Embalming III Lesson 2 (Chapter 17)

What is the definition of an autopsy?

A postmortem examination of the dead human body (organs and tissues) to determine cause of death and/or pathological conditions.

What is another common name for an autopsy?

Necropsy.

What are the two primary types or settings of autopsies?

Medical autopsy (hospital) and medicolegal/forensic autopsy (medical examiner or coroner).

Are medical autopsies optional?

Yes, they are optional, and the family normally must consent.

What are the primary reasons for performing a medical autopsy?

To confirm or verify a diagnosis; when death follows unexpected medical complications; when death follows use of an experimental drug, treatment, or therapy; when death follows surgery; when death occurs after childbirth; when there are concerns about a contagious or hereditary disease; or for insurance claims and settlements.

Are forensic autopsies optional?

No, they are not optional and are ordered by a medical examiner or coroner.

What are the primary purposes of forensic autopsies?

To determine cause of death, determine manner of death (suicide, homicide, accident), establish time of death, confirm identification, and provide information and evidence to legal authorities.

What are the two main categories based on the extent of an autopsy?

Partial autopsy and full autopsy.

What does a partial autopsy examine?

A specific region or a specific cavity.

What does a full autopsy entail beyond an external examination?

Examination of the cranial cavity, abdominal and thoracic cavities, pelvic cavity, neck, eyes, and spine.

What must always be performed first when approaching autopsy treatment?

Case analysis.

What incisions will an autopsied case typically present upon arrival?

A loosely closed Y-incision and a loosely closed cranial/scalp incision.

What are the initial "normal" case preparation steps before opening cavities?

Bathing, primary disinfection, posing the remains, shaving, and setting features.

What are the immediate first steps when starting treatment inside the open cavities?

Remove temporary sutures, open cranial and abdominal/thoracic cavities, remove the breastplate (treat and set aside), and remove the bag containing the viscera.

What are the 6 primary arteries necessary for injection in an autopsied case?

Right and left external iliacs (or common iliacs), right and left common carotids, and right and left axillaries (or subclavians).

What should be done if distribution from the 6 primary arteries is incomplete?

Use knowledge of the vascular system to find and raise an additional artery.

How is embalming timing handled by default for autopsied cases?

Embalming is delayed by default.

What type of embalming solution is recommended for autopsied cases?

A stronger than normal solution due to greater preservative demand, potentially utilizing sectional embalming, waterless solutions, and an active/cosmetic dye.

What are the steps for treating removed viscera?

Place the bagged viscera into a covered container (bucket), perforate/incise the viscera with scissors to create openings for gas release and chemical penetration, add preservative chemical (cavity fluid), close the bag, place a lid on top to eliminate fumes, and let it sit during injection.

How should injection and drainage be performed across body sections?

Inject each section separately starting inferiorly and working superiorly (legs with standard to high pressure, arms with standard to higher pressure, and head with lower pressure starting on the left side).

What specific machine functions and clamping techniques aid injection and distribution?

Consider using the pulse function (especially for the face), intermittent drainage, and clamping leaking arteries with hemostats.

What drainage devices are necessary for an autopsied case?

No drainage devices (forceps or drain tubes) are necessary because drainage flows directly into the open body cavities.

What tool must be run continuously during embalming to manage cavity drainage?

An autopsy aspirator to keep the volume of drainage to a minimum and reduce fumes.

What are the initial steps for treating the cranium?

Reflect the scalp, remove the calvarium (skull cap), disinfect the cavity, support and massage the scalp to prevent forehead creases, and clamp internal carotid arteries inside the cranial cavity during common carotid injection.

What methods can be used to reattach the calvarium?

Adhesive, musculature sutures, calvarium clamps, etc..

Which specific areas require supplemental hypodermic and/or surface embalming?

Shoulders/neck, buttocks, breasts, and the flaps of the open cavity.

What steps are involved in preparing the cavity before closing?

Thoroughly dry the abdominal/thoracic cavity, ligate all injected arteries, ligate the esophagus and rectum, pack cotton into the neck to create natural form/contour, pack the pelvic area to deter leakage, and coat the cavity in preservative powder and/or hardening compound.

What are the two options for returning treated viscera to the body?

The Bag Method and the Stack/Layer Method.

What are the details of the Bag Method for viscera return?

Aspirate excess gas/liquid from the viscera bag, seal/tie it with ligature, place it into the open cavity, maneuver it to fill the cavity, and place towels on the ribs during placement to prevent rips/tears.

What are the details of the Stack/Layer Method for viscera return?

Remove treated viscera from the bag one piece at a time, pat dry, and stack it in the cavity in layers with hardening compound between each layer (like a lasagna).

What stitches can be used to close the cranial scalp incision?

Worm/inversion suture or baseball suture.

Where should the cranial scalp suture start and finish?

Start behind the right ear and finish behind the left ear.

How can hair interference and baldness be managed during cranial closure?

Shave or trim a small strip of hair on both incision margins, or use wax restoration and cosmetics (Restorative Art) for balding cases.

What needle is used for suturing the Y-incision?

A double-curve postmortem needle (size 0).

What stitch is recommended for closing the Y-incision?

Baseball suture, starting at the pubic bone and working superiorly (or top-to-bottom), utilizing bridge sutures or gathering forceps to hold flaps together.

What final steps are taken after suturing the Y-incision?

Glue the sutures, place cotton strips on top for security, and carefully aspirate just below the surface if air is trapped in the cavity.

What are the very final procedures before completing the case?

Bathe the deceased, perform terminal disinfection, use plastic garments with absorbent powder to guard against leakage, check features, and perform any additional treatments.