An electrically-heated blade which may be used to dry moist tissue, reduce swollen tissue, and restore contour to natural form

Electric aspirator ; also known as Tissue Reducer.

Post-Mortem examination of the organs and tissues of a body to determine the cause of death and/or existence of pathological condition(s

Autopsy); also known as Necropsy or Post-Mortem Examination.

this is even more evident when a pre- injection is employed against closed drainage.

Distension of superficial blood vessels

Major process by which body is embalmed Solution enters tissue spaces and cells Helps force out drainage

If coagula are expected, inject RCC right common cartid

Pushes coagula away from head/arms Inject lower limbs separately if necessary

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Embalming II quiz 1

Embalmin 2 terms

Question	Answer
Separation of substances in solution by the difference in their rates of diffusion (i.e. the size of the solute) through a semipermeable membrane.	Dialysis
The movement of molecules or other particles in solution from an area of greater concentration to an area of lesser concentration until uniform concentration is reached. \| Fluid/Embalming definition: Passage of some components of the injected arterial sol	Diffusion
The movement of embalming solutions from the point of injection throughout the arterial system and into the capillaries.	Distribution
Extravascular movement of preservative fluids by gravitational force to the dependent areas of the body.	Gravity filtration
A solution having a greater concentration of dissolved solute than the solution to which it is compared.	Hypertonic
A solution having a lesser concentration of dissolved solute than the solution to which it is compared; solution with a lower osmotic pressure than that of a reference solution.	Hypotonic
Fluid in the supporting connective tissues surrounding body cells (about one-fifth the body weight).	Interstitial fluid
Force created as the flow of embalming solution is established and the elastic arterial walls expand and then contract, resulting in filling of the capillary beds and development of pressure filtration.	Intravascular pressure
A solution having an equal concentration of dissolved solute to that of a standard of reference.	Isotonic
Passage of a pure solvent from a solution of lesser concentration to one of greater solute concentration when the two solutions are separated by a semipermeable membrane which selectively prevents the passage of solute molecules, but is permeable to the s	Osmosis
Positive intravascular pressure causing passage of embalming fluid through the capillary wall to diffuse with the interstitial fluids; causing passage of embalming fluid from an intravascular to an extravascular position.	Pressure filtration
An instrument that is attached to the aspirator tubing and used to aspirate blood and arterial solution from the cavities of autopsied bodies.	Autopsy aspirator
Direct treatment, other than vascular (arterial) embalming, of the contents of the body cavities and the lumina of the hollow viscera; usually accomplished by aspiration and then injection of chemicals using a trocar.	Cavity embalming
Concentrated embalming chemical injected into the cavities of the body following the aspiration of the body; can also be used in hypodermic and surface embalming.	Cavity fluid
A device that connects to a bottle of cavity fluid used to deliver the fluid into the body cavities	Cavity fluid injector
An electrically-heated blade which may be used to dry moist tissue, reduce swollen tissue, and restore contour to natural form	Electric aspirator ; also known as Tissue Reducer.
Apparatus that is connected to the water supply; when the water is turned on a suction is developed and is used to aspirate the contents of the body's cavities.	Hydroaspirator
Embalming instrument used to aspirate the throat by means of the nostrils.	Nasal tube aspirator
Postmortem evacuation of any substance from an external orifice of the body as a result of pressure.	Purge
Repeated aspiration of a cavity.	Reaspiration
Long, hollow, sharply-pointed aspirating instrument patented in 1868 by Samuel Rogers of Philadelphia; used by embalmers to inject cavity fluid and to remove gases, liquids, and semi-solids from the body cavities and hollow organs; may also be used for su	Trocar
A plastic, threaded screw-like device for sealing punctures and small, round trocar openings.	Trocar button
Plastic garment designed to cover the body from chest down to the upper thigh.	Coverall
Crackling sensation produced when gases trapped in tissues are palpated, as in subcutaneous emphysema or tissue gas.	Crepitation
A detailed listing of body conditions and treatments performed by funeral personnel for all bodies received into a facility for preparation.	Embalming report
Injection of embalming chemicals directly into the tissues through the use of a syringe and needle or a trocar.	Hypodermic embalming
The direct contact of body tissues with embalming chemicals.	Surface embalming
Process of cleaning decontaminating prep room instruments, after the preparation of remains. Disinfection procedures carried out at the end of an infectious period, this involves cleaning the entire area that may have been contaminated by the patient.	Terminal disinfection
Plastic garment designed to cover the entire body from the neck to the feet.	Unionall
A disease of the arteries resulting in thickening, hardening, and loss of elasticity of the arterial walls.	Arteriosclerosis
A fluid used primarily to supplement and enhance the action of vascular (arterial) solutions.	Co-injection (fluid)
Superficial bleeding under the skin or a mucous membrane (a bruise) as a result of hemorrhage into the subcutaneous tissues. Bruising discoloration of the skin caused by the extravasation (escape/leakage) of blood into the extravascular tissues, generally	Ecchymosis
The vertical restraining fold of mucous membrane (band of flesh) on the medial aspect (midline) of the inside of each lip connecting the lip with the gum.	Frenulum
Fluid injected primarily to prepare the vascular system (clear it of blood) and body tissues for the injection of the preservative vascular (arterial) solution. This solution is injected before the preservative vascular solution is injected to enable it t	Pre-injection (fluid)
The connection of normally separate parts, for example, a connection of two blood vessels.	Anastomosis
Post-Mortem examination of the organs and tissues of a body to determine the cause of death and/or existence of pathological condition(s	Autopsy); also known as Necropsy or Post-Mortem Examination.
To divide into two parts or branches.	Bifurcation
The circular arterial structure at the base of the brain from which all the principal arteries that supply brain branch.	Circle of Willis
Removal of the eye for tissue transplantation, research, and education.	Eye enucleation
Internal organs enclosed within a body cavity.	Viscera
The reaction of formaldehyde with protein (i.e. nitrogen) to form a new compound called	coagulate
most reliable sign of distribution AND diffusion	Fluid dye
this is even more evident when a pre- injection is employed against closed drainage.	Distension of superficial blood vessels
you can't have drainage if the solution is not moving through the vascular system (i.e. displacement.)	Blood drainage
4. Clearing of intravascular blood discolorations (i.e. livor mortis.)	t
Center of arterial distribution	Arch of aorta
Created by pressure from machine and expansion of elastic arteries	Intravascular Pressure
Intravascular Pressure causes	PRESSURE FILTRATION
PRESSURE FILTRATION	Major process by which body is embalmed Solution enters tissue spaces and cells Helps force out drainage
Intravascular Resistance examples
Sufficient pressure/ROF Slow ROF can help prevent dislodging coagula	t
If coagula are expected, inject RCC right common cartid	Pushes coagula away from head/arms Inject lower limbs separately if necessary
Extravascular Resistance examples
Resistance in capillaries (& venous side)	Slows embalming fluid Holds it within the capillaries More time to diffuse More even distribution and reduce short circuiting
If there were no resistance?	finishd with prep in no time, Ruptured aortic aneurysm need 6 point
Signs of Arterial Solution Distribution	Fluid dye Distension of superficial vessels Temples Top of hands & feet Drainage Clearing of intravascular discoloration
How do we improve distribution?	lower hands, message extremities (firmly!) Can “attract” solution into the area Increase ROF or pressure Pulsation Restrict drainage Inject an adequate amount Relieve abdominal pressure Select another drainage site
What are signs of fluid diffusion?	Dye in the tissue Firming of tissue Loss of skin elasticity Drying of tissue Rounding of fingertips Bleaching of tissue Mottling of tissues Fluorescent dye observed w/black light
From capillaries to tissue spaces:	Pressure Filtration Osmosis Dialysis
From tissue spaces to inside cell	Diffusion Adsorption Gravity filtration
Uses IVP (created by embalming machine) Solute & solvent move to interstitial fluid Some solution moves to drainage Primary mechanism for embalming	Pressure Filtration
Passage of a solvent through a semi-permeable membrane From dilute (low concentration) to concentrated (high concentration)	Osmosis
Separation of substances in a solution by a semipermeable membrane	Dialysis
Crystalloids	are small solutes that can pass through a semi-permeable membrane. Included in this type of solute are preservatives, salts, and germicides
Colloids	are large solutes that can not pass through semi-permeable membranes without the process of ultra filtration. Included in this type of solute are humectants
Scattering or spreading of solution throughout interstitial fluid EXTRAvascular movement	Diffusion
Large particles in cell “attract” and “hold” other molecules to/on surface of the cell	Adsorption
Settling of fluid to dependent parts Extravascular movement Arterial and cavity embalming	Gravity filtration
what is the difference between distribution and diffusion	distribution - movement throughout the vascular system diffusion-movement from vascular system to extravascular area
how can you tell if there is only distribution of arterial fluid	distension of superficial blood vessels
actual pressure 30 differential 20 what is the potential pressure	50
what is example of extra-vascular resistance	rigor mortis
what are the 4 d of arterial embalming	delivery, distribution, diffusion, drainage
movement of solvent from area of lower concentration to area of higher concentration	osmosis
Purposes of Cavity Treatment (Aspiration & perfusion w/cavity fluid)	Reach the substances and microbes found in the spaces within the thoracic, abdomino-pelvic, and sometimes cranial cavities
Purposes of Cavity Treatment (Aspiration & perfusion w/cavity fluid)	Treat those materials found within the hollow viscera and portions of the visceral organs themselves that are not reached by arterial injection
Cavity Embalming Designed to treat…	Contents of hollow viscera Walls of visceral organs Contents of spaces between organs & walls of cavity If not done: odors, gas, & purge can easily develop.
Cavity Treatment When is it NOT done?	Donation of body to a medical school no drainage either
Liquids/semisolids; “coffee ground” appearance; odor	Stomach Purge
Frothy; occasionally blood present; little odor	Lungs Purge
Creamy white semisolid brain matter; gas in eye tissues. mouth, eyes, noses, ears	Brain (rare) Purge
Trocar Guide: Right side of Heart	Entry point: 2 inches to left and 2 inches above the umbilicus Deceased’s left
Trocar Guide: Right side of Heart	Move the trocar along a line from the left anterior-superior iliac spine and the right earlobe; depress the point after you have passed through the diaphragm
Trocar Guide: Stomach	Direct trocar toward the intersection of the 5th intercostal space and the left mid-axillary line Line from center of medial base of axillary space inferiorly along rib cage Continue until trocar enters stomac
Trocar Guide: Bladder	Direct the trocar along the abdominal wall to the symphysis pubis, pull it back slightly and depress it while moving it forward. Should be very noticeable when you hit the bladder...(if the tank was full!)
Trocar Guide: Cecum	Direct trocar toward a point ¼ the distance from the right anterior-superior iliac spine to the pubic symphysis Keep trocar up near the abdominal wall within 4 inches of the anterior-superior iliac spine, dip trocar 2 inches and insert into cecum/colon
Sometimes aspiration is necessary DURING the arterial injection. Abdominal pressure: Gas or edema Can act as extravascular resistance	Partial Aspiration Text suggests using a scalpel to puncture abdomen: a trocar will work as well
tongue & facial tissues distended Thoracic walls all the way to scrotum IF NO ODOR OR SIGNS OF DECOMP Feel for broken rib Tracheotomy Needle punctures	Subcutaneous Emphysema
Aspiration Technique	2 inches to (deceased’s) left & 2 inches superior to navel Inserting on the right would put you in the liver Fanning or “Fan & Layer” method Keep trocar in constant motion
Aspiration Technique	Avoid clogging (small intestine “clingy” tissue) If you hit a pocket of fluid, gas, etc. – stop moving & let it sit!
Advantages of Immediate Aspiration	Large numbers of microbes removed Prevents possibility of translocation Minimizes production of gas Removes materials that could purge Eliminates a bacterial medium (visceral contents) Helps prevent blood discolorations Decreases swelling.
Advantages of Delayed Aspiration	maximum time for the arterial solution to penetrate the tissue spaces by maintaining pressure within the vascular system. Gives tissue more time to firm If you’ve used a humectant co-injection to “fill out” the features, IVP makes this more effective.
Injection of Cavity Fluid	16 oz. for each cavity: (thoracic, abdominal, & pelvic.) On a “standard” case, one bottle is usually sufficient 8 oz. “up” and 8 oz. “down” (250 lbs.+), delayed embalmingswill require two bottles Turn body on side
Injection of Cavity Fluid	Chemicals applied to anterior surface of abdomino-thoracic wall Gravitation through openings made during aspiration Leave the fluid “high” in the abdomen Absorbed by or rest upon posterior surface of cavity walls
Cranial Aspiration (Not common)	Use a small (infant) trocar and insert it into the nostril until you pierce the Cribriform Plate of the Ethmoid Bone Inject a small (few oz.) amount of cavity fluid using a hypodermic syringe Tightly pack the nostrils with cotton
Closure of Entry Point	Trocar Button Purse string suture “N” or Reverse Stitch Many embalmers will put an adhesive/sealant over the button before dressing.
Re-aspiration & Re-injection	Noticeable amount of gas in the abdomen prior to dressing Ship-out or ship-in When decomposition is present Recent abdominal surgery Obese cases Evidence of gas or purge
Re-aspiration & Re-injection	Blood infection or infection of abdominal cavity (e.g., sepsis) Drowning case Bodies with ascites Trade Calls: You never know who’s been working on the body!
what causes stomach purge	build up of pressure
how to create more surface space in viscera	aspiration. important to get cavity fluid into the inside of organs
Generally done AFTER arterial and cavity injection	Treatments for areas with insufficient preservation Suturing incisions Removal/closure of invasive devices Purge, swelling, discoloration, packing Surveillance until disposition
If an area has not received fluid: INJECT through a second injection point!!! When in doubt, simplest corrective treatment is to INJECT THE AREA ARTERIALLY!	Appearance of areas lacking solution: Little/no evidence of dye Discolorations (IV and EV) still present Lack of fixation
Supplemental Treatments	Surface Embalming Liquids, gels, powders (powders are the LEAST effective) Surface pack/compress Hypodermic Embalming Arterial solution or straight arterial fluid Small areas: Eyelids, mouth, fingers Large areas: Lower legs
Mouth/Lips Cotton over teeth/dentures & saturate with cavity fluid (use hypodermic syringe) Glue lips Preservative works from the inside to preserve tissue Cosmetics can be applied immediately with this technique	Special Internal Treatments for Facial Areas
Eyelids Use cotton for closure or place over eyecaps Saturate with cavity fluid Glue eyes Cosmetics can be applied	Special Internal Treatments for Facial Areas
Nose Cotton saturated with cavity fluid inserted far back in nostrils Inject cavity fluid w/small gauge needle May want to channel Difficult for fluid to enter cartilaginous tissue	Special Internal Treatments for Facial Areas
Access facial areas from inside mouth when using a needle/syringe Leakage will not exit onto face (into mouth) These openings will not “close” as they do when using tissue builder	Hypodermic Embalming
Closing Incisons	Two general methods: Sutures Super adhesives
Preparation of Incisions	Suture AFTER cavity treatment (but before cavity injection) Relieves IV pressure – reduces leakage Make sure all vessels are SECURELY TIED Force any edema out of incision Dry incision Cauterant pack (can leave in or remove before closing)
Preparation of Incisions	several sutures before applying powder Create a pocket for sealing powder Apply surface glue over incision
Stomach	Epigastric
Heart	Left Hypochondriac
Spleen	Left Hypochondriac
Transverse colon	Umbilical
Cecum, appendix	Right Inguinal (Iliac)
Bladder	Hypogastric
Cotton or Linen (waxed) Ligature	Linen is stronger and should be used for autopsy suturing
Dental floss can be used on visible areas (e.g. intra-dermal)	Needles Make sure the ligature fills the hole left by the needle E.g. using single ligature with a HUGE double-curved needle!
DO NOT PULL ON THE LIGATURE This weakens ligature where it passes through eye	t
Types of Sutures	Individual (Bridge) Baseball (Sail) Single Intradermal (Hidden) Double Intradermal Inversion (Worm) Interlocking (Lock) Continuous (Whip)
Baseball (Sail) Suture	most common most secure Can be airtight (if done properly) Used for: Incision site Autopsy Long bone donations Disadvantage: ridge is formed
Double Intradermal	One needle on each end of the ligature One end is “anchored” – greater hold
Individual (Bridge)	Individual sutures Used to align tissue prior to, during, or after embalming: E.g. lining up autopsy Temporary Removed and replaced with permanent suture
Single Intradermal (Hidden)	Goes through subcutaneous suture only! Used on exposed areas of body Directed through subcutaneous tissue only Dermis Back and forth through the dermis Pull ligature on each end to close suture
Double Intradermal Suture	One ligature – two needles One needle on each end of the ligature Similar to lacing a shoe Permanently fixed on each end Greater holding power than single Close: insert each end of ligature into one needle Insert under skin and exit ½ inch incision
Inversion (Worm) Suture	Will gather or turn under tissue Not visible and can be waxed Same pattern as single intradermal Stitches made parallel to incision edges Good for carotid areas in lieu of baseball No darkened, raised areas Good for scalp closure on autopsy
Continuous (Whip) Stitch	Continuous (Whip) temporarly Used by autopsy technicians Long bone donations Surgery deaths Contains blood and other contents during transfer
“N” Suture and Purse-string	Both can be used for colostomy openings Puncture wounds, trocar entry points Hypovalve trocar
Adhesives	Can be used to close vessel incisions Common carotid Close cranial autopsies Long autopsy incisions should be sutured
Invasive Devices	IV Needles and venous catheters Generally speaking, leave needles/IVs IN PLACE until injection is complete.
Invasive Devices	Swelling and discoloration can occur if devices are removed prior to injection IV sites on top of hand or antecubital fossa Close with super glue
Pacemakers (IPGs)	Must be removed if body is to be cremated Pressure buildup during cremation & they can rupture forcefully Small explosion in retort
Pacemakers (IPGs)	Certain units can contain radioactive material and must be returned to manufacturer No longer in production Should be removed by trained physicians
Removal of Pacemakers after arterial injection	Small incision above unit Externalize unit Place magnet over unit to TEMPORARILY deactivate Sever anchor stitches Cut wire leads – one at a time Incision sealing powder Suture incision
Colostomy Bags	Opening of the colon through the abdominal wall to the skin surface.
exposed portion of the bowel	Stoma
Remove bag AFTER injection Rinse with cavity fluid and dispose Digital pressure to force stoma back into abdomen Purse-string or N suture	t
Decubitus ulcer	Surface pack (Syn-Gel, Postene, etc.)
Purge	Reaspirate if body has purged after embalming Packing orifices
Final Washing/Drying of Body	Particular attention to removal of blood Shoulders Hair (if jugular vein was accessed) Don’t use abrasive side of pad on face Turn body on sides to clean and dry Thorough drying eliminates potential for mold growth
Ulcerations, Lesions, Discolorations	Surface compress of phenol can be used on discolorations after embalming Much more effective to hypodermically inject ecchymoses BEFORE arterial embalming!
ascites	Excess abdominal fluid in a certain area
Remove pitting edema the whole body	anasarca
Remove pitting edema (anasarca) with:	Gravitation (elevation of head) Massage Channeling of area Application of pressure Pneumatic collar Weights Elastic bandage Water collar Digital pressure
Distension	Swelling/edema of eyes Weighted surface compress Water Cavity fluid on cotton under eyes Hypodermic injection of phenol/cavity fluid Heated spatula Channel area and manipulate fluid towards opening
Problem with removing edema from face/eyes is wrinkling of skin Preservation is always first concern Can remove wrinkles with spatula	use cream with it
Spongy feeling of gas as it moves through the tissues when palpated “Snap, crackle, pop” Gas in facial tissues can only be removed by channeling	Crepitation
Capri Pants Plastic Garments	Single unit Combination of pants and stockings one unit footy panjimas
Plastic Garments Pants	like shorts waist to knee Use embalming powder or autopsy compound Deodorize and prevent mold growth
unionalls	whole body?
Final Steps	Terminal disinfection Instruments, equipment, surfaces, personal hygiene, etc. Clean the embalming machine tank Prepare the embalming report
C. perfringens can be passed via contaminated instruments	t
Cold chemical sterilant 2.65% glutaraldehyde 3-12 hours	DSD
Keep water in machine	Keeps gaskets moist
Infant body normally contains a large amount of moisture	DO NOT USE PRE-INJECTION
nfant body will not require AS MUCH preservative but will require a similar strength due to moisture content and rapid rate of decomposition	Use standard arterial/co-injection fluids Mouth former will not work; will normally have to use a muscular/mandibular suture
Infant Common Injection Sites	Common Carotid Artery Femoral Artery Always inject distally first to see effects of fluid Abdominal Aorta Ascending Aorta Incision through sternum must be held open with retraction during procedure
Immersion Technique	Majority of premature infants are embalmed via immersion; soaking in a plastic container weigh on top to keep under
4-12 Year Olds Most common injection sites Common carotid and femoral arteries	Delicate skin Use medium index fluid (18-25) Facial hair (lanugo) should be removed to ensure proper cosmetic application Watch rate of flow low rate with children delicate vessels
Pre-Injection	Fluid as well as procedure
Pre-Injection Fluid Chemical containing VERY LITTLE or NO preservative	Process Arterial injection of this chemical (diluted) into to prepare vascular system and body tissues to receive preservative solution
Done PRIOR TO injection of arterial preservative solution Pre-Injection Fluid	Clears intra-vascular blood discolorations Remove blood in vascular system Adjust pH of tissue
Pre-Injection:  When to use it…	When good distribution is expected Recent death Jaundice cases No edema Emaciated cases
Pre-Injection:  When to NOT to use it…(according to text)	When circulation issues are expected Lengthy post-mortem interval Early signs of decomposition Arteriosclerosis Autopsies Refrigerated cases Edematous cases Expected swelling/distension
Ideal rate of flow	10-15 minutes per gallon (for first gallon) 10 minutes per gallon = 10 minutes per 128 oz. = 12.8 oz./min
Ideal pressure	5 – 20 lbs. Should overcome most bodily resistance
Elderly Considerations	It is possible to apply pressure to these limbs to change their position Damage: broken bones, etc. lead to distribution problems
Atherosclerosis Form of “arteriosclerosis” Plaque buildup	Poor circulation leads to other conditions Decubitus ulcers
Senile Purpura (“Ecchymosis”)	Most common in elderly Extravascular, irregularly-shaped blood discoloration often appearing on the arms and back of hands Due to fragility of capillaries
Senile Purpura (Ecchymosis)	These areas generally will not clear during injection They will often become engorged with blood and swell very noticeably during embalming
Ecchymosis: Treatment	Subcutaneous injection with a cauterant such as Dryene BEFORE arterial injection Inject first, observe how area reacts and inject hypodermically afterwards if needed Possibility of disrupting capillary beds when injecting before embalming
Diabetes	Darkness in lower extremities Best to stay away from femoral arteries Strong arterial solution as kidney/liver problems are common
Treatment for Diabetics	Use common carotid vessels Strong solution Kidneys Dye Poor circulation Massage limbs
Medical (Hospital) Autopsy Verify or confirm diagnosis (e.g. CJD) Common at teaching hospitals Medicolegal (Forensic) Autopsy Ascertain the cause and/or manner of death Violence, trauma, sudden deaths not attributable to disease	Types of Autopsies
Partial autopsy Only one cavity is opened (cranial, thoracic, abdominal)	Types of Autopsies
Work Practice Controls Autopsies	Watch for broken bones/rib cage Avoid high water pressure (but use continuous water flow) Don’t flip ligature (when removing temporary sutures) Continuous aspiration Clamp leaking arteries
Normally requires a stronger-than-average arterial solution Pre-injection would NOT be recommended!	Extended refrigeration can cause DEHYDRATION Different type of solution? Delays INCREASE the possibility of DISTENSION
Refrigeration Concerns	Subcutaneous tissue may become firm due to low temperatures False sign of distribution Can lead to swelling if RoF is too high
Refrigeration Concerns	Bring about hemolysis of blood trapped in superficial tissues Can be mistaken for dye/distribution BENEFIT: Can keep blood in a liquid state
Autopsies	NO drainage devices are necessary. Can still use intermittent drainage Vary the pressure and rate of flow depending upon which area is being injected.
Remove viscera bag and sternum DO NOT handle the viscera bag assertively Cavity fluid (or SynGel HV) can be poured into the viscera bag	Coat the sternum in Syn-Gel HV or Basic Dryene Wrap sternum in cotton and soak with Phenol Place the bag in a stainless steel bucket
Suggested Order of Preparation	Set features Remove viscera Ligate vessels Mix solution Begin injection: Legs Arms Head (which side first?) Supplemental treatments Dry cavities and add compound or gel Return viscera bag
R & L common iliac arteries Look for leaking from internal iliacs (in pelvic cavity)	Drainage will flow into main body cavity via common iliac veins (or IVC) Hemostat (or digital pressure) for intermittent drainage Volume/strength depend on pathological conditions
Injecting the Upper Extremities	R & L subclavian arteries Distribution to shoulders, back of neck, upper back Not achieved when axillary artery is used IMPORTANT: Must clamp the vertebral artery (in cranial vault) when injecting the subclavians!
Injecting the Head	R & L common carotid arteries Inject left side first to avoid over-embalming the right side L & R internal carotid arteries must be clamped (in the cranial cavity)
Circle of Willis:	arterial circle at the base of the brain which supplies blood to the brain
Supplemental Hypodermic Injection	Hypovalve trocar on trunk walls, buttocks, breasts, shoulder & neck Distribution to abdominal walls during injection of iliac arteries Pack pelvic cavity (prevents rectal leakage) Fill out the neck region
Viscera have been soaking in cavity fluid in the bag Some embalmers pour cavity fluid AFTER bag has been placed in the cavity Some embalmers remove the viscera, coat in powder, and place them each into the cavity	Cotton over severed ribs to prevent bag from tearing Aspiration hose in bag with ligature around hose Remove air and tie bag up high so there is room for viscera to move
Closure of the Main Cavity	Position sternum first (covered on both sides w/gel or powder) Bring three flaps together in middle – tie w/one suture Suture from this point towards one shoulder Pull on ligature NOT needle
Closure of the Main Cavity	Start abdominal suture at pubic symphysis When you hit the middle of the Y, continue up towards other shoulder Incision sealing powder is important in shoulder areas: common leakage spot
Closing the Head	Can be sutured or stapled Notch in calvarium Make notches for calvarium clamps Reflect scalp forward, add Webril and soak in Dryene to cauterize tissue around the skull
Closing the Head Prior to injection	Use incision sealer if needed (hard to wash out of hair) If you have dried tissue effectively, skin staples will work well
Methods of calvarium attachment	Suture through temporal muscle Calvarium clamps Superglue Plaster of Paris Needle injector wires Drill holes & wire Bald head – glue
Autopsies: Head Closure	Baseball or worm (Inversion) suture Super adhesive (Aron Alpha) Putty along the cut line of the forehead Smooth out any contour Start on the right and work towards the left Excessive shampoo/hair clamps to keep hair in place
Partial Autopsies	Cranial only Thoracic only Abdominal only
Cranial Autopsy	Method 1: RCI Clamp vertebral artery Method 2: Inject RCC only Clamp L. internal carotid and vertebral arteries Method 3: Femoral injection Clamp all vessels in brain (R & L internal carotids and R & L vertebrals)
Thoracic Autopsy	Drainage from lower extremities and abdomen: inferior vena cava Inject head and arms same as normal post Lower extremities: Use thoracic aorta; OR… Inject femoral arteries (superiorly and inferiorly)
Abdominal Autopsy	Inject legs via external iliac arteries Thorax, upper extremities, & head: Abdominal aorta R. common carotid artery Clamp abdominal aorta RCI
Preparation of Tissue Donors Injection Techniques	External access Raise vessels at commonly used injection sites Internal access Open procurement incisions and attempt to utilize arterial structures that are still in tact
External Access	Raise commonly-used arteries and veins RCC/RIJ Femorals Anticipate multiple injection sites Leakage
Internal Access	Full organ procurement Heart, lungs, liver, kidney, pancreas, small bowel Embalming is very similar to autopsy
Internal Access	Keys to success Being familiar with anatomical structures and relationships Anticipating which vessels have been severed Similar to embalming a partial autopsy case
Embalming Techniques donors	Stronger solution Lengthy post-mortem interval Hypodermic injection Often on large areas May be trauma present
Eye Enucleation	swelling around orbital cavity is most common problem! RCI – control arterial solution entering the head! Avoid pre-injection!
Eye Enucleation	Do not use a weak arterial solution; slightly stronger than normal Avoid excessive manipulation of the eyes Let embalming solution drain from eyes during injection Use lower rate of flow and lower pressure
Cornea Removal	Often must remove vitreous humor Gel-like substance that fills space between lens and retina During injection Fill with cotton saturated with gel or cavity fluid After embalming Fill with putty Eyecap
Long Bone Donation: Method 1 (Legs only)	Support medial and lateral sides of legs w/head blocks Creates a channel for blood & embalming solution
Long Bone Donation: Method 1 (Legs only)	Remove all sutures Leave prosthetics in place Difficult to get back into position Locate any ligatures put in place by procurement team Locating vessels
Long Bone Donation: Method 1 (Legs only)	Locate/ligate L & R femoral arteries Have all clamps out and ready and watch for “leakers” Can inject superiorly for upper extremities/trunk/head Hypodermic injection where needed Dry tissue with cotton Add hardening Add cotton to recreate fullnes
Long Bone Donation: Method 2 Free Flow Method	Leave procurement sutures iliac arteries Inject at least ½ gallon of STRONG solution leg Stop injection and allow solution to saturate the tissues while arms, head & trunk are embalmed With scalpel, puncture the lower leg; insert drain tube or troc
Long Bone Donation: Method 3  Saturated Packing	Open all procurement incisions Pack with absorbent material and re-suture As you suture, saturate cotton with cavity fluid or arterial fluid Creating an internal compress Inject thigh muscles with hypovalve or infant trocar
Skin Donors	Major problems with skin donors: Drying of the affected areas Control of seepage or leakage
Skin Donors	Apply cauterant (Dryene) or surface compress after arterial injection Air dry – may take several hours Will take on yellow-brown appearance Fan or hair dryer
two common closure methods used by embalmers today	adhesive (super glue,) suturing. wait till after aspriting to suture due to the pressure it would have on sutures and weaken it
Gels and powers which is least effective agent for surface embalming	powders because they dont have the coating like the gel stick to the skin
are iv's removed before or after embaming why	after, would cause swelling and discoloration. use adhesive (super glue to close)
Difference between unionalls and coveralls	unionalls body suit all the way up sleaves coveralls no arms
immersion technique for infants, what age	premature infants, plastic tub, should be the strength that would be used if you were using arterial injection. wrap in weberal then make sure they do not float to the top.
what would a long scar down the inner thigh indicate	veins removed in legs to put into the heart bypass surgery.
what is the most common sclerotic artery	femeral
how arterial fluids are diluted in a waterless embalming	putting fluid in that does not have flodymaldhyde example proflow
what pressure setting is sufficient	20
which should u do with an autopsy case: high rate of flow to reduce swelling or use a stronger solution	open system so ROF doesnt matter use a stronger solution
you raise the common carotid on an organ donor which method of access are you using	external
to use intermittent drainage the legs of an autopsy which veins do you clamp	iliac
structure that contains all principal arteries that supply the brain	circle of willis
main purpose of a hospital autopsy	confirm diagnosis
embalming an autopsy case that is only thoracic where does drainage occur from the lower extremites	inferior vein a cava
ideal injection site for lower extremites on an autopsy	iliac can do both legs at once
what is the difference between free flow method and saturated packing method when dealing with long bone donor	free flow leave it open embalm like normal saturated packing soak fluid in with cotton in inciation
embalming a full autopsy will you use internal or external to find the carotid	internal
what type of treatment used on truck walls for an autopsy	hypo
C x V = C’ x V’ C=20 index V=24 ounces Solve for C’ V’=2.5 gallons 2.5 x 128 ounces per gallon=320 ounces 20 x 24 = C’ x 320 480 = C’ x 320 480/320= 1.5% C’=1.5% Primary Dilution	Solve for C V =24 C’= 1.9% V’= 3 gallons 3 x 128 ounces per gallon= 384 ounces C x 24 =1.9% x 384 C x 24= 729.6 729.6/24= 30.4 C= 30.4 index
V= 16 ounces C’= 1.2 % Primary Dilution V’= 2 gallons 2 x 128 ounces per gallon=256 ounces Solve for C C x 16= 1.2% x 256 C x 16 = 307.2 307.2/16= 19.2 C= 19.2 index Chemical A-OK Company Pierce 16 ounces of fluid 240 ounces of water	C x V = C’ x V’ C= 24 index C’= 2.5% Primary Dilution V’= 2.5 Gallons 2.5 x 128 ounces per gallon=320 ounces Solve for V 24 x V = 1.8% x 320 24x V= 576 576/24= 24 V=24 ounce
Delivery (also known as Injection) of solution from embalming machine into the arterial system	Distribution of solution throughout the arterial system (intravascular
Diffusion of solution from intravascular (arteries) to extravascular spaces	interstitial fluid
Of these two concepts (pressure vs. rate of flow), rate of flow is considered the more critical factor as it has a greater bearing on	Even distribution b. Swelling (distension) of tissues E. Injection pressure F. Center of fluid (arterial) distribution
Blood drainage - you can't have drainage if the solution is not moving through the vascular system (i.e. displacement.	Clearing of intravascular blood discolorations (i.e. livor mortis.)
Signs of arterial solution diffusion (extravascular movement of solution from capillaries into the tissue):	Drying of the tissues 5. Rounding of fingertips, lips, and toes 6. Mottling of tissues - this occurs as the tissue begins to bleach out
For embalming to occur, passive (physical) transport systems are required to move the solution from the capillaries to the interstitial tissue spaces.	The primary passive (physical) transport systems we use in embalming are pressure filtration, osmosis, and dialysis
s the process of using pressure to force solution through the pores in the membrane, this is done usually from the capillaries to the interstitial space. 1. Caused by intravascular pressure (IVP) that is generated by the embalming machine	Pressure filtration
Solution moves through the interstitial fluid by means of diffusion and gravitational filtration.	solution moves from the interstitial spaces into the cell by means of osmosis, dialysis, and adsorption
his process occurs as solution moves from the interstitial space into the cells	Adsorption
his process is an extreme version of the pressure filtration. If you use ultra filtration, you will destroy the membrane in the process, unlike pressure filtration that primarily allows the membrane to remain intact (due to its permeability.	This is usually done if the pressure and rate of flow are set too high on the embalming machine can occur either the movement from the intravascular vessels to the extravascular interstitial space
There are rare occasions when an autopsy will be done AFTER arterial embalming. In this case, cavity treatment would not be employed as destroying the viscera would essentially render an autopsy pointless.	t
Delaying aspiration maintains the pressure within the vascular system and allows a more thorough distribution of the arterial solution into the tissues.	t
The only way to remove gas is to lance and channel the area (after embalming!	t
f a viewing is desired, arterial injection may be attempted but, more often than not, the infant will be immersed in a container of undiluted arterial fluid for at least 24 hours	t
It can be said then that the "ideal" rate of flow would be anywhere from 8 - 13 oz./minute on the first gallon	t
Quite often, a frenulum suture or even a mandibular suture (which is more secure than the frenulum/musculature suture) will be required to close the mouth	t
This particular type of arteriosclerosis is known as atherosclerosis: a condition in which plaque buildup	t
Extensive incisions in chest wall and many times down the inner leg if the greater saphenous vein has been taken for transplant in a coronary bypass operation	In cases of diabetes, gangrene is common in the lower extremities.
efrigeration will exacerbate this tendency as the tissue gets firm from the cold temperatures (cold stiffening) and swell more easily with higher rates of flow	t
It is important to note that the vertebral arteries, which branch off the subclavian arteries and traverse up the neck through foramina in the cervical vertebrae) will need to be clamped, either near the point of injection or at the base of the brain	(the vertebral arteries anastomose to form the basilar artery).
The connection of normally separate parts or spaces so they intercommunicate; such as the connection (or joining) of two blood vessels (e.g., the left and right vertebral arteries anastomose into the basilar artery.)	Anastomosis
The circulation established for an organ or a part of an organ through the intercommunication of blood vessels when the original direct blood supply is obstructed or abolished	Collateral Circulation
lock down" technique. This is an effective technique in reducing tension on the ligature (and subsequent breakage) when suturing autopsy or donor cases	t
calvarium attachment but the calvarium clamp has shown to be the best and most secure method of closure.	Begin suturing the head on the RIGHT side. This way, the closing sutures will be on the non-visible left side
Leave procurement sutures in place; inject external iliac arteries with a very strong solution. Stop after at least one-half gallon of solution has been injected into each leg and let the fluid saturate into the tissues while the arms, head & trunk are	Free flow method
Saturated packing method	done in conjunction with hypodermic embalming
Open suture injection	open up ALL sutures and use hemostats to clamp interrupted vessels

Created by: jcowing

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