pressure and the rate of flow should be sufficient to move arterial solution through the entire body. 7. The liver may be enlarged, and its functions decreased. This should improve drainage, as the level of clotting factor in the blood will be low. In the presence of anasarca, or generalized edema, good distribution and drainage is anticipated. 8. Pulmonary edema is often observed in cases of congestive heart failure, lung purge is anticipated. Coat the facial tissues with massage cream and allow purge to continue during the embalming process. 9. Perform thorough cavity treatment and pack the nasal cavity with cotton after embalming. Ascites dilutes cavity fluid. Re-aspiration and re-injection of the cavities may be indicated. 10. Distension in the neck tissues can be removed during cavity aspiration. Direct the tip of the trocar into the neck and channel the tissues.

The pressure and fluid should be removed prior to arterial injection by:

1. Using a scalpel to make a small incision about where the trocar would go (or use the trocar, but do NOT aspirate!). 2. Use a trocar to remove the build up of fluids and gases near the abdominal wall.

different types of aneurysms

1. saccular 2. fusiform 3. ruptured

Complications from Congestive Heart Failure:

1.Blood is congested in the right side of the heart. 2.The neck veins are engorged with blood 3. Facial tissues are discolored due to blood congestion 4. Lips, ears, and fingertips appear cyanotic (bluish-purplish discoloration due to a lack of oxygenated blood). 5.Generalized pitting edema, ascites, and edema of the legs and feet may be present. 6.Blood may be more viscous due to an increase in red blood cells (polycythemia). 7.Salt is retained in the body fluids.

What percent increase in total body water constitutes the body being classified as having "edema"?

10%

Embalming and Maintaining Proper Moisture:

Areas customarily viewed, the face, neck, arms, and hands should present a natural appearance. Dehydrated tissues, visible discolorations, and features swollen with edema are unacceptable. The control of moisture is a primary concern for the embalmer. Establishment and maintenance of proper moisture balance prevents extreme conditions associated with dehydration and edema. Good tissue moisture begins during arterial embalming and is supplemented with various embalming treatments and continues with proper post-embalming care

What is the term for fatty deposits within the vessels that cause them to thicken??

Atheroma

How would you even know if a decedent has vasodilation or vasoconstriction since you cannot view the vascular system?

Because the dyes in your arterial solution will indicate that one side of the body has received a large amount of solution and the other side a small amount. This difference is often evident down the midline of the body

The Bonze will consult what in order to determine the best day to casket someone who is Buddhist?

Book of Dates

What is the term for the tiny pathways created within vessels during arteriosclerosis?

Canalization

If you use too much of a humectant supplemental fluid, what is most likely to occur?

Dehydration of tissues

Dehydration and edema can be caused by:

Disease processes Drug therapies Surgical procedures Long-term mortuary refrigeration.

Antemortem Causes of Dehydration:

Hemorrhage Febrile diseases (with fever) Kidney diseases Diabetes Some cancers and localized neoplasms Some first- and second-degree burns Some diseases like tuberculosis and acquired immunodeficiency syndrome (AIDS) Excessive vomiting & diarrhea Drugs that increase urine excretion (diuretics) Decreased water intake

Stan Duke died at the local hospital and was released to you. When talking to the family, they mention that he had been on dialysis and began to not feel well. He was diabetic and had ketoacidosis. When you receive Mr. Duke, he has a sallow color and smells like urine. What should you assume that Mr. Duke has?

Renal failure

Sources of extravascular resistance and suggestions on how to overcome resistances are listed here:

Rigor mortis - Relieve as much rigor as possible prior to arterial injection. Ascites - Drain the fluid in the abdomen prior to, or during arterial injection. Gas in the cavities - Release gases in the abdomen prior to, or during arterial injection. Bandages - Remove tight bandages prior to injection. Contact pressure - Massage the affected areas. Tumors. - Excise when necessary; permission is required. Swollen lymph nodes - Treat with sectional injection. Hydrothorax - Drainage of the pleural cavities may be impractical prior to embalming. Visceral weight - Utilize injection and drainage points above and below the heart.

Embalming Solvents

Rinse solvent from the skin thoroughly as this product will also dehydrate tissues.

Wicking

is a post-embalming process to remove edema from body regions. A scalpel is used to create one or several small openings in a dependent area of the edematous tissue. Long lengths of dry cotton serve as wicks to draw the edema from the area. Wicks are inserted directly into the area using forceps or a hemostat. The opposite end of the wick extends into the side drain of the embalming table. Numerous wicks can overlap to create additional length. The capillary action of the wick will draw the edema from the tissues over time. Manual pressure placed on the edematous area can increase and speed the drainage of the edema. Allow passive drainage to continue for several hours. The opening can be closed with a trocar button or a reverse suture and sealed with a surface adhesive. Plastic garments are recommended.

edema

is said to be established when there is a 10% increase in total body water.

sallow

loss of natural complexion color