Chapter 19: Delayed Embalming

bodies in which there is been a time delay between death and preparation exhibit 3 common problems

• Difficulty in achieving even distribution for a variety of reasons which can result in over embalming in one area and lack of embalming in another.

• Swelling, especially in the facial (parotid), submandibular, and submaxillary glands.

• Increased preservative demand.

delays it

what does refrigeration do to decomposition?

after injection, most bodies exhibit some degree of firming

When is preservation absorption usually greatest?

concentration of preservative is highest at this point

Why is preservation absorption greatest after injection?

the 5 sign of decomposition

Odor

Gas

Purge

Discoloration

Desquamation

several hours up to a day later

If a sufficient amount of preservative has been injected, complete firming can occur within…

a minimum amount of stronger solution for preservation

What type of solution is best on bodies that have delays prior to embalming?

Manual Aids

Typically require the action of the embalmer resulting in pressure

• lowering the arms
• firm massage
• squeezing the fingers and nail beds
• rotating of flexing limbs
• elevation
• weights
• compresses
• pneumatic collars

Mechanical Aids

Typically require an instrument

• drain tubes

• pressure and rate of flow

• pulsation

• size of arterial tube

three choices for under-embalmed areas

• sectional embalming

• surface embalming

• hypodermic embalming

One point injection

this injection technique is not recommended for delayed cases due to lack of control of fluid entering the head

Restricted cervical injection or six point injection

injection techniques strongly suggested for delayed preparation

very slowly injected to cut back on the chance of rupture and coagula being dislodged

When there is been a long delay between death and embalming, the un-autopsied body should be…

recommended methods of pulsation to distribute fluid to the extremities

• using embalming machine with a pulse setting

• manually turn the rate of flow valve on and off

• bend the delivery hose

it is very dangerous

why is starting and stopping the flow of fluid with the rate of flow valve not recommended to create pulsation ?

It can damage the pump

why can turning the embalming machine off and on not recommended to create pulsation?

well muscled bodies

rigor is most evident in what type of bodies?

they are nearly impossible to articulate

what makes bodies with intense rigor difficult to prepare?

emaciated and cachexiated bodies

what type of bodies generally do not form very intense rigor?

the body cannot replenish ATP and lactic acid builds up in the muscles

Why does rigor mortis occur?

yes, it does in cases of trauma (cadaveric spasm)

can rigor instantaneously occur in certain situations ?

bodies with high temperatures and when exertion or exercise have preceded death

in what type of bodies will rigor rapidly occur?

recognizable

in 2-4 hours, rigor is…

fully established

in 6-12 hours, rigor is…

completely passed

in 36 hours, rigor is…

firming of prerigor

Good absorption; firming is good

firming of rigor

little absorption; firming is due to the rigor present and swelling

firming of post rigor

great need for preservative; firming is difficult to achieve

the sooner the passage

The sooner the onset of rigor…

increase or decrease it

Environmental temperature, activity level, and other considerations can do what to the time frame of rigor?

preservative demand of prerigor

good absorption; protein centers to which preservatives attach and cross-link proteins are readily available, tissue pH is slightly alkaline and fluids work best in this pH range.

preservative demand of rigor

little absorption of preservative; the protein centers to which preservatives attach are engaged in maintaining the state of rigor mortis, vessels of lumens are reduced so distribution is decreased, muscle protein is contracted so fluid does not penetrate the muscle fibers well, acid pH retards absorption

preservative demand of post rigor

great demand; proteins have disorganized (or broken) and many centers are available for preservative attachment, the alkaline pH increases absorption, nitrogenous waste will neutralize preservative

complications presented with rigor

▸features may be difficult to set
▸packing of throat may be impossible
▸distribution of fluid will be poor due to rigor in the muscles within the arterial and venous walls
▸tissues tend to swell because fluid does not penetrate muscles during rigor but flows to areas with little resistance
▸the pH of tissues is not ideal for fluid reactions while in rigor
▸firmness of rigor can be a false sign a fixation

coinjection (buffers or anticoagulants)

what chemical in needed to help adjust the tissue pH in various areas of the body?

things to help with setting the jaw

Use of a towel to firmly manipulate the jaw, massaging the temporalis, cover chin with towel and press firmly with palm, cotton may need to be forced into the mouth

right internal jugular

the best drainage site

medium to strong

type of arterial solution used

no

should preinjection be used when distribution difficulties are expected?

a minimum amount of strong solution

use of what type of solution helps to control swelling and achieve good preservation and tissue fixation?

Advantages of short-term refrigeration

▸slows the progress of rigor
▸slows decomposition
▸maintains blood in a liquid state

short term refrigeration

livor mortis can be expected to be intense after…

Disadvantages of long-term refrigeration

▸ dehydration (lips, eyes, fingertips)
▸ thickening of blood especially independent tissues
▸ gravitation of fluids may cause postmortem edema
▸ wrapping in plastic may cause skin slip or other conditions due to moisture
▸ increased capillary permeability
▸ Easy rupture of capillaries
▸ Tissue breakdown due to autolysis
▸ Increased coagula and blood viscosity
▸ Rapid hemolysis
▸ Rapid distension of abdomen during injection resulting in purge
▸ Cold solidified fatty substances resulting in false firming

Postmortem Caloricity

may increase rigor mortis and decomposition

green

it is not unusual to find what type of discolorations on the abdomen when bodies are removed from refrigeration?

Autolysis bacterial activity

continue while the body is in refrigeration, faster at first while the body is still warm and then slows as it cools.

intense staining

If the head has not been raised, what may be present?

Postmortem stain and Tardieu spots

may be lightened but cannot be removed entirely. Use of cosmetic is required.

dehydrated tissues

can range in color from yellow to brown to black in both Caucasians and African-Americans

opaque cosmetics

what must be used to cover discoloration from dehydrated tissues?

wrapping the body in a sheet

doing what for a long period of time during refrigeration may result in dehydration?

slowly, using a strong arterial solution with dye as a tracer

arterial injection of the trunk should be done how?

to help combat formaldehyde gray

extra amounts of fluid dye should be used why?

the hemolysis of blood trapped in surface tissues

The skin of refrigerated bodies can have a slight pinkness due to…

False signs of preservation

▸the cold fatty tissue mimicking preservation
▸firmness from swollen tissues
▸pink from hemolysis

gravitation of fluids

If the head has been raised, dehydration may be present due to…

moisturize the lips

A good application of massage cream on the outside and inside of the buccal cavity can help to…

dehydration, be sure to also use supplemental chemicals (humectant/coinjection)

A mild arterial solution may be required for injecting the head due to…

reinjected after reaspiration.

If any gases escape when the trocar button is removed, if the abdomen appears distended, or if the large surface veins of the neck appear distended, the cavity should be…

during embalming and with the final washing

As little water is possible should be run over the body…

thoroughly, a hair dryer is recommended

how should the body be dried?

after the body has had time to warm/reach room temperature

when should cosmetics be applied?

Ice crystals

what forms when the body freezes?

they can tear tissues, especially when the body is manipulated

why are ice crystals problematic?

no

should you warm the body by pouring water over it?

frozen bodies

restricted cervical or a multipoint injection are a must for…

guidelines for the preparation of frozen bodies

▸Inject as soon as it is possible to raise an artery and vein
▸Strong arterial solution should be used
▸Rate of flow should be very slow
▸Little to no drainage
▸Water should be warm to hot for your arterial solution
▸If using a specialty fluid, follow manufacturer's recommendations

stronger than average or waterless, dyes should be used

what type of solution should be used to inject the head of frozen bodies?

Factors that speed onset of
decomposition

▸ elevated environmental heat
▸ elevated and retained body heat
▸ high moisture content in the body
▸ translocation of intestinal bacteria

decomposition

After the passage or rigor mortis, noticeable signs of ____________ can begin to be observed

the cause of greenish discoloration in the bowel/large intestine

Hydrogen sulfide produced in the colon after death reacts with hemoglobin breakdown products

the first external sign of decomposition

a green discoloration in the lower right quadrant of the abdomen

green discoloration

proceeds up the anterior abdominal and thoracic walls as far as the neck and chin

marbling

superficial vessels breaks down and the hemoglobin combines with hydrogen sulfide to produce a green black discoloration, vessels take on a spider web appearance, this is an extravascular discoloration called:

small capillaries breakdown

the cause of petechial and purpura, Tardieu spot

Foul amines and mercaptans combined with ammonia and hydrogen sulfide

what produces the odors of decomposition?

converts them to odorless methylol compounds

what does embalming do to the compounds that cause the odors of decomposition?

converts it to odorless hexamethylene

what does formaldehyde do to ammonia?

how to reduce odors

Bathing the surface of the body with a solution prepared by mixing 2 pints of hydrogen peroxide with 1/2 cup of baking soda and adding a tablespoon of liquid soap. This solution is left on the skin surface for several minutes before rinsing and drying.

heat and humidity

Conditions favoring gas formation

cold and dry environment

Conditions hindering gas formation

severe disfigurement & purge

Gases can cause swelling which result in…

numerous nitrogenous products produced by autolytic and proteolytic decomposition of body proteins

what increases the preservative demand of bodies with advanced decomposition?

minimize the number of arterial coagula in the smaller arteries

the purpose of using six point injection on advanced decomposition cases

the aorta

which artery will likely have tons of coagula, necessitating sectional embalming for advanced decomposition cases?

general embalming protocol for advanced decomposition cases

⊳ Start in the legs, go to the arms, inject the trunk using the carotids. At all times the carotids leading into the head should be left open.
⊳ Aspirate the body after the trunk is injected (immediately after injection).
⊳ Set the features.
⊳ Inject the left side of the head and then the right.
⊳ Aspirate the cavities again and inject them with an appropriate cavity fluid

inject the head after cavity injection and aspiration, then respirate and reinject after head injection

what is important to remember regarding injection of bodies with advanced decomposition?

a very slow one

for bodies with advanced decomposition, what rate of flow should the trunk and viscera be injected with?

slow at first, increased later

for bodies with advanced decomposition, what rate of flow should the limbs be injected with?

instant tissue fixation (high pressure, high rate of flow spurts) with a waterless solution

what injection technique is recommended for the limbs of advanced decomp cases?

the bend of the elbow

to inject the arms insert the hypovalve trocar into the area of…

the upper anterior portion of the arm

to inject the shoulder and upper chest insert the hypovalve trocar into…

on the medial side of the leg above or below the knee or from the ankle up

to inject the legs insert the hypovalve trocar into…

the lateral walls of the trunk at approximately the level of the mid-axillary line

to inject the trunk insert the hypovalve trocar into…

virtually mandatory to prevent liability

for advanced decomposition cases, plastic garments are…

inside the plastic garments

for advanced decomposition cases, embalming powder or even moisture absorbing kitty litter should be used

control odors

while preservation is important, it is more important to…

decomposing bodies

dehydration is never a concern with what types of bodies?