embalm 2 final (8, 10, 15-23)

Tissue recovery must be completed within _____________of death when the deceased has been refrigerated and __________ when there has been no refrigeration

24 hrs

15 hrs

The major difficulty involved with embalming a body with organ donation is _____________________________

Disruptions

The embalmer can anticipate that the organ donor has been given _________________prior to the removal of the organ to prevent the blood from clotting

Heparin

Problems associated with eye enucleation include: (3)

1.) Swelling & Distention

2.) Ecchymosis

3.) Small Lacerations

To help control swelling during embalming an eye enucleation, it is recommended to: (6)

1.) Restricted cervical

2.) No peinjection

3.) Strong arterial solutions

4.) Avoid excessive manipulation

5.) Drain arterial solution from eye

6.) Avoid rapid rates of flow & high injection pressure

With delayed embalming the embalmer can expect:

Problems in achieving __________of arterial solution.

____________ - especially in the neck (parotid glands, submandibular and submaxillary glands) and eyelids.

___________ - break down of proteins increases the sites for attachment of preservative.

an even distribution

swelling

increased preservative demand

Arterial Solution for Delayed Embalming must be:

Stronger than average - _________________ when decomposition is present.

The first half-gallon may be made milder in an attempt to clear blood discolorations, but should be followed by ___________ strength or higher.

The body should be injected _____________________.

_______________ and ____________ may be helpful to distribute fluid to the extremities.

25 index or higher

2.0%

very slowly

pulsation

higher preservatives

Tissue pH is ______________ and arterial fluids work best in this pH range.

slightly alkaline

Rigor begins as soon as the body cannot replenish

ATP (Adenosine Triphosphate)

During the rigor stage, muscle protein is _______________ so fluid does not ___________________ well

contracted

penetrate muscle fibers

The ______________ retards the absorption of preservative during rigor mortis

acid pH

Rigor passes in approximately ___________ following death

36 hrs

Embalming the body after rigor:

The body is in ___________ and needs __________ & ____________

decomposition

strong solution & slow injection

Advantages of Short-term Refrigeration:

Slows the progress of:

Slows:

Maintains blood in a:

Rigor Mortis

Decomposition

Liquid State

A long-term problem of refrigeration is Increased ___________ in the vascular system; increased ___________________

Coagula

Blood Viscosity

Factors that speed the onset of decomposition:

Elevated environmental______

Elevated and retained body _______

High ______________ content in the body

Translocation of ___________________

Heat

Heat

Moisture

Intestinal Bacteria

________ produced in the colon after death reacts with hemoglobin breakdown products to produce the greenish discoloration seen in the bowel.

Hydrogen Sulfide

As the proteins break down, AMINES and MERCAPTANS combine with _________________ and ______________ to produce the odors of decomposition.

Ammonia

Hydrogen Sulfide

_________ can create intense gas accompanied by a very foul odor

Clostridium Perfringes

Nitrogenous products also shift the body pH to a ______________.

Strong Alkalinity

Embalming solutions react best with proteins under ___________ pH conditions.

SLIGHTLY Alkaline

Inject ____________ for a case with decomposition.

Slowly

Pigments that create skin color include: (3)

1.) Melanin (brown, black)

2.) Carotene (yellow)

3.) Hemoglobin (red)

The cellular elements that remain present in the body after death:

Melanin & Carotene

After death the red blood cells which contain the hemoglobin no longer receive a fresh supply of oxygen so their bright red color is diminished. Because of this the deceased is described as having a:

Death Pallor (paleness of the skin)

_________ & ________have a greater influence on the color of the skin than the lost postmortem blood elements

Melanin & Carotene

Antemortem, intravascular blood discolorations include: (3)

1.) Hypostasis

2.) Carbon Monoxide

3.) Capillary Congestion

Carbon monoxide poisoning is a ___________ coloring

Cherry-Red

A small pinpoint skin hemorrhage is:

A large bruise caused by escape of blood into the tissues:

A flat medium-sized hemorrhage beneath the skin surface:

A swollen blood-filled area within the skin:

Petechiae

Ecchymosis

Purpura

Hematoma

Is a postmortem, intravascular discoloration

Livor Mortis

Postmortem stain is a/an:_________________discoloration

Postmortem, Extravascular

Tardieu spots are _____________discolorations

Postmortem, Extravascular

Embalming treatments for livor mortis include: (7)

1.) sectional embalming

2.) continuous drainage

3.) clearing of the nailbeds

4.) elevate head and shoulders

5.) pre-injection or mild solution

6.) carotid artery and internal jugular

7.) raising, massaging, and flexing of limbs

In carbon monoxide deaths, often there is a delay between death and preparation and in this case it becomes an ____________________ condition because of the delay

Intravascular & Antemortem

Embalming treatments for ecchymosis or hematoma of the eye include: (6)

1.) restricted cervical

2.) stronger solution and smaller volume

3.) no pre-injection in the head

4.) cotton with cavity fluid for eye closure

5.) hypodermically inject before embalming

6.) incise or puncture swollen & discolored eyelids

When embalming a gunshot wound, the embalmer can expect: ________________ &______________ of the eye area when injury is to the face or head.

Ecchymosis & Swelling

Embalming treatments for postmortem stain include: (4)

1.) strong arterial solution

2.) minimum embalming solution volume

3.) dye tracer

4.) no-preinjection

When embalming a body with jaundice ________________ takes precedence over clearing of the discolorations

Preservation

Yellow or mild jaundice is often first detected in the:

Sclera (whites) of the eye

An arterial fluid used for clearing jaundice:

Jaundice Fluid

The reaction that changes bilirubin to biliverdin:

Oxidation

A sign of chronic renal failure is a:

"Sallow Yellow color" or Bronzing of skin

The discoloration of the skin resulting from renal failure is due to:

Urochrome

Ammonia in the tissues and blood resulting from renal failure neutralizes the HCHO to:

Urotropin

If a body with renal failure has been dead for a long period, gangrene is present, or there is heavy clotting and ischemic necrosis is present, the embalmer should:

Be cautious regarding preinjection

Measures to prevent "Formaldehyde Gray" include: (3)

1.) drainage

2.) heart aspiration

3.) elevate head & shoulders

Formaldehyde Gray can be corrected by:

Opaque Cosmetics

Treatment for "razor burn" would include: (3)

1.) light layer of cream cosmetics (prevent drying)

2.) cream cosmetics

3.) allow browning & apply opaque cosmetics

Treatment for "Scaling Skin" would include:

Remove loose skin

Decomposition discoloration is first seen as a:

Green discoloration in right inguinal area

In decomposition, the skeletal tissues change from

Yellow to Green to Blue-Black to Black

The marbling of the veins in decomposition discoloration can be:

Bleached with external compresses

Treatments for abrasions include: (3)

1.) do not apply massage cream to abrasions

2.) dry tissues

3.) use surface compresses

Treatment for blisters includes: (4)

1.) lance & drain

2.) remove damaged skin

3.) cauterize

4.) dry

Treatments for desquamation include: (8)

1.) apply topical disinfectant

2.) open and drain vesicles

3.) remove loose skin

4.) apply surface compresses

5.) sectional embalming

6.) hypodermic embalming

7.) clean away preservative chemicals

8.) dry the area

Treatments for pustular and ulcerative lesions include: (5)

1.) disinfect the surface of the lesions

2.) open and drain lesion

3.) embalm the body

4.) hypodermic embalm or surface compress

5.) dry the area

Decubitus ulcers are:

bedsores

To control the odor of decubitus ulcers:

Embalming Powders

Treatments for hangings and strangulation include: (4)

1.) restricted cervical injection

2.) no preinjection

3.) medium to strong arterial solution

4.) treat rope abrasions on neck

When treating bodies for poisoning, the first concern should be

Preservation

The blistering of 2nd degree burns are rarely seen because

They are usually opened & drained prior to death

The concern with embalming burned bodies is

The systemic effects of kidney failure and generalized edema causing a very high preservative demand

Treatments for burned bodies include: (8)

1.) strong or waterless arterial fluid

2.) dye as tracer

3.) multipoint injection

4.) remove loose skin

5.) apply surface compresses

6.) paint visible areas with autopsy gels

7.) clean skin with solvent

8.) dry

A major objective when treating burned bodies is:

Dry & clean for cosmetic work

If a body with a gunshot wound to the head has not been autopsied, the embalmer may expect:

Brain fluid purge

Pre-embalming treatments for a gunshot wound to the head would include: (6)

1.) clean & disinfect

2.) pack entry & exit wound

3.) apply massage cream

4.) align fractured bones

5.) temporary bridge sutures

6.) apply compresses

Treatments for arterial injection of a gunshot wound to the head would include: (4)

1.) strong solution for head

2.) restricted cervical injection

3.) use instant tissue fixation

4.) hypodermic embalming

Treatment for exsanguinations would include: (3)

1.) strong arterial solution with dye

2.) sectional embalming

3.) hypodermically inject trunk & body walls

For Dehydration:

1. Follow the dilution recommendations by the manufacturer. Strengths of ________________ will add moisture.

.75% to 1.5%

For Dehydration:

2. Use _________________ drainage which will help to distribute and diffuse the arterial fluid.

Intermittent

For Dehydration:

3. ______________________ - better distributes and less tissue fluid is withdrawn.

Slower Injection

For Dehydration:

4. If refrigerating before embalming - cover with a _________________________ to prevent dehydration of surface tissues.

Plastic Sheet

For Dehydration:

5. Use ___________________________ cotton to set the features.

Non-Absorbent

For Dehydration:

6. Warm water solutions increase fluid reaction. ________________________________ slow the formaldehyde reaction and allows for better distribution and diffusion.

Cool Solution

For Dehydration:

7. After embalming - ___________________________________ to prevent circulating air from dehydrating the surface.

Cover the Body

For Dehydration:

8. ______________________________________ helps to reduce moisture loss to the atmosphere.

Massage Cream & Cream Cosmetics

For Dehydration:

9. If there is a long delay between embalming and viewing, do not excessively __________________________________ during storage because the liquids will gravitate AWAY from the facial tissues.

Elevate the Head

For Dehydration:

10. Using too much ___________________ can have the opposite effect of drying the tissues.

Humectant

Desiccated lips, eyelids, or fingertips - May need correction with ________, __________, and _______

wax

tissue building

opaque cosmetics

Dehydration of large facial areas from embalming and air flow over the body - Use massage cream before cosmetics application; ______________ may be needed to cover discolorations; may need ________________.

opaque cosmetics

tissue builder

___________ - is extreme dehydration. These type of bodies are _______________

Desiccation

Not Viewable

________ - the abnormal collection of fluid in tissue spaces, serous cavities, or both.

Edema

______ Edema - within the cells; must be excised for reduction (but this is not recommended). Could be caused by an allergic reaction or extended use of corticosteroids.

Solid

________ Edema - between the cells; may be moved by gravity or punctured and drained; use strong arterial solution; hypodermic and surface embalming; and plastic garments.

Pitting

Pulmonary Edema - in the ______________ of the lungs; creates purge; aspiration and injection of the lungs.

Alveoli

Embalming Complications Associated With Renal Failure:

1.) The body appears _____________ (an unhealthy yellow or brown color) because of the altered reaction between the proteins and the preservative.

2.) __________ in the blood and tissues neutralize preservatives.

3.) Skin infections may be caused by uremic ___________

Sallow

Uremic Wates

Purities

For burned bodies, waterless or ___________ with __________ should be used.

very strong arterial solution

added dye

At the capillaries, some of the arterial solution will leave the vascular system to enter the interstitial spaces, where it will come into contact with the ___________ and _____________.

body cells

cellular proteins

Arteries have 3 layers:

1. _________________ - the inner lining of endothelial cells which lines the entire blood vascular system and composes the walls of the capillaries.

2. _________________ - the middle layer composed of muscle cells and elastic tissue.

3. _________________ - the outer layer, composed mostly of connective tissue.

1.) Intima

2.) Media

3.) Adventitia

(Arteries have I.M.A.)

In the United States, one in every _______ deaths is attributable to ____________ disease.

two

cardiovascular disease

Embalming treatments for arteriosclerosis:

Increase the ___________of the solution.

Use a _________ chemical to aid in distribution.

Begin injection using a ___________ rate of flow.

When multipoint is required, use ____________ and ______________.

_____________ and ________________ to aid distribution.

Use the _____________ and _____________ for the initial injection & drainage.

strength

coinjection

very slow

higher pressure & pulsation / lower hands over the table & gently massage

common carotid & internal jugular

A ruptured aortic aneurysm can seriously affect _______________ in the un-autopsied body.

fluid distribution

Embalming treatments for ruptured aortic aneurysm:

- Use a ___________ arterial solution with additional dye as tracer.

- Inject ___________.

- If there is drainage, _______________.

- If there is no drainage and the abdomen begins to swell, ______________ the injection and institute _________________.

- If surgical repair of the vessel was performed, ____________ can often accompany this repair.

strong

slowly

continue to inject

stop / multipoint injection

extreme facial edema

The volume and pressure created by the fluid from the heart and the fluid from the bronchial arteries may cause ____________

Lung Purge

Frequently after a Cerebrovascular Accident (CVA; Stroke); the vessels on one side of the body may undergo _________________.

In an effort to supply more ___________ to the tissues in life, the vessels on the opposite side of the body have undergone ____________.

_____________ injection may be necessary, but in most bodies injection of a sufficient quantity of solution should overcome the problem.

vasoconstriction

oxygen / vasodilation

multisite

In the case of arterial coagula, use the _________________ as the primary injection point to push coagula toward the legs.

___________________ injection of the legs may be necessary.

Common Carotid

Multipoint

What is more of a problem, arterial or venous coagula?

Arterial

For venous coagula, use the_____________ vein for drainage because coagula in the right atrium can be removed with angular spring forceps.

Right Internal Jugular

Rigor mortis is an EXTRAVASCULAR RESISTANCE, it can be relieved with:

manipulation

In cases of EXTRAVASCULAR RESISTANCE, ____________ injection pressure may be needed to promote distribution.

Higher