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Embalming II quiz 2
| Question | Answer |
|---|---|
| Separation of compounds into simpler substances by the action of microbial and/or autolytic enzymes. | Decomposition |
| The separation of the epidermis from the underlying dermis as a result of putrefaction | Desquamation; also known as Skin Slip. |
| Amount of formaldehyde required to effectively preserve remains; depends on the condition of the tissues as determined in the embalming analysis | Formaldehyde demand ; also known as Preservative Demand. |
| The nonprotein portion of hemoglobin; the red pigment of hemoglobin. | Heme |
| Destruction of red blood cells that releases heme. | Hemolysis |
| a very strong arterial solution (often waterless solution is injected under high pressure in spurts into a body area; very little solution is injected as the technique attempts to limit swelling; effective in cases with facial trauma or decomposition | Instant tissue fixation (Head freeze) |
| Intravascular, red-blue discoloration resulting from postmortem hypostasis of blood | Livor mortis (Cadaveric lividity) |
| The rise in body temperature after death due to continued cellular metabolism. | Postmortem caloricity |
| Extravascular color change that occurs when heme, released by hemolysis of red blood cells, seeps through the vessel walls and into the body tissues. | Postmortem stain |
| Any one of a group of nitrogenous organic compounds formed by the action of putrefactive bacteria on proteins (e.g. indole, skatole, cadaverine, and putrescine). | Ptomaine |
| Method of injection wherein BOTH common carotid arteries are raised prior to arterial injection to control entry of arterial solution into the head. | Restricted cervical injection |
| Postmortem stiffening of the body muscles by natural body processes. | Rigor mortis |
| Post-mortem, extra-vascular blood discoloration consisting of minute petechial hemorrhages caused by the rupture of minute vessels as blood settles into the depend areas of the body; it is accompanied by livor mortis. | Tardieu spots |
| Three common problems when a delay has occurred between death and embalming: | Distribution issues 1. Possible causes B. Swelling issues 1. Use a minimum amount of a stronger solution to minimize distension! C. Preservative demand issues |
| some extreme cases | Six-point injection C. Arterial solution: Strength and volume 1. Fluids with an index of 25 or higher are recommended 2. Waterless embalming |
| A. Three stages of rigor | |
| Formaldehyde demand during the stages of rigor | |
| Table 19-1 C. Problems when embalming a body in rigor 1. Proteins are "locked" together | pH issues and need for a coinjection fluid (i.e. a buffer) for more even distribution and uniform firming of tissue. 3. Once rigor passes, preservative demand goes through the roof! 4. Absorption and firming during each stage of rigor |
| False sign of preservation - might be the rigor or distension and NOT the preservative | t |
| Preparation of Refrigerated Bodies A. Advantages of short-term refrigeration 1. Slows the progress of rigor mortis 2. Slows decomposition | Maintains blood in a liquid state (intense livor mortis (intravascular) and Tardieu spots - an extra-vascular condition!) |
| Most bodies are now wrapped or placed in a plastic pouch for refrigeration. This pouch can cause problems for the embalmer. | Heat generated by the body (post-mortem caloricity) can cause decomposition (abdominal gases, desquamation |
| The text lists several problems the embalmer can anticipate when bodies have been wrapped in plastic and refrigerated for an extended period. | False signs of embalming 1. Firmness from swollen tissues 2. Pink coloration from hemolysis (which resembles fluid dye) a. Release of heme into tissues 3. Firmness from solidified subcutaneous body fats (due to cold temp) |
| Frozen Tissues 1. If tissue becomes frozen, DO NOT attempt to thaw the body with warm water. Ice crystals that form when tissue freezes will tear the tissue if manipulated | Allow the body to warm gradually by letting it sit in the prep room at room temperature. |
| Preparation of Bodies Showing Signs of Decomposition A. Factors that increase the onset of decomposition B. Signs of Decomposition | Color changes a. First "external" sign b. Marbling c. Postmortem stain vs. livor mortis 2. Odors a. Production of ptomaines 3. Purge 4. Gases |
| Embalming complications in a case of early decomposition 1. Fluid distribution is poor - coagula in vascular system. | Drainage is poor - blood is decomposing ("sludge formation") Tissues easily swell - capillaries are breaking down OR rate of flow is too high! no firming due to protein breakdown |
| Formation of nitrogenous wastes due - these ammonia-based products neutralize HCHO! | t |
| Text suggests closing the mouth after injection. Since the mouth area may swell during embalming, it may be easier to obtain a proper closure after injection. 2. The tongue will often protrude and be swollen | wollen tongue is to wrap it with cotton and saturated it with phenol (e.g. Basic Dryene.) You can also inject phenol directly into the tongue. These methods have been shown to reduce the size of a swollen tongue |
| Sooner the embalming, fewer the problems! | As time between death and preparation increases, so do the difficulties you’ll likely encounter! |
| Delayed Embalming Analysis: Six Factors | Body Age, weight, musculature Cause/manner of death Disease processes Medications PM physical and chemical changes Post-embalming goals |
| PM Physical Changes | Algor mortis Hypostasis Livor mortis - Treatment? Dehydration - Treatment? Increase in blood viscosity - Treatment? Endogenous invasion of microorganisms - |
| PM Chemical Changes | Post mortem caloricity Rigor mortis Where is pH during rigor? Treatment? Shift in body pH Post mortem stain How is this formed? Treatment? Decomposition |
| 3 Common Problems w/Delays | Problem achieving even distribution Bodies will easily swell Increased preservative demand more fluid needed |
| Problem #1: Uneven Distribution | Rigor mortis Postmortem coagula Increased viscosity (arterial & venous side) Breakdown of capillary system Some areas receive too much, some not enough |
| Problem #2: Bodies Easily Swell | Unsupported tissue – neck & eyelids Minimize swelling of the facial tissues with RCI Not uncommon for swelling to begin right away Strong solutions can minimize swelling |
| Channeling of neck, incisions or applying weight to swollen area (e.g., wet cotton on eyes) Bodies will not assimilate solution well | t |
| Problem #3: Increased HCHO Demand | Decomposition & breakdown of proteins Nitrogenous waste/ammonia |
| Other points for delays | Slow injection to prevent dislodged coagula Dye to indicate distribution and prevent HCHO gray Important to break up rigor During rigor, proteins are locked together making it difficult for preservative to attach to muscle proteins |
| Embalming Techniques for Delayed Cases | Stronger-than-average solution strength 25 or higher Instant tissue fixation Extreme situations Can be used in different sections of the body Waterless solution Low RoF Prevents coagula from being dislodged |
| Prep of Bodies in Rigor | Three stages of rigor Primary flaccidity (right before onset) Period of rigor Secondary flaccidity- after rigor demand for HCHo |
| Once rigor passes, HCHO demand greatly increases! (Table 19-1) | Proteins have broken apart Alkaline pH Nitrogenous wastes |
| Problems Associated w/Rigor | Positioning Features may be difficult to set Poor distribution (extra-vascular pressure on arteries) Poor drainage (same reason) Tissue tend to swell pH is not conducive to fluid reaction (acidic) Firmness of rigor can be false sign of embalming |
| Frozen Tissues | Don’t warm a frozen body with warm water Ice crystals will tear tissues if warmed quickly or manipulated Let body thaw by leaving it on the prep table for several hours |
| More Decomposition Problems | Mouth can be closed after injection Allows room for lips/mouth to swell Delayed firming allows you to wait to close Swollen Tongue Digital pressure Force tongue behind dentures Excise tissue as a last resort |
| Refrigerated Cases Dehydration Caloricity Green discoloration | Livor mortis is intense PM Stain can rapidly occur Petechiae and Tardieu spots – ruptured capillaries |
| Refrigerated Cases | Capillaries can easily rupture Gravitation of blood and bodily fluids Intense livor mortis – WHY? Rapid hemolysis leads to stain |
| Refrigerated Cases | Moist, clammy tissue causes skin slip Plastic pouch Skin slip Signs of decomposition Rapid distension of abdominal organs Purge Cold solidified subcutaneous fatty tissue False sign of preservation |
| Refrigerated Cases | Higher HCHO Demand Slow ROF Well-coordinated solution with dye Stronger than normal Appropriate for body type Graying can occur if PM Stain is present Extra dye – especially for tissue that has solidified |
| Refrigerated Cases | False signs of preservation Cold stiffening Pinkness to skinvcaused byHemolysis Firming of swollen tissue |
| Refrigerated Cases | Restricted Cervical Injection Minimize swelling Drainage may be difficult (if refrigeration is long enough) Coagula Use internal jugular for drainage Multipoint injection |
| Signs of Decomposition | Color Change Trunk – lower right quadrant Livor mortis and PM Stain Odor Purge Gas Desquamation Chemical changes |
| Delayed Embalming Protocol | Do Not Pre-inject these cases!!! Only adding weak solution/moisture RCI or 6 Point Minimize coagula movement Little to no drainage |
| Two meanings of “Discoloration” | Color is removed or lost Exsanguination Embalmer must restore internally (dye) or externally (cosmetics) To change color “Any abnormal color appearance” Localized or general Razor burn, jaundice, abrasion, ecchymosis, livor mortis |
| Classifications: Cause Discoloration | Blood Drugs/therapeutic Pathological Surface agents Reaction to embalming chemicals Decomposition |
| Classifications: Occurrence when | Antemortem- Blood Drugs Pathological Surface Postmortem- Blood (Livor mortis) Reaction to chemicals Decomposition |
| Classifications: Location | Intravascular Livor mortis, CO poisoning Easily removable Extravascular Postmortem stain, Tardieu spots, ecchymosis, hematoma Not easily removable or substantially reduced |
| Discolorations | Pre-injection can be used to clear intravascular discolorations “Reaction Controlled Fluids” Can distribute and diffuse with tissue before “setting” the discoloration as a stain E.g. injecting bruise before arterial injection |
| Extravascular Discolorations | Ecchymosis, purpura, petechia, hematoma, postmortem stain, Tardieu spots Tardieu spots: pinpoint hemorrhages in areas of advanced livor mortis Injection of stronger solution Helps bleach; cannot completely remove |
| Extravascular Discolorations | Ecchymosis – very large discoloration Hypodermic injection w/phenol (more effective BEFORE arterial injectio |
| Post-mortem Stain | EXTRA-vascular discoloration Breakdown of RBCs (hemolysis) – heme stains tissue Will not clear when area is palpated Stronger arterial solution Dye added (HCHO + blood = HCHO Gray) Avoid pre-injection (due to lengthy delay |
| Jaundice | When a disease causes hepatic (liver) failure, excessive hemolysis, or obstruction of gallbladder contents (bile), the amount of bilirubin in the serum increases and the tissues become yellow. First noticeable in the sclera of the eyes |
| Jaundice | Can sometimes be accompanied by renal failure Presence of ammonia in the system Neutralizes HCHO Don’t mistake jaundice for sallow discoloration that usually accompanies renal failure Requires strong solution |
| Jaundice Treatments: #1 | Low index fluid Jaundial: Champion glutaraldehyde-based fluid Jaundibalm: Pierce HCHO-based 10 Index fluid Metasyn: Dodge HCHO-based (Index 20-35) Jaundofiant: Dodge dual-component of 19.5 Index HCHO-based fluid and a Control activator |
| Jaundice Treatments: #2 | Pre-Injection May wash out some of the discoloration Can add dye – will usually splotch |
| Jaundice Treatments: #3Mild arterial solution Inject large quantities of low-HCHO fluid/solution to avoid “greening” effect Result is usually under-embalmed bodies that are difficult to cosmetize due to soft tissues | When using these weak solutions, embalmers are also tempted to use large quantities of water. This can lead to edema, bloating, and swelling. PRESERVATION takes precedence over the DISCOLORATION! |
| Jaundice Treatments: #4 | use of cavity fluids Not common at all Works at a different pH level Will sear off tiny vessels before proper penetration and preservation can take place. There are reasons why cavity fluids are made for cavity embalming (and vice versa). |
| Jaundice Treatments: #5 | Use of bleaching co-injection solution ESCO’s Hexyethylphenoform |
| Jaundice Treatments: #6 | Relative Counter-staining Views jaundice as a true “stain” of the tissue Use of dye & increased preservative with each injection Most embalmers will just use dye |
| Discolorations: Embalming chemical-related | Dehydration Classic colors: yellow, brown, & black Caused by: Injection of too much arterial solution Use of solution that is too strong Continuous/concurrent drainage- dehydration |
| Jaundice: Yellow to green | Caused by conversion of bilirubin (yellow bile pigment) to biliverdin (green bile pigment) through an oxidation reaction |
| Jaundice: Yellow to green | Generally accepted theory is that HCHO creates an acidic environment which causes the conversion of the pigment from yellow to green A high-index fluid is more likely to create this environment |
| Discolorations: Embalming chemical-related | Formaldehyde Gray HCHO mixes with excess blood in system Caused by poor drainage Over-embalming? Formaldehyde Burn Strong solution into localized skin areas (capillary breakdown) Raised, rash-like appearance (“Orange Peel” effect) |
| Abrasions | DO NOT APPLY CREAM: Let them dry out (use hairdryer if necessary) |
| Hanging/Strangulation | Two types can occur Extreme congestion if pressure was on venous system No discoloration if pressure was on the arterial system Case in What Cheer, IA |
| Carbon Monoxide Poisoning | Common method of suicide Cherry-red discoloration Carboxyhemoglobin ANTEMORTEM – INTRAVASCULAR discoloration Should clear during arterial injection Because of delays (M.E. investigation/autopsy), often sets as a stain |
| Ecchymosis (large) 2. Purpura (medium) 3. Petechia (small pinpoint) | t |
| Wet gangren | |
| Dry gangrene | |
| Relative counterstaining method Theory stating that only "proper solution" is to counterstain the discoloration | b. Begin with small amount of standard arterial fluid and large amount of cosmetic dye in most vivid red possible c. Subsequent injections raise the amount of arterial fluid each time and reduce the amount of dye each time |
| Surface Discoloring Agents A. Blood, betadine, adhesive tape marks, gentian violet (anti-fungal agent), paint, mercurochrome, and tobacco tars | Most can easily be removed with soap or solvent C. Should be cleaned prior to embalming as pores are easier to clean and easier to evaluate skin for distribution/diffusion when clean |
| 1. Good distribution with bad drainage | 2. Face & neck take on a cyanotic appearance |
| Occurs if sufficient pressure is applied to tissues to damage the capillaries: most common in elderly people with thin skin | postmortem Bruising |
| Can either have extensive or few blood discolorations depending on whether congestion or drainage has occurred (i.e. arterial or venous side) 2. Will normally be an autopsy case which will drain a great amount of blood from the head | Hangings and strangulations |
| Burned bodies 1. Systemic effects include bacterial infections, lack of blood flow to peripheral areas and kidney failure and resulting buildup of wastes | First Degree: Skin surface is red; only the epithelium is affected 3. Second Degree: The skin blisters and edema is present; destruction of deep layers of epidermis and upper layers of dermis 4. Third Degree: Tissues are charred |
| Drownings | If enough gas is generated to bring the body to the surface, the body floats face downward. Resulting livor mortis and postmortem stain are intense in the facial area. |
| When eye problems exist, always encourage the use of glasses on the deceased. The lights over the casket reflect off the lenses and hide some of the problem areas. | t |
| Characterized not so much by discoloration as by lack of color due to blood loss | Exsanguination |
| intense livor mortis as the refrigeration keeps blood in a liquid form; tardieu spots common. | 2. Elevate head/shoulders ASAP |
| when ammonia is present in the body what type of fluid should be used | strong high index |
| when dealing with a refrigerated case, what is the best plan to eliminate false signs of embalming | dye so you can see where solution has gone. tissue gets pink due to refrigerated. |
| what type of drainage can you expect from a body that has been refrigerated for an hour | slower but great drainage just a little bit thicker |
| what course of action should you take to clear tardieu spots? why will they only clear this way | tardieu spots use phonel extravasuar so will not clear in arterail injection. pin point from hemorrhaging of vessels example hanging |
| what is desquamation and how should you treat it | skin slip, surface pack |
| instant tissue fixation and what type of solution is most effective | trama strong solution, high pressure, short burst |
| what is most likely the cause of swelling | iv taken out before embalming |
| when working on a frozen body what must you do before embalming and how to accomplish it | sit in room temp. warm water will tear vessels with the ice cryistals |
| what causes rigor mortis and how to unlock it | stiffening of the joints proteins lock together in joints time will make them unlock naturaly |
| you are concerned about coagula as you begin to embalm a body what is the most effective way to embalm | slow pressure and take time so you dont break coagula free. would block smaller vessels causes bad drainage and distrubtion |
| which of the following causes a post mortem extra vascular stain rigor mortis urotropin livor mortis heme | heme |
| Antemortem injuries resulting from friction of the skin against a firm object resulting in the removal of the epidermis. | Abrasion |
| A pigment produced by the liver that is excreted in bile which causes a yellow discoloration of the skin and eyes when it accumulates in those organs; yellow, brown, or orange pigment in bile. | Bilirubin |
| A green pigment that can occur in bile; often a result of an oxidation reaction between formaldehyde and bilirubin; can create a permanent green discoloration in the skin. | Biliverdin |
| A bluish discoloration of the skin or mucous membrane resulting from poor circulation or inadequate oxygenation of the blood. | Cyanosis |
| Localized area of necrosis on the skin (a skin ulcer), progressing to the underlying tissues, due to prolonged external pressure over the area (e.g. from lying in one position too long), particularly over a bony prominence such as the sacrum (tail bone), | Decubitus ulcer (Bedsore) |
| The separation of the epidermis from the underlying dermis as a result of putrefaction | Desquamation (Skin slip) |
| Any abnormal color in or upon the human body. | Discoloration |
| 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 |
| Loss of blood to the point where life can no longer be sustained. | Exsanguination |
| Formaldehyde burn | |
| Gray discoloration of the body caused by the reaction of formaldehyde with hemoglobin to form methyl-hemoglobin. | Formaldehyde gray |
| Destruction of red blood cells that releases heme. | Hemolysis |
| Process of blood and/or other fluids settling to the dependent portions of the body; can occur in the antemortem, agonal, or postmortem periods. | Hypostasis |
| Condition characterized by excessive concentrations of bilirubin in the skin and tissues, cornea, body fluids, and mucous membranes with a resulting yellow appearance. | Jaundice |
| An area of structural damage as the result of disease; abnormal change involving any tissue or organ due to disease or injury. | Lesion |
| Intravascular, red-blue discoloration resulting from postmortem hypostasis of blood; | Livor mortis (Cadaveric lividity |
| Antemortem, pinpoint, extravascular blood discoloration visible as purplish hemorrhages of the skin or mucous membranes. | Petechia |
| Extravascular color change that occurs when heme, released by hemolysis of red blood cells, seeps through the vessel walls and into the body tissues. | Postmortem stain |
| Purplish discoloration of the tissues due to widespread hemorrhage into the skin or mucous membranes; spontaneous bleeding in the subcutaneous tissues causing the appearance of purple patches on the skin. | Purpura |
| Generalized accumulation of serous fluid; generalized edema in subcutaneous tissue. | Anasarca |
| Accumulation of serous fluids in the peritoneal (abdominal) cavity. | Ascites |
| Cellular (Solid) edema | |
| Extreme dehydration often resulting in post-embalming discolorations; rendered thoroughly dry; exhausted of moisture. | Dessication |
| Abnormal accumulation of fluids in tissue or body cavities. | Edema |
| Abnormal collection of edematous fluid in a sac-like cavity in the body, most commonly edema of the scrotum. | Hydrocele |
| Abnormal accumulation of cerebrospinal fluid in the ventricles of the brain, causing compression of the brain and possibly enlargement of the cranium. | Hydrocephalus |
| Abnormal accumulation of edematous fluid within the pericardial sac. | Hydropericardium |
| Abnormal accumulation of fluid in the thoracic cavity. | Hydrothorax |
| Condition in which interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation. | Pitting (Intercellular) edema |
| Weakening of the embalming fluid by the fluids in the body, both vascular and interstitial. | Secondary dilution |
| For a normal, healthy (160 lbs.) male adult, water makes up 55 to 60% of total body weight. | Refrigeration is one of the leading causes of a postmortem loss of moisture. 3. The embalming process can either add or greatly reduce moisture. a. Formaldehyde dries tissue |
| Thoroughly embalmed tissues dehydrate LESS than under-embalmed tissues. c. One simple way to maintain proper moisture levels during embalming is to follow the dilution recommendations on the label of the arterial fluid | Other techniques to maintain good moisture balance: 5. Warm water solutions INCREASE fluid/formaldehyde reaction |
| Surface tension changes with variations in water/solution temperature. As the temperature rises, the surface tension value of a solution DECREASES. Consequently, if warm water is used to prepare the solution | The solution may be expected to penetrate more rapidly into the tissues due to lowered surface tension b. The chemical reaction between the preservative and the tissue will take place more rapidly firming action will occur faster than usual. |
| Cool water slows the formaldehyde reaction which allows for better distribution/diffusion throughout the body | t |
| Preparation of the Dehydrated Body A. Postmortem Dehydration | Refrigeration and gravitation can remove moisture from the upper body areas such as the face & neck. |
| Refrigeration keeps blood in a liquid state a. Blood & tissue fluids gravitate (hypostasis) to the dependent parts of the body. | t |
| Upper areas (i.e. non-dependent) of the body lose moisture due to surface evaporation and the gravitation of fluids | Viscosity of blood will thicken due to loss of moisture which will in turn increase postmortem coagula in the vascular system. This will obviously present problems with fluid distribution. |
| Desiccation a. Dehydrated bodies tend to decompose more slowly as water is necessary for decomposition. | Desiccation is a form of preservation but desiccated bodies are NOT viewable. B. Treatments To Minimize/Prevent Post-embalming Dehydration C. Edema |
| 1. Three general body sites: | intracellular edema b. Intercellular edema |
| Anasarca c. Edema within the body cavity 4. Be familiar with diseases/conditions that are associated with edema | t |
| Moisture is retained by the cell OR abnormal amounts of fluid are allowed to pass into the cell. These tissues feel very firm to the touch and indentations are not made when pushed upon (as in pitting edema.) | Cellular (Solid) Edema * Frequently seen when large doses of corticosteroids have been administered This form of edema (usually found in the face) does NOT respond to embalming treatments |
| Intercellular (Pitting) Edema: An imprint will remain when the area is pushed on by the embalmer. | Edema of Body Cavities: Edema of the cavities DOES NOT dilute the arterial solution |
| Embalming Problems Created By Edema 1. Affected areas are swollen 2. Fluid can pass through the skin a. Can dampen clothing and casket lining | Edema can cause leakage through intravenous punctures and hypodermic openings. 4. Will speed up decomposition 5. Creates a secondary dilution of arterial solution E. Arterial Treatments for Generalized Edema |
| Inject a solution of sufficient strength and volume to counteract the secondary dilution that occur in the tissues b. Remove as much edema from the tissues as possible | Neck tissues can be channeled during cavity treatment to provide a route for fluids to drain from the face, scalp and neck into the thoracic cavities. 3. After embalming, body can be placed on a cot for several hours with the head end fully elevated an |
| Use an average to strong arterial solution accompanied by an Epsom Salt co- injection 5. A Restricted Cervical Injection is recommended | This allows for saturation of the trunk with a stronger solution without over- injection of the head. The head can be injected separately after the trunk |
| nterrupted Injection a. Inject 1.5 to 2 gallons of solution, stop injection to allow time for the osmotic exchange to occur. Inject another 0.5 to 1 gallon and stop. Vigorous massage of limbs TOWARD the heart | 8 oz./gallon of a 25-index fluid * THEORY: Ensures good distribution, large amount of preservative, washes out a good portion of edema |
| Addition of dehydrating co-injection chemicals * These can sometimes produce a firmness which SHOULD NOT be mistaken for preservation e. Use of Epsom Salts in the arterial solution | t |
| Treatment of Localized EdemaGeneral techniques a. Sectional injection b. Hypodermic injection c. Elevation and gravitation d. Channeling and wicking e. Lancing and channeling f. Plastic garments/absorbent powder | Legs: Inject leg separately and raise legs to gravitate fluid into pelvic cavity from where it can be aspirated b. Arms: Inject arm separately and raise arm to gravitate fluid into the upper arm c. Trunk: Hypodermic injection - USE PLASTIC GARMENTS |
| Ascites: No secondary dilution will occur as the arterial solution will not reach the body cavities! | Make a small incision or use trocar to remove fluids from the cavity e. Hydrothorax: Use trocar to remove fluid f. Hydrocele: Insert a trocar into the scrotum via the pubic symphysis |
| Wrap scrotum with a towel and use manual pressure to force fluid back into the body cavity. b. Fill scrotum with cavity fluid nditions | c. Avoid puncturing the scrotum: difficult to seal g. Hydrocephalus: Pass a large needle through the cribriform plate G. Special Co |
| Burned Bodies 2. Renal Failure a. Brings about an increase in toxic wastes (urea, uric acid, ammonia and creatine) b. These bodies decompose rapidly Waste products in the bloodstream/tissues neutralize formaldehyde. | d. Tissues do not firm normally as the proteins have been altered. e. Cavity embalming is VERY IMPORTANT as bleeding will often occur in the gastrointestinal tract. This provides an excellent medium for bacterial growth and potential for purge. |
| Total Body Water 55-60% of total body weight (Normal to obese) Approximately 65% for thin bodies | Edema Established when there is a 10% increase in total body water |
| Embalming can either add or greatly reduce moisture in the tissues | Thoroughly-embalmed tissues dehydrate LESS than under-embalmed tissues Simple way to maintain proper moisture level during the embalming process is to follow dilution recommendations on arterial fluid label. |
| Techniques to maintain a good balance of moisture in the body Astringent: a chemical that tends to shrink or constrict body tissues | Hypertonic solutions cause cells to shrink as water rushes out of cells into the solute, whereas hypotonic solutions cause cells to swell as water from the solution rushes into the cells. Avoid continuous drainage |
| Techniques to maintain a good balance of moisture in the body Avoid rapid arterial injection and drainage Slower injection increases penetration and reduces “short-circuiting” Less fluid is withdrawn from tissues | Delay of aspiration Better diffusing of arterial solution Text suggests injecting last portion (1/4 gallon?) of solution against closed drainage Cover refrigerated body with plastic sheeting to prevent dehydration |
| Other suggestions for moisture control | Fumes from injection of cavity fluids into the neck area can dehydrate the mouth and nose Pack mouth and nostrils with cotton Using warm/hot water solutions will increase the fluid/HCHO reaction |
| Postmortem Dehydration | Dehydration following death Refrigeration and gravitation (hypostasis) are two main causes Remove moisture from upper body areas |
| Dehydrated bodies tend to decompose more slowly as water is necessary for decomposition Extreme dehydration is called dessication-Arterial injection and/or hypodermic treatments are usually ineffective | Dessicated bodies are not usually viewable Certain areas can become dessicated Lips: black and wrinkled Tips of fingers: parchment-like skin; yellowish-brown |
| Minimizing postmortem dehydration Inject a large amount of solution to replenish lost moisture Avoid excessive massage | Several techniques are the same as those discussed to maintain moisture balance (e.g., moderate solution, slow injection, intermittent drainage, etc.) Use a humectant Improper use of humectants can dehydrate a body |
| EdemaDefined as the abnormal collection of fluid in tissue spaces, serous cavities or both. Can be found in three body sites: | ntracellular: within the individual cells (“cellular” or “solid” edema) Intercellular: spaces between the cells (“pitting” edema) Can be localized - edema face after aortic repair surgery Can be generalized: Anasarca - present in all dependent tissue |
| Cellular (Solid) Edema (Intracellular) on steroids | Moisture is retained by the cell or an abnormal amount of moisture is allowed to pass into the cell (i.e. within the cell) Tissues appear swollen and will not leave an indentation when pressed upon |
| Commonly seen in cases of corticosteroid treatment Prednisone or Cortisone for example Most generally used to reduce inflammation Brain tumor patients, rheumatoid arthritis, lupus | Text suggests deep tissue excision as only possible method of treatment (not practical) Difficult to maintain uniform depth |
| Intercellular Edema Also known as “Pitting Edema” Drained from tissues into circulatory system via a hypertonic solution with edema co-injection fluid | Fluid accumulates between the cells Can be manipulated; will leave an imprint Usually responds well to embalming treatments Gravitation Place body on a cot after embalming and allow edema to gravitate towards feet |
| Ascites | Edema of the abdominal (“peritoneal”) cavity Edema is found within the cavity and surrounds the abdominal viscera |
| Hydrothorax | dema of the pleural cavity Cavities surrounding the lungs May involve one or both cavities |
| Hydrocephalus | Edema of the cranial cavity |
| Hydrocele Accumulation of serous fluids in the male scrotum Can be drained | Although not effectively Difficult to close puncture Insert trocar into the scrotum (from abdominal entry point) Aspirate fluid and inject cavity fluid |
| Edema of the body cavities does NOT dilute the arterial solution. If a body exhibits ascites, it is not necessary to increase the strength of the arterial solution because of the edema in the abdominal cavity | Edema of the cavities does NOT mix with the arterial solution in the vascular system. “Secondary Dilution” Concern is that the edema might dilute the cavity fluid when injected. |
| Edema can pass through the skin Dampen clothing, casket interiors, etc. Leakage from IV sites, punctures, etc. | More difficult to close due to excess moisture Suturing incisions can be more difficult Tissue may tear Wicking Speeds decomposition process Secondary dilution |
| nject a solution of sufficient strength and volume to counteract the secondary dilution that occur in the tissues Remove as much edema from the tissues as possible | These fluids increase the osmotic quality of the arterial solution by the addition of salts or large colloidal molecules Addition of Epsom salts to arterial solution Salt draws the edema from the tissue spaces towards the concentrated arterial solution |
| Epsom salt solution should normally be injected sectionally Restricted cervical injection Keep stirring the tank! | Massage is very important in this technique Massage downward to encourage venous drainage |
| Use a LARGE amount of humectant Normal amount adds/retains moisture Large amounts have opposite effect 20-24 oz. per gallon | arge molecules of humectant draw moisture from tissue into capillaries Humectant must be VEGETABLE-based Not lanolin (i.e. animal) |
| Edema of legs | Do not prepare a solution for the entire body based on edema in the legs only Sectional (femoral/iliac) injection Edema can be gravitated into the pelvic cavity and aspirated from there |
| Edema of arms | Wrinkled hands – Duct tape at wrists/tissue builder |
| Edema of trunk | Hypodermic injection (via hypovalve trocar) is usually the most effective treatment |
| Fluid in cavity surround viscera (abdominal cavity) No secondary dilution of arterial solution; cavity fluid - YES Abdominal pressure can interfere with distribution and drainage Make a small incision with a scalpel to drain or use a trocar | Ascites |
| Aspiration should remove edema | Hydrothorax |
| Hydrocephalus | Can be drained by passing a large hypodermic needle through the nostril and directing it through the cribriform plate into the cranial cavity Rapid decomposition can occur if not drained |
| Burned Bodies Edema accompanies burns (esp. 2nd degree) Death often result of RENAL FAILURE | Skin is damaged Waste products normally leaving body via skin are retained in blood Kidneys cannot handle retained waste Gross distention |
| Long incisions are common treatments in burn unit | Cannot be sutured Disinfect and air dry Allow body to leak as long as possible Unionall w/powder |
| Increase in toxic wastes Urea Uric acid Ammonia Creatine | Skin turns sallow from urochrome buildup Can worsen after embalming Rapid decomposition |
| Once rigor passes, HCHO demand greatly increases! (Table 19-1) | Proteins have broken apart Alkaline pH Nitrogenous wastes |
| Caloricity causes | Green discoloration |
| Petechiae and Tardieu spots | ruptured capillaries |
| Graying can occur if PM Stain is present | Extra dye – especially for tissue that has solidified |
| Cyanosis is associated with what | lack of Oxygen |
| what are the colors associated with dehydration | black brown yellow |
| of ecchymosis or co poisoning which can be cleared by arterial injection | co poisoning |
| surface discoloration examples: should be removed when why | blood, betadine, tape mark. before embalming to better see what the skin looks like. so you see what you are dealing with. Opens the pores. embalming will close the pores |
| what causes formaldehyde gray | blood that is not drained mixed with formaldehyde. see it the most in around the mouth |
| of the 4 d's which would ecchymosis affect | diffision |
| you notice the reddish purple discoloration begin to fade as you inject solution which discoloration is this | livor mortis |
| bilirubin is what color and biliverdin is what color | bilirubin yellow biliverdin green |
| what condition in characterzed by an excess amount of bilirubin | jaundice |
| what are pinpoint extravascular blood discolorations referred to | petechia |
| What is the difference between ascites and anasarca | ascites is in thoracic or abdominal cavity anasarca is generized body wide |
| what type of drainage will maintain a moisture balance | intermitted |
| what type of solution must be used when nitrogenous waste is present in the body. | high index |
| which dehydrates more thoroughly embalmed tissue or under embalmed tissue | thoroughly embalmed. under is not going to dehydrate its going to demp |
| what do you use to speed up the fluid tissue reaction and reduce the changes of swelling | use warm water |
| what embalming process do you utilize for a dessicated body | nothing can be done |
| what percent of increased in body moisture determines when edema is established | 10% |
| what is the accumulation of fluid in the peritoneal cavity | ascites |
| hydrocele or hydrocephalus which is accumulation of fluid in the brain | hydrocephalus |
| a secondary dilution of arterial solution is caused by which type of edema | anasarca |
| a secondary dilution of cavity fluid is caused by what type of edema | ascites |
| it is best to treat recent facial edema with what type of chemical | epsom salt |
| what is an effective way to treat ascites | pock a hole to relieve pressure |
| Surface Discoloring Agents | Blood, betadine, adhesive tape marks, gentian violet (anti-fungal agent), paint, mercurochrome, and tobacco tars |
| Good distribution with bad drainage 2. Face & neck take on a cyanotic appearance 3. Cyanosis E. Postmortem Bruising | t |
| Brought about by the action of bacterial and/or autolytic enzymes on the body tissues as a result of decomposition 1. Yellow, green, blue-black, black 2. Progressive skin color changes | t |
| 2. Refrigeration is one of the leading causes of a postmortem loss of moisture. | t |
| Surface tension changes with variations in water/solution temperature. As the temperature rises, the surface tension value of a solution DECREASES. | Consequently, if warm water is used to prepare the solution: a. The solution may be expected to penetrate more rapidly into the tissues due to lowered surface tension b. The chemical reaction between the preservative and the tissue will take place mor |
| Cool water slows the formaldehyde reaction which allows for better distribution/diffusion throughout the body | t |
| * Frequently seen when large doses of corticosteroids have been administered | Cellular (Solid) Edema: Moisture is retained by the cell OR abnormal amounts of fluid are allowed to pass into the cell |
| Edema of Body Cavities: Edema of the cavities DOES NOT dilute the arterial solution! | t |
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jcowing