WIP test 2 - obesity, decomposition, elderly, emaciation, edema

test is 11/7, study hard and the world is yours.

when making obesity removals, what could you use?

use cot, ambulance gurney or hospital gurney

can you get assistance when transporting an obese case to the funeral home?

yes! you could ask law enforcement (nonemergency line), call the local ambulance service, or the fire department

what are some areas of issue with obesity cases?

body size, equipment and access, caskets and vaults, cemetery or crematory requirements, transport issues 

what is a bariatric stretcher?

gurney, doesn’t fold, can hold up to 1000 lb (depends on type) - can be found in ambulance

should you kick out a bariatric stretcher’s legs in an attempt to unfold it?

NO, should automatically fold out

how can you get an obese case onto the embalming table?

can call other funeral directors for help

what item could you use to help move an obese case?

smooth mover, glider

if something or someone falls…

…DO NOT CATCH IT OR THEM

when handling an obese case, how should you position them?

shoulders of obese case should be raised off table, can extend neck temporarily to locate carotid

if an obese decedent’s back is pressed against the table, what should you be aware of?

that distribution and diffusion could be impaired due to the pressure

what should you avoid using when embalming an obese decedent?

the femoral, because it can be underneath leg fat

what injection site do you generally use for an obese decedent?

common carotid, draining through the jugular - can also raise the external iliac if the legs are not getting distribution

how much fluid should you use for an obese decedent?

need large amount of fluid, fluid can be average strength

what may be present if varicose veins are visible?

blood clots may be observed in drainage

what sort of pressure should be used when embalming an obese decedent?

depends, but medium pressure is generally advisable due to blood clotting

what should you keep in mind when monitoring an obese decedent being embalmed?

be aware of swelling, monitor to make sure features are not being distorted 

what are some anticipated problems with obese cases?

purge because of pressure, and gases formed in GI tract

how many aspiration points should you use for an obese case?

two points of aspiration, can use traditional amount of fluid - cavity areas don’t get bigger even as people gain weight, duh

if an obese decedent has been autopsied, what should you be mindful about regarding the skin flaps?

be aware that skin flaps must be open, can duct tape them or support them otherwise so they do not hang over the side of the table/prevent drainage

you can get a wider casket, but you can’t get a…

longer casket, so be aware of that when you’re embalming someone (do they need a bend in the legs?)

what can you use to place an obese decedent in the casket?

a mortuary body lift

what is decomposition?

complex organic compounds are broken down into simpler substances through the action of microbial or autolytic enzymes

what are the five kinds of decomposition?

proteolysis, autolysis, lipolysis, fermentation, saccharolytic

what is proteolysis?

process of breaking down proteins into smaller peptides

what is autolysis?

breakdown of self by self’s enzymes 

what is lipolysis?

metabolic process of breaking down stored fat into glycerol and free fatty acids

what is fermentation?

anaerobic breakdown of carbohydrates like glucose into simpler molecules such as organic acids or alcohol

what is saccharolytic?

breakdown of sugars

what are the five signs of decomposition?

color, purge, gas, odor, skin slip

what color does the trunk typically turn during decomposition?

green, specifically in right quadrant of abdomen

how is gas produced?

chemical and microbe activities during decomposition of solid waste

what can you expect if clostridium perfringens causes gas buildup?

blistering, stomach purge, rectal purge

what can the distention of the abdominal cavity cause?

lung purge, stomach purge, rectal purge

what products of decomposition cause foul odor?

cadaverine and putrescine

what is skin slip caused by?

hydrolysis

what are the extrinsic factors of decomposition?

• temp

• moisture

• access of air

• animal activity

• pressure due to clothing or ground

• bacteria

what are the intrinsic factors of decomposition?

• internal moisture

• febrile diseases 

• gas and moist gangrene

• bacteria in body

what is the tissue order of decomposition? (fastest to slowest)

• liquid tissues (blood and lymph)

• soft tissues (parenchyma of organs)

• firm tissues (muscle and stroma of organs)

• hard tissues (cartilage and bone)

what is the first stage of decomposition?

fresh (1-2 days)

what is the second stage of decomposition?

bloating (2-6 days)

what is the third stage of decomposition?

decay (5-11 days)

what is the fourth stage of decomposition?

post decay (10 - 25 days)

what is the fifth stage of decomposition?

dry (25+ days)

how do you treat skin slip?

saturate cotton with cauterant and place on broken areas of skin

what is a potential concern with any body outside for an extended period of time in weather over 50 degrees F?

insects, specifically those like maggots or blow flies

if you are seeing poor fluid distribution, what could you conclude?

that coagula is present in arterial system

if you are seeing poor drainage, what could you conclude?

that blood and vessels have begun to decompose

what is cannizzaro’s reaction?

lack of cross linking in proteins, little to no tissue fixation because proteins have broken down extremely

what could you place in the unionall of a more decomposed decedent to help with smell?

cherry charm

what do you have to be sure to do before waxing and cosmetizing a decedent?

ensure that the area you are waxing and making up is completely dry

what is edema?

abnormal collection of fluid in tissue spaces or serous cavities, can be intracellular

what is cellular edema?

occurs when abnormal amount of interstitial fluid passes into and is retained by cell, cannot be drained from tissues

what is intracellular edema/pitting edema?

fluids accumulate between cells of body, can be drained from tissues

what is anasarca?

severe generalized body wide edema

what is ascites?

accumulation of serous fluid in peritoneal cavity

what is hydrothorax?

accumulation of fluid in thoracic cavity

what is hydrocephalus?

accumulation of cerebrospinal fluid within ventricle of brain

what is hydropericardium?

accumulation of fluid in pericardial cavity

what are some causes of hydrocephalus?

meningitis, lesions, tumors, stroke, brain injury 

what are some possible complications of embalming an elderly case?

• arteriosclerosis

• poor circulation

• emaciation

• low protein level

• underlying diseases

what may help embalming an elderly case?

pre-injection can help in dehydrated cases, use slightly higher concentration to counteract low protein level, humectants and water conditioners can be useful

what injection technique should be used for elderly cases unless complications arise?

single point injection

how do you treat bedsores?

dry and pack with drying powder, can hypo late stage bedsores, in more severe cases you debride tissue, hypo inject untreated areas, put a surface pack on

what is gas gangrene?

highly fatal disease caused by contamination of a wound by certain spore forming, toxin producing gram positive bacteria - antemortem

what is tissue gas?

gas that can form in body tissues due to contamination and decomposition - postmortem

what are some possible complications of a tissue gas case?

highly infectious, can be spread from instrument to instrument, swelling of tissues and crackling beneath hands if touched, blisters contain gas and purulent fluid