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Embalmin 3
| Question | Answer |
|---|---|
| A localized abnormal dilation of a blood vessel resulting in a weakness of the vessel. | Aneurysm |
| A disease of the arteries resulting in thickening, hardening, and loss of elasticity of the arterial walls. | Arteriosclerosis |
| Fatty degeneration or thickening of the walls of the larger arteries occurring in atherosclerosis; very common in femoral arteries of the elderly. | Atheroma |
| Atherosclerosis | |
| Formation of new channels in a tissue. | Canalization |
| Necrosis resulting from localized deprivation of arterial blood supply; also known as Ischemic Necrosis. Condition that results when the body part that dies had little blood and remains aseptic; the arteries but not the veins are obstructed. | Dry gangrene |
| Embolus | |
| Outside the blood vascular system. | Extravascular resistance |
| A condition of reduced/inadequate blood supply to an organ or part of the body, often resulting in damage to or death of tissue. | Ischemia |
| The cavity or opening of a hollow structure such as a vein, artery, or intestine. | Lumen |
| Phlebitis | |
| Thrombus | |
| Vasoconstriction | |
| Vasodilation | |
| Necrotic tissue that is moist as a result of inadequate venous drainage; may be accompanied by bacterial infection | Wet (Moist) gangrene |
| Vascular Considerations Narrowing/obstruction of lumen is major concern Cavity or opening of a hollow structure such as an artery Decrease/stoppage of flow into an area | Intravascular issues Result in break or tear in vessel Minor: petechiae Major: aortic aneurysm |
| Be familiar with conditions and subsequent embalming concerns listed on Table 22-1 | look at phone |
| Aneurysm-Localized dilation of an artery | If it ruptures, NO distribution |
| Cerebrovascular accident-“Stroke” caused by a clot or rupture of a small artery in the brain | Vasoconstriction may occur on one side of body, reducing fluid distribution |
| Diabetes-Endocrine decrease affecting blood glucose levels | Poor peripheral circulation can reduce distribution; gangrenous areas require hypodermic/surface treatments; breakdown in proteins results in poor firming |
| Gangrene (Dry) – aka Ischemic Necrosis--Poor arterial circulation into area of body causing death of cells | Distribution impossible to establish; surface & hypodermic treatments |
| NEED name from pp -Disease/condition accompanied by elevation of body temperature | Decomposition may be speeded; dehydration possible; blood coagulation causes congestion; distribution/drainage may be difficult to establish |
| Gangrene (Moist or Wet)-Occlusion of veins draining a body area that becomes site of bacterial infection | Arterially inject STRONG fluid into affected area; necrotic tissue treated hypodermically and surface |
| Ischemia-Lack of blood supply to an area, frequently resulting in tissue necrosis | Arterial solution cannot reach affected area; Hypo/surface treatments |
| Phlebitis-Inflammation of a vein | Edema may be present in the area; blood does not easily drain; discolorations may result |
| Thrombosis-Blood clots attached to inner wall of a blood vessel | Distribution may be difficult; if occurring in a vein, drainage may be difficult |
| Arteriosclerosis-Term applied to a number of pathological conditions causing a thickening, hardening, and loss of elasticity of the walls of an artery | Can be found in almost anyone over age 30 Mid-50s w/heart disease Most common in femoral artery Common carotid recommended injection site |
| Atherosclerosis-Hardening of the arteries Fat, cholesterol, and other substances build up in the walls of arteries (Plaque) Avoid making incising an artery where the atheroma can be felt (if possible) | Lowering hands over the sides of the table and gently but firmly massaging the limbs can help distribution of fluid in sclerotic bodies |
| Aneurysm Localized dilation of an artery Ruptured aneurysm can cause serious problems for an embalmer | Ruptured Aortic Aneurysm Seriously affect fluid distribution If surgical repair done to aorta, extreme FACIAL EDEMA can often accompany repair Femoral vessels usually sclerotic |
| Aortic Aneurysm If no drainage and abdomen begins to swell… | STOP the injection Institute a multi-point injection No drainage indicates a loss of embalming solution into the thoracic or abdominal cavity. Inject trunk walls with hypovalve trocar |
| Congestive Heart Failure Heart function as a pump is inadequate to meet the body's needs Caused by diseases that: | Weaken the heart muscle Cause stiffening of the heart muscles Increase O2 demand by the body tissue |
| Congestive Heart Failure Weakened heart muscles may not be able to supply enough blood to the kidneys Kidneys begin to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can cause the body to retain more fluid | Lungs may become congested with fluid (pulmonary edema) |
| Fluid may accumulate in the liver, thereby impairing its ability to rid the body of toxins and produce essential proteins | Fluid also may accumulate in the extremities, resulting in swelling of ankles and feet (edema) |
| Congestive Heart Failure: Complications affecting embalming process | Blood is congested in right side of heart Neck veins are engorged with blood Facial tissues are dark due to congestion in right side of heart and veins of neck Lips, ears, fingers are cyanotic (bluish discoloration resulting from lack of O2) |
| Congestive Heart Failure: Complications affecting embalming process | Anasarca may be present Legs and feet most common Ascites is possible Blood may be more viscous Increase in RBCs |
| CHF: Embalming Treatments Carotid artery injected & RIJ for drainage Good drainage from head RCI First gallon is mild to clear discolorations and congestion | Increase strength Especially if edema is present Lower arms over table Discolorations in hand/fingers Pulmonary edema (common in CHF) May cause lung purge – allow to continue |
| CHF: Embalming Treatments Thorough aspiration | Removes distention in neck tissues Immediately following arterial injection May need to treat ascites |
| Vasodilation and Vasoconstriction Common in stroke victims Vessels on one side of body dilate to supply more oxygen to the tissues of affected side Vessels on other side constrict | VERY evident when dye is used during injection Line of demarcation |
| Arterial Coagula Some blood remains in arteries after death Blood can congeal during post-mortem period Injection of solution can push these clots into smaller arteries By injecting common carotid arteries: | Clots are moved towards feet not head If femoral used, coagula could be pushed into carotid and/or subclavian arteries prevent flow into facial tissues injecting carotids, coagula moved towards iliac and femoral arteries Sectional embalming of legs |
| Venous Coagula Veins enlarge towards drainage site Opposite of arterial side Venous coagula not as problematic Failure to remove venous coagula can cause: | Distention Discoloration Massage from distal points toward heart INTERMITTENT DRAINAGE!!! |
| Diabetes Chronic disease in which there are high levels of sugar in the blood (glucose) Distribution is primary concern Diabetics tend to develop arteriosclerosis | Poor peripheral circulation can be expected “Brown” discoloration in lower extremities Increased risk for bacterial and mycotic infections |
| Diabetes: Embalming Techniques Pre-inject or mild strength Clear discolorations Establish distribution | RCI is suggested Use higher pressures towards trunk Overcome circulatory issues Intermittent drainage Abnormal pH values |
| Diabetes: Embalming Techniques Abnormal pH value Difficulty in firming Moderate to strong solution w/co-injection | Many obese individuals are diabetic RCI and RIJ LARGE volume of solution is needed! RCI will prevent over-embalming Mycotic infections are often found in lungs Thorough cavity treatment |
| Diabetes: Embalming Techniques Gangrene may be present in distal tissues Fingers/toes These areas will NOT receive distribution Hypodermic treatment and surface treatments Foot | Decubitus ulcers Disinfect topically Hypodermic and/or surface treatments RCI will allow for milder solution into head Emaciation |
| Extra-vascular Resistance Pressure on outside of artery or vein Restrict flow into a body region Slightly stronger solution Higher pressures RCI Better distribution | Stop injection and allow drainage to occur Prevent blood discolorations Concurrent drainage throughout |
| Sources of Extra-vascular Resistance Rigor Mortis Relieve prior to injection Ascites Drain cavity prior to injection Gas in cavities Puncture abdomen and relieve gas prior to injection | Bandages Remove before injection Contact pressure Massage |
| Sources & Treatments of Extra-vascular Resistance Tumors Excise with permission Sectional embalming may be necessary Swollen Lymph Nodes Sectional injection may be necessary | Hydrothorax Drainage possible but often difficult Visceral Weight Above- and Below-heart injection points |
| Necrosis and putrefaction of tissue as a result of invasion by anaerobic gas-forming bacillus, especially Clostridium perfringens; antemortem form of gangrene. | Gas gangrene |
| Postmortem evacuation of any substance from an external orifice of the body as a result of pressure. | Purge |
| Sallow | |
| Subcutaneous emphysema | |
| Postmortem accumulation of gas in tissues or cavities brought about by an anaerobic gas-forming bacillus, most commonly, Clostridium perfringens. | Tissue gas |
| Uremia | |
| A compound formed when formaldehyde reacts with ammonia; this reaction neutralizes the formaldehyde and creates a risk of under-embalming. | Urotropin |
| Avoid pre-injection fluids when distribution problems are expected 1. Swelling can result when the preservative is eventually injected | Cases with vascular diseases will have been treated with blood thinners/anti- coagulants so distribution or clots shouldn't be a problem. |
| arteriosclerosis A. Femoral artery is most likely to be affected by this condition (specifically atherosclerosis. | If the femoral artery is being used, avoid cutting into the artery where an atheroma can be felt |
| is a bulge in a blood vessel, much like a bulge on an over-inflated inner tube. Aneurysms are dangerous because they may burst, spilling blood outside of the aorta and leaving a person at risk for hemorrhaging within the abdominal cavity | aneurysm |
| The aorta, the main artery leading away from the heart, can sometimes develop an aneurysm. Aortic aneurysms usually occur in the abdomen below the kidneys (abdominal aneurysm), but may occur in the chest cavity (thoracic aneurysm | This can happen if the wall of the aorta becomes weakened by a buildup of fatty deposits called plaque. This is called atherosclerosis |
| If, upon injection, there is no drainage, stop the injection and begin a multi-point injection. 2. No drainage would indicate a loss of embalming solution into the thoracic or abdominal cavity. | aortic aneurysm |
| As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, | but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down |
| Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema | Blood is congested in the right side of the heart |
| V. Arterial Coagula A femoral injection could move the coagula towards the common carotid arteries and block distribution to the facial tissues | njecting via common carotid arteries will push the towards the legs |
| Diabetes mellitus A. Individuals with diabetes tend to develop arteriosclerosis. 1. Poor circulation can be anticipated 2. Gangrenous areas can require surface/hypodermic embalming | t |
| occurs when the arterial side is blocked causing the tissue to darken and die. This type of gangrene cannot be treated with arterial injection (due to the blockage.) | Dry gangrene |
| occurs when the venous side is blocked; blood can get into the area but cannot leave. This causes a putrefactive "wet" condition that is often accompanied by a bacterial infection | Wet gangrene |
| Extravascular Resistance | Pressure on the outside of an artery or vein. B. Be familiar with listed sources of resistance and suggested treatments. |
| Selected Conditions Postmortem evacuation of any substance from any external orifice of the body as a result of pressure. | Purge |
| Causes of Pressure rterial solution – Leakage through an ulceration in bowel, stomach, esophagus or lungs Ascites (peritoneal edema) and Hydrothorax (edema of thoracic cavity) | Gas – can create sufficient pressure on the stomach to force contents through the mouth or nose; or on the diaphragm to force lung contents out Visceral expansion expand if rate of flow is too high causing pressure on the stomach and lungs |
| Protecting skin from purge | stomach purge contains hydrochloric acid which can dry or discolor the skin If arterial solution is present in purge, the dye in the fluid can also stain the skin Apply massage cream to areas affected by purge |
| Pre-Embalming Purge | Stomach purge Lung purge Anal purge Brain purge |
| Usually consists of stomach contents and possibly blood if esophageal vessels have ruptured. Stomach contains hydrochloric acid which makes contents brown in color and can dehydrate or discolor the skin | "Coffee ground" appearance Stomach Purge |
| Frothy (due to air trapped in lungs) May be red (due to presence of blood) Usually little odor | Lung Purge |
| Should be forced from the body by applying pressure to the lower abdomen Allow it to continue during embalming as fecal matter is difficult to aspirate from the body | Anal Purge When cleaning the body, turn it on its side so the buttocks, backs of the legs and table can be cleaned Use plastic garments (with powder to control any odor.) |
| Usually a result of skull fracture, surgery or trauma Possible for gas to build up inside cranium Brain purge from the nose is rare; can also come from ear | Brain Purge |
| Embalming Solution Purge Remember that you have to replace the loss of embalming solution that has purged by injecting a sufficient total amount of solution | When arterial solution is present in purge during injection and drainage IS occurring, continue injection until a sufficient amount of solution to satisfy preservative demand. |
| When arterial solution is present in purge during injection and drainage is NOT occurring, major loss of solution is occurring somewhere and there is not distribution Begin a sectional (six-point) injection where needed | Embalming Solution Purge |
| Prevention of Post-Embalming PurgeThorough aspiration Inject additional cavity fluid Hypodermic injection of areas not receiving fluid Reaspiration! | Especially bodies coming from other FH’s Some FH’s have a policy to reaspirate before dressing Pack nose and throat with cotton Tie off or sever trachea and esophagus |
| Five types of gas in dead human body: | Subcutaneous emphysema Air from embalming machine Gas gangrene Tissue gas Decomposition gas |
| Subcutaneous Emphysema Most frequently encountered gas condition Caused by antemortem subcutaneous emphysema Brought about by a tear or puncture of the pleural sac or lung tissue | Common in compound rib fractures, tracheotomies, lung surgery, CPR NOT caused by a microbe and DOES NOT intensify after death Can escape through incisions, channeling of tissue |
| Air from embalming apparatus | Not common Automatic shutoff Most common when using an air pressure machine or hand pump |
| Gas Gangrene (Antemortem condition) Fatal disease caused by contamination of a wound infection by a toxin-producing, spore-forming anaerobic bacterium, Clostridium perfringens. | Organism grows in wound tissue (especially muscle); releases exotoxins and ferments muscle sugars. The pressure and gas tear the tissue apart. |
| Gas Gangrene (Antemortem condition) | Common after severe trauma (contact w/filth, manure, surface soil) Farm or car accidents Close-range gunshot wounds Compound fractures |
| Gas Gangrene Skin becomes dark red, then green and finally black Considerable swelling that extends rapidly over the body Tissue tends to “crackle” when touched - CREPITATION | May not be visible right away if death occurs quickly after injury; totally internal May not show up for hours after embalming |
| Tissue Gas (Postmortem condition) C. perfringens are very resistant to most disinfectants Condition can occur after embalming if all tissues have not been properly treated Distension is greatest in soft tissue areas Eyelids, neck, scrotum; | May begin prior to death as gas gangrene Postmortem by translocation of the gas bacillus from the intestinal tract Can be transferred from one body to another via contaminated embalming instruments, hypodermic needles, autopsy instruments |
| Decomposition Gas two factors responsible for decomposition Autolytic enzymes Bacterial enzymes Responsible for the odor of decomposition | Not usually as intense as gas gangrene or tissue gas Cannot be spread from body to body by contaminated instruments Generation of gas ceases when tissues are properly embalmed Can be removed by aspiration and channeling |
| Selected Conditions Treatments for Gas Restricted cervical injection Inject a VERY strong solution Both incisions can provide an escape route for gas | If gas appears to have originated in an extremity, a sectional embalming should be performed. Create a barrier (if gas is in an extremity) by hypodermically injecting cavity fluid |
| General Treatments for Gas The ONLY effective way to remove gas from distended tissues is to lance and channel the tissues to release the gas With the exception of subcutaneous emphysema, | just releasing the gas won’t stop regeneration; the microbe must be killed Triton 28 is a sporicidal arterial fluid that is effective against these microbes Soak instruments in strong disinfectant for several hours afterwards; discard scalpel blade |
| Embalming Protocol Subcutaneous Emphysema Does not involve microbes No odor, skin slip, etc. Only need to remove gas from body | Trocar puncture will usually be effective Using an RCI provides two incisions for exit points |
| Embalming Protocol Decomposition gas, Gas gangrene, Tissue gas All have bacterial origin Important to saturate tissues with strong arterial solution RCI allows injection of large quantities of solution into trunk (Why?) | Special-purpose fluids (e.g. Triton 28, Omega, etc.) Sectional injection if gas originates in extremities Waterless Use hypodermic to create barrier of cavity fluid |
| Selected Conditions Facial Trauma blunt force trauma can be divided into two general categories: Skin is broken (abrasion, laceration) Skin is not broken (contusion, hematoma) | Align fractures, lacerated skin areas (superglue or removing dermis to create a “channel”) Instant tissue fixation (other term?) |
| Selected Conditions Renal Failure Sallow color to skin due to urochrome buildup: (A pigmented blood product that gives urine its yellowish color) | Uremic pruritis – Itching sensation Excoriations – marks from scratching Increased levels of ammonia (definite smell) Edema |
| Selected Conditions Renal Failure High levels of ammonia neutralize HCHO Edema promotes hydrolytic decomposition | DO NOT PRE-INJECT cases of renal failure Tissues will easily swell if circulation is poor Use a very strong solution and employ a restricted cervical injection to avoid over-embalming the head |
| Selected Conditions Obesity Positioning Keep shoulders high off table 3 levels: head is highest, chest, then abdomen Keeping head high helps with raising vessels and helps prevent purge Use cloth straps for arms | raise the iliac arteries at the level More superficial than the femoral arteries - common for arteries to be quite small Inject large amounts of strong solution Tissue firmness makes dressing easier Visceral weight can cause stomach purge |
| Selected Conditions Mycotic Infections Those infections caused by a fungus Avoid compressions of thoracic/abdominal cavities when making removals | Fungal organisms can be expelled into the air Place a mask on the deceased Watch for open superficial lesions and do not touch without gloves |
| How Long Will Embalming Last? Generally accepted consensus states that long-term preservation should far surpass the period of the funeral and ideally continue as long as the grieving process of the mourners. | Because grieving can last a lifetime, it might be reasonable to say that preservation should last numerous decades. |
| Delayed Viewing Avoid excess elevation of head Fluids can drain from face; “sunken” appearance Feature building prior to storage Soft areas can be injected with a 1:1 cavity fluid/humectant solution Spray with a mold retardant | Do not store in a closed, sealed environment Encourages mold growth Sealing the casket encourages mold growth Close eyes & mouth with superglue to avoid over-drying of tissue Difficult to achieve closure if done later |
| Re-Embalming Ship-ins from Florida, Arizona, California, etc. Cavity work will have been done | Multi-point injection Drain from heart (there won’t be much drainage) Waterless solution if needed |
| Reasons for Delayed Viewing Family needs to make travel arrangements Difficulty in locating family Remains are being shipped to a foreign country | Family members are waiting for someone to be released from hospital After an accident Family members are awaiting imminent death of another family member. Accident, Nursing Home, etc. |
| Common Carrier | Any carrier required bylaw to convey passengers or freight without refusal if the approved fare of charge is paid; travels according to a set schedule. Airlines, railroads, etc. |
| Private Carrier | An individual or company that transports only in particular instances and only for those it chooses to contract with. Liver, private aircraft, etc. |
| Used for casketed remains Only the bottom is made of wood; sides, ends and top are made of heavy-grade cardboard | Air Tray |
| Wood-based container that has sides, ends and inside top all made of wood (plywood or fiberboard.) An exterior cardboard cover is placed over the top Used when only the body is being transported | Combination Air Tray |
| Shipping via Airline Place blocks at the end of the feet to prevent movement/head slipping off the head block Partially dress remains (hospital gown) & plastic garments Place the casket bed in its lowest position | Do not seal the casket when shipping by air Turn key enough times to lock it into place will seal the casket and simply leave the cap off of the sealing tube. Turn the pillow over – (purge) |
| Shipping Cremains | U.S. Post Office is the best way to ship cremated remains. Fed Ex, UPS will not accept them for delivery Most airlines will accept them |
| Zeigler Case | international travel |
| 1. When purge occurs from the nose or mouth during injection, the tissues of the face should be protected with massage cream. | Stomach purge contains hydrochloric acid which can dry and/or discolor the skin. Dye in the arterial fluid (if present in purge) can stain the skin. |
| . Use a nasal tube aspirator to remove purge from the upper areas of trachea and esophagus | Stomach Purge a. Usually consists of stomach contents and possibly blood if esophageal vessels have ruptured. |
| a. Should be forced from the body by applying pressure to the lower abdomen | b. Allow it to continue during embalming as fecal matter is difficult to aspirate from the body |
| . If arterial solution is present in purge but drainage is occurring, continue injecting until the preservative demand is met. | If arterial solution is present in purge but drainage has STOPPED, a major fluid loss is taking place and distribution is not happening. A SECTIONAL INJECTION will need to be implemented. |
| Usually occurs after severe trauma; especially farm or auto accidents, closerange shotgun discharges; also likely after compound fractures. 4. Dark red at first, turns green, then black; extensive swelling | . Gas Gangrene |
| Can be spread by contaminated hypodermic needles and instruments | Tissue Gas |
| B. Generally speaking, there are two "classes" of chemotherapeutic agents: | |
| Cytotoxic | act directly on the tumor cells to bring about their death |
| Antimetabolite | deprives the tumor cells of nutrition by serving as a substitute for an essential metabolite needed by the tumor cells for growth |
| B. Enzymes are proteins that break down other proteins | Can also speed up decomposition reactions C. A goal of embalming should be to make proteins resistant to these enzymes 1. By treating the proteins themselves so they aren't susceptible to enzymes |
| Most chemotherapeutic agents are nephrotoxic: 1. Cause a breakdown in kidney function | t |
| problems arising from chemotherapy are not a result of the chemotherapeutic drugs reacting with formaldehyde (or other aldehydes.) There is not enough of the drug present in the body after death | (even after aggressive therapy) to cause such a reaction. It is the physiological effect of the drug on the body that is the root of the embalming complications. |
| Most systemically administered drugs will affect a change in the permeability of cell membranes. | . If a chemotherapeutic agent reduces/destroys the permeability of the |
| Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body’s white blood cells and chemicals can protect us from infection and foreign substances such as bacteria and viruses. | In certain diseases, however, the body’s defense system doesn’t function properly. This may cause inflammation to work against the body’s tissues and cause damage. Inflammation is characterized by redness, warmth, swelling and pain. |
| Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells. | The main embalming problem caused by corticosteroids is that they block the cell membrane by decreasing its permeability. C. It is usually necessary to restore permeability to the cells of these bodies. Employing a pre-injection will restore some permea |
| Physical wasting with loss of weight and muscle mass caused by disease. Patients with advanced cancer, AIDS and some other major chronic progressive diseases may appear cachectic | Cachexia |
| Most chemotherapeutic agents do not affect only one organ. Most have a pronounced effect on other organs and tissues in the body. | All agents will eventually find their way to the liver and be excreted through the kidneys creating the possibility of damage and embalming complications. |
| . Standard practices should conceivably keep the remains intact for months or years with no special treatments. | Generally accepted consensus states that long-term preservation should far surpass the period of the funeral and ideally continue as long as the grieving process of the mourners. |
Created by:
jcowing