ET II - Embalming the Autopsied Case

Autopsy

A postmortem examination of the dead human body; performed after homicides, deaths in the workplace, SIDS, intra- and perioperative accidental deaths; embalmer's liability to make a note of type of autopsy and whether viscera was returned or not.

Medical Autopsy

Hospital autopsy that requires consent from family.

Medicolegal Autopsy

Forensic autopsy that does not require family consent.

Overview for Autopsied Cases

Fluid Strength-stronger than usual; Use dyes; Massage to promote distribution; Use restricted drainage-clamp off appropriate veins

Embalming the Autopsied Case: Suggested Order of Operation (1)

Disinfect with topical disinfectant (Dis-spray, Nu-it, Sanifectant)

Embalming the Autopsied Case: Suggested Order of Operation (2)

Shave & set features

Embalming the Autopsied Case: Suggested Order of Operation (3)

Remove sutures and viscera (if returned)

Embalming the Autopsied Case: Suggested Order of Operation (4)

Mix fluids-apply case analysis

Embalming the Autopsied Case: Suggested Order of Operation (5)

Injects at rates and pressure appropriate for area (Legs, arms, & head in that order)

Embalming the Autopsied Case: Suggested Order of Operation (6)

Supplemental treatments-hypo-inject sidewalls, flaps, shoulders, neck etc.

Embalming the Autopsied Case: Suggested Order of Operation (7)

Drain all liquids via PM aspirator and treat with hardening compound or autopsy gel

Embalming the Autopsied Case: Suggested Order of Operation (8)

Treat abdominal, thoracic & neck areas; Return viscera, fill with cotton, or sheeting saturated with cavity fluid

Embalming the Autopsied Case: Suggested Order of Operation (9)

Cavity treatment cont.; Fill out neck area with cotton etc.

Embalming the Autopsied Case: Suggested Order of Operation (10)

Suture thoracic & abdominal cavities

Embalming the Autopsied Case: Suggested Order of Operation (11)

Dry cranial cavity add HC, cotton etc. and attach calvarium.

Embalming the Autopsied Case: Suggested Order of Operation (12)

Wash and dry body

Embalming the Autopsied Case: Suggested Order of Operation (13)

Place glue over incisions and cover with webril or cotton

Embalming the Autopsied Case: Suggested Order of Operation (14)

Optional step-Place body in coveralls, plastics and add embalming powder.

Embalming the Autopsied Case: Suggested Order of Operation (15)

Fill out embalming report. This could save you or your firm, should you be sued for negligent or poor embalming practices. Document what you used and did.

Embalming the Autopsied Case

1.) Sanitize remains; position appropriately; 2.) Remove all sutures and treat with disinfectant spray. The scalp and head can be sprayed with Phenol right away to start the drying and cauterizing of area; 3.) Locate and inspect arteries to be injected; 4.) Features can be set now - or wait until head is to be injected; 5.) Mix fluids- can be mixed after step 1. Remember that a stronger solution should be used due to delay between death and embalming; 6.) Co-injections should be chosen based upon the needs of the body (i.e. case analysis); 7.) Inject lower extremities first

Injecting the Lower Extremities (1)

Common iliacs first choice; External iliacs (feed the legs); Internal iliacs (feed the buttocks, perineal, and anal tissues); Internal may leak and can be clamped with hemostat; If all arteries are severed raise the femoral arteries

Injecting the Lower Extremities (2)

Drainage should be removed via postmortem aspirator to prevent HCHO exposure. (Some embalmers leave drainage to osmotically/surface embalm the cavity); Massage legs and feet to promote distribution and drainage; ½ gallon to 2 gallons can be injected, depending on the case

Injecting the Lower Extremities (3)

If vessels in legs are sclerotic, hypodermic treatment can be employed; Intermittent drainage may aid in distribution. This is accomplished by clamping off the drainage with hemostat or digitally blocking drainage; Could use a "Y Injector" for simultaneous injection

Injecting the Upper Extremities & Head

Option to use Arch of Aorta if left intact for access.

Left Side of Head/Face Injection

Use Left Subclavian Artery and Left Common Carotid Artery.

Right Side of Head/Face Injection

Use Brachiocephalic Artery, Right Subclavian Artery, and Right Common Carotid Artery.

Subclavians

Use to inject arms if possible to provide added preservation to the back of the neck, parotid area, and shoulders; Features should be set when using subclavian arteries because the vertebral arteries will supply the head with some fluid (or clamp off vertebral arteries).

Axillaries Injection Method

If arch or accessible vessels are gone raise the axillary arteries by dissecting through the pectoralis major muscle; With this method, after arm is injected, the cannula can be turned toward the torso (heart) to try to achieve the same results as when the subclavian is injected; Hands and arms should be positioned at this time; If needed, the radial and ulnar arteries can be injected as well

Injecting the Head

Injection of the head is accomplished by using the R & L common carotid (1st choice) arteries as injection sites; The external carotids (2nd choice) can be used if the common carotids are severed

Injecting the Face

Accomplished by using the R & L common carotid arteries as injection sites; external carotid arteries can be used if common carotids are not accessible/severed; clamp off the internal carotids in the cranial vault near the Sella Turcica; If the parotid area swells, a machine with pulsation can be used and or a stronger solution

Hypodermic Injection

The flaps and sidewalls can be channeled with a hypo-valve trocar and then injected with an arterial solution; Cavity walls can be coated with autopsy gel (Syngel, Postene, Hexaphene); If viscera isn't returned cavity fluid soaked sheets or cotton can be used to fill the area; pelvic area should be packed to prevent leaks

Treatment of Viscera

Make a note on the embalming report whether the viscera was returned or not; State also if viscera was prepared and placed in the body or in a separate container and then placed in the casket or shipping case; 32 oz of cavity fluid should be the minimum amount used if viscera is in a viscera bag; text suggests treating the viscera at the end of the procedure, but most embalmers do this in the first few steps; Dry packing the viscera is another way of treating the organs. Hardening compound is placed over the organs; Rebuild the throat and pack neck area above collar bones.

Closing Incisions (Torso)

Place the viscera bag in the cavity; Coat sidewalls and breastplate with autopsy compound (Viseroc, Millenium powder); Use minimum #5 twist, linen ligate; Bring all 3 flaps together (page 318); Start at the pubic symphysis for abdominal area; Tie ligature in a knot; Use a baseball stitch. This stitch is very strong and airtight when properly done; Suture from the xiphoid process and continue towards the shoulder. Add incision sealer to prevent leaks

Baseball Stitch

Stich that is made from beneath up through the skin, and the needle is crossed from side to side with each stitch like a baseball.

Cranial Vault Filling

Fill cranial vault with rolled cotton, para-formaldehyde, and incision sealing powders.

Closing the Incision: Cranium

Spray the reflected scalp with a cauterant. (Good idea to do at the beginning); Putty can be used to seal off the foramen magnum, vertebral arteries, and internal carotid arteries; Cotton and absorbent powder should be placed in the cranial vault; More putty can be applied to the "rim" of the skull to seal and seat the calvaria; Ways to secure the calvaria to the skull, Calvaria clamps, Ligate, Plaster of Paris Bandage, CA or super glue, Drill and wire, Needle injector- criss cross wires

Suturing the Scalp

Suture the scalp closed beginning on the right side and using a baseball or worm stitch; Apply incision seal powder as you go; Entire head can be closed with CA glue (Dodge Chemical Co)

Final Preps

Wash hair and skin thoroughly, dry hair and skin with a towel, cover sutures with surface glue and roll cotton or Webril cotton; Place in plastic garments; Add absorbing, odor controlling and/or paraformaldehyde as needed; Complete your case report!

Posterior Neck Incision

Done to determine if neck was broke and or for muscle damage and strangulations; Leaking is biggest problem; Pack with phenol or cauterant then embalm as normal autopsy; Must be rolled onto side or face to suture; TIGHT suture with ample amounts of putty and or drying, incision powder; Baseball suture; Glue and cotton on sutures; Place in plastic garment, Unionall specifically; Use Emmerich Cranial Cap with Absorbant Cranial Insert

Restricted Cervical Method (Cranial Partial Autopsy)

Uses 3 cannulas: 1 cannula up the RCCA, 1 cannula down the RCCA, 1 cannula up the LCCA; tie off lower portion of LCCA; Use RIJV for drainage - Inject down first to embalm trunk & extremities; Inject LCCA second, clamp off LICA; Inject RCCA last, clamp off RICA

Normal or 1-point Injection Method (Cranial Partial Autopsy)

Uses 2 cannulas: 1 cannula up the RCCA, 1 cannula down the RCCA; clamp off LICA and right and left vertebral arteries; Use RIJV for drainage- Inject down first to embalm trunk & extremities & left side of head; Inject up the RCCA last, clamp off RICA

Femoral Injection Method (Cranial Partial Autopsy)

Uses 2 cannulas: 1 cannula up the RFA, 1 cannula down the RFA; Use RFA for drainage - Inject down the right leg first; Inject up the RFA to embalm the rest of the body; Clamp off right and left ICA's and right and left VA to stop leakage during injection.

Injecting Arms and Head (Thoracic Partial Autopsies)

One or more thoracic organs have been removed (neck left undisturbed); Drainage taken via SVC if neck is undisturbed; Arms and head can be injected the same as normal autopsy; LSA & RSA for arms, LCCA & RCCA for head (clamp ICA's)

Injecting Abdomen & Legs (Thoracic Partial Autopsy) Method 1

Using the thoracic aorta (near diaphragm); Place large cannula down the aorta to embalm abdominal walls, abdominal contents/organs and lower extremities; Clamp off leaks as located (possibly the R & L inferior and superior epigastric arteries); Close thoracic cavity as you would any autopsy; Aspirate abdomen and inject with cavity fluid

Injecting Abdomen & Legs (Thoracic Partial Autopsy) Method 2

Using the RFA artery and 2 cannulas; Inject down RFA to embalm right leg; Inject up RFA to embalm left leg, abdominal walls and abdominal contents/organs; Clamp off the thoracic aorta to stop leaking; Close thoracic cavity as you would any autopsy; Aspirate abdomen and inject with cavity fluid

Injecting the Legs (Abdominal Partial Autopsies)

Abdominal organs are removed; Drainage taken via IVC; Legs are injected via the right and left common iliac arteries (CIA), per normal autopsy protocol.

Injecting Thorax, Upper Extremities and Head (Abdominal Partial Autopsy) Method 1

Inject up the abdominal aorta (inferior to the diaphragm); Clamp leaks if/as necessary to stop fluid loss; Treat abdominal cavity as any autopsy closure; Aspirate the thorax and inject cavity fluid

Injecting Thorax, Upper Extremities and Head (Abdominal Partial Autopsy) Method 2

Raise the RCCA and add 1 cannula up and 1 cannula down; Inject down the RCCA to preserve arms, thorax & left side of the head; Inject up the RCCA to preserve the right side of the face; Clamp leaks if/as necessary to stop fluid loss; Treat abdominal cavity as any autopsy closure; Aspirate the thorax and inject cavity fluid

Partial Autopsies: Cavity Treatment

Whichever cavity has not been opened should be aspirated with a trocar and injected with cavity fluid; The cavity that was autopsied can be painted with gel, hardening compound or hypo injected with arterial fluid; Cotton or sheeting soaked in cavity fluid..if viscera not returned; Close with baseball stitch; Do "final prep" (wash, dry, plastics, etc.); Complete report!