Embalming 3 week 2

aids to achieve better distribution of fluid

manual aids, mechanical aids, operative aid

manual aids

physically moving body parts

mechanical aids

using instruments

operative aids

channeling, wicking, incising, excising

conditions predisposing to decomp

• Edema -Peritonitis -Burns (second degree) -Gangrene

• Trauma -advanced pregnancy -febrile cases -septicemia

• Drowning -corpulence -renal failure -post-surgical bodies

  • Tissue gas

edema

• Abnormal accumulation of fluids in tissues or body cavities

  • Types

    • Intracellular - within the cells

    • Intercellular - within the spaces of the cells

      • Within the body cavities

peritonitis

• Inflammation (itis) of the peritoneum (perito-) aka lining of the abdomen

  • Caused by leakage in intestines, i.e burst appendix or a hole in the colon

1st and 2nd degree burns

• First degree

  • Superficial 

  • Affects the epidermal (top) layer

  • Sun burn

• Second degree

  • Deep

  • Affects the posterior dermal layer

    • Skin blisters may develop (fluid) 

3rd degree and 4th degree burns types

• Third degree

  • Full thickness

  • Destruction of both epidermal/dermal layers

  • Tissues are black,brown, white or yellow

  • May appear charred

  • Hair follicles and glandular inclusions are destroyed

• Fourth degree

  • Most severe 

  • Destroys all layers of skin

  • Possibly involves muscle/bone

    • Nerve endings are destroyed 

wet gangrene

• Caused by venous obstruction

  • Infected tissues appear bright reddish to black

dry gangrene

• Caused by arterial insufficiency 

  • Appear reddish to black 

trauma to decedent

• Trauma is often accompanied by bruising which leads to a higher moisture content in the tissue. High moisture content is the embalmer’s enemy and one of the decomposition’s dearest friends

advanced pregnancy

• Swollen feet + added moisture

  • Added moisture from the contents of the uterus

febrile cases

• A disease or condition accompanied by an elevation of body temperature

  • Added temps leads to added moisture, meaning DECOMP

septicemia

condition known by the presence of bacteria in the blood (speeds decomp)

drowning and corpulence (obesity)

• More than likely a prolonged time in water, leading to added moisture and decomposition 

• Fat cells are wet 

  • More fat cells with predispose to decomp

renal failure

• Kidneys help to filter out fluids

• Kidney failure can lead to added fluid

  • Added fluid leads to decomp

post surgical bodies

• Probably not completely closed (if death occurred during surgery)

  • Open bodies can lead to decomp

• Possible added delays by postmortem exams

  • Can be infected with clostridium perfringens (tissue gas)

tissue gas

• Postmortem formation of gas associated with anaerobic gas forming bacilli; most commonly clostridium perfringens

• Conditions predisposing

  • Recent abdominal surgery

  • Presence of gangrene at time of death

  • Intestinal ulcerations or perforations

  • Contaminated skin wounds or punctures

  • Intestinal obstructions or hemorrhage

  • Unsatisfactory embalming 

    • Contact with contaminated instruments 

chemicals to treat decomp cases

• Moderate to strong fluid

• Coinjection fluids (edemaco) 

• First half gallon can be less strong to clear blood discolorations

  • Hypertonic solution  (2.0%) can follow

  • Draw out extra fluid

• Waterless solutions can be useful! 

mechanical and manual aids

• Pressure and rate of flow

• Massage

  • Relieve rigor 

controlled injection/drainage for decomp cases

• Sectional / 6 point injection 

  • Controls when and where the pressure is going

  • Higher pressure can be applied to the limbs and lower the face

• Restricted cervical injection

  • Raising both carotids

  • Clamping one off to control injection to face/head

    • Allows to aspirate body before injecting head 

sectional hypodermic injection for decomp cases

• If there has been no fluid distribution to a limb and you have raised everything you can raise, you can hypodermically inject that limb 

treatment of bodies where decomp is present part 1

• Step 1 - Evaluate

  • How much decomp is present?

  • Is there an insect presence?

  • Abdominal gases?

  • Desquamation?

  • What is the state of the facial orifices?

• Insect eggs/larvae presence

  • Pour disinfectant spray in orifices

  • Pack orifices with saturated cotton

  • Remove and replace cotton 

  • To prevent larvae from being deposited by flies it’s important to pack the nose and ears. Make sure that the mouth has a firm line of closure

• Abdominal gases

  • Build up from bacteria

  • Conditions favorite heat and humidity (bloat) 

  • Can cause

    • Bloating and swelling

    • Protrusion of tongue and eyes

    • Distention of male penis

  • Can create lung, stomach, and purges

  • Treatments include

    • Max index fluid (36% index)

    • No preinjection

    • Additional die

    • 6 point injection/restricted cervical

    • Little to no drainage expected

    • Aspirate after injection and inject cavity fluid

    • Expect to aspirate 

  • Abdomen distended tightly prior to injection

    • Introduce trocar before embalming

      • DO NOT FULLY ASPIRATE - only keep the trocar just beneath the anterior wall to relieve pressure

treatment of bodies where decomp is present part 2

• Body Orifices

  • Leakages will be expected

    • Pack, pack, pack

  • Prior to embalming

    • Nasal aspirator can be used to eliminate initial fluids

    • Dry mouth and nose as much as possible

    • Set features

  • During embalming

    • Expect purge

    • Keep water running as you inject

    • Don’t let purge sit on the face for too long because of possibly bleaching the face

  • After embalming

    • Nasal aspirator again

    • Pack with cotton

    • Before dressing, remove and replace cotton, possible reaspiration

      • Anal and vaginal leakage may require packing as well 

Chemicals when decomposition is present

• Max index fluid (36%+)

• Advanced decomp may prevent viewing

  • Embalming for preservation only 

  • Arteries are the last structure to decompose

  • No drainage expected

  • Treat body surfaces with autopsy gel (phenol based), preservative and drying powders

  • Wrap in sheets

  • Transfer to a disaster pouch, which is a heavy-duty body bag

• Cavity injection

  • Large volume to ensure drying to viscera and control odors/leakage

  • Hypodermic injection may be necessary 

PPE

• Respirator

• Face mask

• Gowns

  • Gloves - double 

preservation for decomp cases

• Sectional treatment

  • Ensures added preservation in each section

• Hypodermic and surface treatments

  • Mold inhibiting agents

• Avoiding dehydration

  • Add fluids to inhibit dehydration

  • Restorative 

• Inhibitor fluid

  • TOPICAL USE ONLY

  • Lacks in tissue moisture on delayed disposition 

  • Keeps skin surfaces hydrated

  • Prevents dessication of fluid and hands

  • Prohibits mold growth

    • Stabilizes surface tissue for long-term holds

post embalming changes

• Apply and reapply massage cream to avoid dehydration

• Delay cavity treatment

• Delay cosmetic treatment

• Tissue building 

treatment of body during storage

• Head and shoulder elevation

• Air circulation around body

• Monitor body for changes and treat as necessary

• Apply and reapply mold inhibitor

  • Dress just prior to viewing 

post embalming monitoring

• Observe and treat as encountered

  • Eye and mouth separators

  • softening/darkening of tissues

  • Presence of gas

  • Dehydration of fingertips of features

    • Insect infestation 

treatment of bodies in disasters

• High volumes

• Supplement normal injection to slow decomp

  • Hypodermic injection

  • Surface treatments

    • Plastic garments 

treatments with no vascular injection

• aspirate/inject cavities

• Hypodermically inject

• Wrap body

• Preservative powder

• Plastic sheeting

• Disaster pouch

  • ID on the pouch 

waterless embalming

• Injection a solution of arterial chemical mixed with coinjection with NO tap water added. The combination allows the solution to penetrate more evenly into tissue for superior embalming results. 

• Ideal for cases

  • Advanced putrefaction/tissue gas

  • Stops decomposition immediately 

    • Very effective for through embalming the delayed disposition case that we don’t want to dehydrate or overfirm 

metaflow

coinjection that disperses arterial obstacles and stimulates drainage, it helps increase the removal of waste products left by chemo drugs

rectifiant

- neutralizes the adverse embalming effects of chemicals found in the water supply and dissolved in the body fluids. 

restorative

(humectant) it restores the hydration layer on emaciated cells. It improves the appearances of facial features and can restore characteristic expressions. It’s used in all cases except edema ones. 

normal cases for waterless embalming

• Normal cases - possibly delayed disposition

  • 1 bottle arterial

  • 4 bottles metaflow

  • 4 bottles rectifiant

  • 1 bottle restorative

    • Repeat as needed

      • A restricted cervical injection, using both carotid arteries is recommended for all cases.

moderately difficult case

• - chemotherapy, autopsied, some putrefaction, or dead a few days

  • 2 bottles arterial

  • 4 bottles metaflow

  • 4 bottle of rectifiant

    • Repeat as needed

very difficult cases

• advanced putrefaction, gas gangrene, skin slip, heavy chemo

  • 3 bottles arterial

  • 3 bottles of metaflow

  • 3 bottles rectifiant 

    • Repeat as needed

      • Edema - same guidelines as VERY DIFFICULT cases with addition of 1 and ½ bottles of edemaco

extreme edema cases

•  use for whatever body parts show extreme edematous tissue - the head, one side of the head, an arm/leg, trunk, sidewalls. The remainder of the body can be treated with a very strong solution of the waterless solution used for the difficult cases

  • 1 or 2 bottles of introfiant

  • 1 bottle of metasyn

  • 1 bottle of rectifiant

  • 1 or ½ bottle of edema co