FSE2140 Embalming II Chapters 16-20

Factors that influence preparation techniques:

Age

Size

Weight of the body

Cause of death

Moisture conditions

Postmortem changes

Discoloration

A factor that must always be considered in the pre-embalming analysis of the body:

Age

Can children and adults be embalmed with large amounts of strong arterial solutions?

TEs, many children die from diseases that produce edema or show evidence of advanced postmortem changes.

Infant period

Birth to 18m

Toddler period

18-48m

For infants, the body water is what % of total body weight?

75%

At 1 year of age, the body water declines to the normal adult level of what % total body weight

60%

T/F: Infant skin is much more delicate than adult skin

True - it can easily distend and wrinkle on injection of the arterial solution

Are most infants autopsied?

Yes, but infants dead from birth defects and systemic disease may not be

T/F: The embalmer should not use pre-injection as the preservative solution for embalming infants.

True - though they may not need as much volume as an adult, infants ay require a strong arterial solution like an adult.

Premature infants are referred to as 'preterm' in pediatric medicine if they weigh less than __ pounds at birth or are born prior to the end of the __ week of gestation.

5.5 pounds and 37 weeks

Stillborn is a fetus that dies __to delivery from the uterus

Prior

Intravenous tubes should be left in place and removed __ arterial injections in infants.

After

Tracheotomy tubes or any tubing placed into the mouth or nose should be removed __ to arterial injection.

Prior

Infant eye caps may be cut down from adult sized ones or __ can be placed under the lids to affect closure

Cotton pads

Many embalmers use a __ suture can be used for infants because a needle injector method of closure may not be possible.

Muscular

T/F: The embalmer may leave the mouth open a bit on an infant

True - it makes the infant appear to be sleeping

Due to difficulties creating a line of mouth closure in an infant, an embalmer can use a thick adhesive emollient __ that can help to hold the lips in position.

Cream

In infants, the mouth is generally glued __ arterial and cavity embalming because air from the lungs can become trapped in the mouth.

After

T/F: The placement of the arms of an infant are always just like an adults.

False - the child's arms may be arranged along the sides of the trunk or they may be holding a toy.

Are the legs often visible during the viewing of an infant?

Yes

T/F: The common carotid artery is the largest and therefore most usable artery when embalming an infant.

True

In what direction do you turn the head of an infant when you raise the common carotid artery?

The opposite direction

In a variant technique involving the aorta as a primary injection point, the __ __ is used.

Ascending Aorta

When injecting the ascending aorta, drainage can be taken from the __ auricle of the heart.

Right

Auricle

The small ear like appendage on the right atrium of the heart.

In preparing infants to be embalmed, the embalmer should use __ injection which yields very satisfactory results.

Arterial

Areas not reached by arterial injections can be used by __ and __ embalming.

Hypodermic and surface

Four types of autopsies performed on infants:

1. Complete - Cranial and trunk cavities are opened and the visceral is removed

2. Partial - Only one cavity is opened (cranial, thoracic, abdominal or spine)

3. Special (local) - Only one organ is removed or a special examination is made of the rout of blood vessels or nerves

4. Tissue - Cornea, whole eye, skin and bones are tissues that may be removed for transplant.

Infant body tissue contains a higher percentage of __ than adult body tissues.

Water

In the autopsied infant, the __ are embalmed before the head or the arms - this allows the embalmer to adjust the fluid strengths and the dyes.

Legs

__ arterial solutions easily distend tissues, another reason to use arterial solution at a strength close to that used in the adult.

Weak

The head of an autopsied infant may be injected __ from within an incised neck area or natural opening (mouth and nostrils) or an incised scalp area.

Hypodermically

Arms and legs may be injected __ from within the open trunk cavity.

Hypodermically

Internal compresses, also called inlays, are __ or __ that is well dampened with cavity fluid and inserted into such areas as the interior of the neck, cranium and the trunk cavity when devoid of viscera.

Cotton or sheeting

Preservative gels are __ chemicals that are painted over the __ as well as under the anterior chest and abdominal skin flaps before skin suturing.

Semisolid and calvarium

External compresses are cotton saturated with __ cavity fluid or a __ preservative that may be used to preserve areas as small as ears or the entire body.

Undiluted cavity fluid and topical

T/F: The cavity fluid should be added before the bag of viscera has been positioned within the body cavity.

False - it should be added afterwards.

The easiest compress may be premature infants is the __ compress. The infant is wrapped in cotton saturated with cavity fluid or painted with autopsy gel.

External

For 4-12 year olds, a medium index of __ to __ is most satisfactory and you use a __ rate of flow.

18 to 25 and slow

For buck teeth, place a small layer of cotton over the __ teeth and gum.

Lower

Causes of death in 4-12 year olds:

Infectious and contagious diseases - meningitis and pneumonia

Childhood Viral Disease

Systemic Diseases - leukemia and cystic fibrosis

Causes of death in adolescent/adults 13-75 year olds:

Heart disease, malignancies, and accidents

The order of injection sites when embalming a normal adult body:

1. RCI

2. One-point using Common Carotid Artery

3. Femoral

Some embalmers use o injection chemicals as a substitute for water, creating a __ solution. They can be used with almost all arterial solutions.

Waterless

The important factor is the __ __ __ which is how fast or in what volume the fluid entered the body.

Rate of Flow

T/F: The IDEAL rate of flow is 10-12 minutes per gallon for the first gallon of solution.

False - 10-15 minutes.

Arthritis can cause many issues. These include:

Positioning and fluid distribution systems.

For deceased diabetics, it would be best to use the __ for injection.

Common Carotid

The biggest issue with mouth closure with diabetics is the atrophy of the __ and the __. You must use a muscular or mandibular suture.

Maxilla and mandible

Arteriosclerosis is most prevalent in the __ artery and can bring about poor peripheral circulation, loss of a limb and gangrene

Femoral

Decubitus ulcers (bedsores) are developed in individuals with poor circulation and there is pressure contact. You should __ treat around these ulcers using a small trocar and undiluted cavity fluid.

Hypodermically

The rupturing of a vessel is a ruptured __.

Aneurysm

Senile purpura is also called ecchymosis is an __ irregularly shaped blood discoloration that often appears on the arms and the backs of the hands.

Extravascular

T/F: Senile Purpura areas often engorge with fluid and swell during arterial injection. This darkens them.

True

If senile purpura is in evidence over the hands and arms of the body, how would you embalm?

You should strengthen the arterial solution and use a slow rate of flow.

If the skin over the purpural areas has been torn or break open, all loose skin should be __. This should be done at the beginning of the embalming.

Removed.

Malignancy (cancers) causes:

1. Disseminated intravascular coagulation.

2. Distribution of metabolism by uncontrolled secretion of hormones

3. Secretion of both peptide and steroid hormones by many tumors.

4. Anemia

5. Cachexia - the wasting away of tissue (atrophy)

Metabolic disturbances, renal and respiratory failures are a result in the buildup of __ waste in the tissue.

Metabolic

A colostomy bag can stay in place during arterial injection and __ treatment and then be removed, disinfected with cavity fluid.

Cavity

Due to cardiac disease, __ may be present in the facial tissues

Edema

If there is extensive edema of the facial tissues, restricted cervical injection should be used and a __ solution should be injected for its treatment.

Strong

A pacemaker is usually in the upper __ portion of the chest that runs into the internal jugular vein and then into the heart

Lateral

Diabetes Mellitus is both an acute and __ metabolic disorder characterized principally by hyperglycemia resulting from a deficiency of insulin.

Chronic

Hyperglycemia

An excess of sugar in the blood.

Manifestations of Diabetes Mellitus:

1. Hyperglycemia - excess of sugar in the blood

2. Glycosuria - sugar in the urine

3. Ketosis - buildup of acid in the blood/tissues

Pathological changes that results from Diabetes Mellitus:

1. Poor peripheral circulation

2. Gangrene

3. Kidney Failure

4. Fungal infestations

5. Strong odor of Acetone

Use a __ arterial solution when embalming a body with Diabetes Mellitus; also use a __ injection.

Strong and RCI

Cavity embalming should __ follow arterial injection for Diabetes Mellitus.

Immediately

Reasons for medico-legal autopsy ordered by a coroner or medical examiner:

1. To determine the cause of death

2. To determine the manner of death

3. Establish the time of death

4. Recovering, identifying and preserving evidence.

5. Provide factual info for legal authorities.

6. Separate deaths due to disease or due to external causes

Supplemental treatments for the preparation of the autopsied body:

Hypodermic injection of the trunk walls, the shoulders, the neck and the buttocks

T/F: You use a minimum of three bottles of cavity fluid to be mixed and poured over the viscera before the bag is returned to the cavities.

False - use a minimum of two bottles

If the viscera is returned to the cavities NOT in plastic bags, they should be soaked in __ for several hours, returned to the abdominal and thoracic cavities and covered well with absorbent autopsy hardening compound.

Cavity fluid

To close the cavities, bring all three flaps of the incision together and tie them together with __ suture.

One.

When suturing the scalp incision, the two types of sutures are:

1. Inversion suture (worm)

2. Baseball suture

Battered child syndrome can be very extensive and __.

Invasive

A pathologist may trace the origins of a __ to look for the source of the clot.

Pulmonary embolism

The excision done on a suspected drug overdose __ be closed by a suture

Cannot

A square keloid scar (fibrous tissue) is cut out, often in the. __ when the pathologist is checking for drug overdoses.

Bend of the elbow

In a cranial autopsy, the __ is removed

Brain

In a thoracic partial autopsy, __ or more organs of the cavity have been removed.

One

Drainage from a thoracic partial autopsy taken for the lower extremities and the abdomen are drained through the __ __ __ which is located at the lower right area of the diaphragm.

Inferior Vena Cava

In the abdominal partial autopsy, the contents of the abdominal cavity are __.

Removed

Legs can be injected from the external __ arteries.

Iliac

__ injection can be used to preserve the abdominal walls and buttocks.

Hypodermic

Restoration of the deceased to natural __ and __ is indirectly related to embalming.

Form and color

Two important criteria must be achieved for good restoration work. These are that the body must be __ and completely __.

Firm and dry

A group of similar cells that perform a specific function.

Tissue

A part of the body formed of two or more tissues that performs a specialized function.

Organ

Organ recovery and transplantation is very time sensitive. The patient must still be on a __ and remain the ICU until taken to the operating room.

Ventilator

Tissue recovery must be completed within __ hours of death when the deceased has been refrigerated and __ hours when there has been no refrigeration.

24 hours and 15 hours.

Uniform Anatomical Gift Act

The act allows any person 18 years or older to donate all organs and tissues of their body for transplantation, research, or educational purposes after his or her death.

Organs that can be recovered for transplant:

1. Heart

2. Lungs

3. Heart and lungs en bloc

4. Liver

5. Kidneys

6. Pancreas

7. Small bowel

The cause and __ of death may affect the viability and transplantability of organs.

Circumstances

The embalmer has two options for the arterial injection of an organ donor

1. External Access

2. Internal Access

External access is when embalming is accomplished by raising __ at one of the commonly used injection and drainage sites.

Vessels

Internal access is when the embalmers opens the __ incisions and attempts to inject the body utilizing the arterial structures that remain intact in the areas where organ recovery has taken.

Procurement

Keys to successful autopsy and organ donor embalming include:

1. Knowing anatomical structures and relationships

2. Anticipating which vessels have been cut.

Because of a time delay, a __ arterial solution may be necessary.

Stronger

Enucleated

The entire eyeball is removed.