embalming quiz 5

Obesity challenges

Transportation, removal difficulty (can enlist help from fire dept, police, EMTs)

Obese body transportation

Bariatric gurney/stretcher (doesn’t fold), holds up to 1000 lbs. 7 positions, 29 inches wide

Movers for obese bodies

Smooth movers, bariatric transfer sheet (700-900 lbs capacity)

Obese body positioning

Shoulders high off the table and supported, keep head at highest point to prevent purge but may need to be dropped back to access arteries. Keep elbows as close to body wall as possible, tie arms into position if needed

Best vessel for obese cases

Right common carotid because it is larger and easier to access, right internal jugular for drainage. femoral is too deep with lots of adipose in the way

Drainage for obese cases

Use drainage forceps instead of drain tube bc of shorter neck. Use ones curved away from neck bc long straight ones may leave a mark

Obese case fluid

Need large volume of fluid. slightly stronger than average even higher if there is edema.

Fluid distribution for obese cases

Massage, manipulation, and intermittent drainage. If legs don’t receive fluid, use external iliac

Two mains complications of obese cases

Purge and gas

Cavity embalming for obese cases

May need to use 2 trocar aspiration/injection points, use traditional amount or a little more (1.5 up, 1.5 down)

Clothing for obese cases

Cut and tuck when in casket depending on body size

Post embalming body transfer

Mortuary body lift (1000 lbs max), but has height and width limits

Decomposition

Process where complex organic compounds are broken down into simple substances, through the action of microbial or autolytic enzymes

What are the five types of decomposition?

Proteolysis, autolysis, lipolysis, fermentation, and saccharolytic

Proteolysis

Process of breaking down proteins into smaller peptides or amino acids

Autolysis

Breakdown of self by self on its own enzymes

Lipolysis

Breakdown of stored fats (triglycerides) into glycerol and free fatty acids

Fermentation

The anaerobic breakdown of carbs like glucose into simpler molecules, like organic acids and alcohols

Saccharolytic

Sugar breakdown

What are the five signs of decomposition?

Color, purge, gas, odor, skin slip

Color

Green discoloration in the right lower quadrant of the abdomen. Large intestine will be defined. can be seen up to the neck and chin. There can also be vascular marbling in superficial vessels. Also postmortem staining, especially concerning if face down.

Purge

Putrefactive body fluids become forced out of body orifices.

Gas

Produced by microbial activity during the decomp of solid waste. If clostridium perfringens (tissue gas) causes gas you can expect blistering, stomach, purge, and rectal purge. Heat and humidity can cause gas production, gas will cause bloat and swelling and eyes and tongue will protrude.

Odor

As autolysis and petrifaction occur, their products will emit a foul odor (cadaverine and putrescine). Clostridium perfringens can cause a pungent odor

Skin slip

On limbs and face

extrinsic factors of decomp

Temperature, moisture and humidity, dry air, access of air, animal activity and bugs, pressure, and bacteria

Intrinsic factors of decomp

Internal moisture, fibril diseases like infections, gas gangrene/moist gangrene, internal bacteria

Mode of death effecting decomp

Drowning, suicide, accidental death trauma

Order of tissue decomposition

1. Liquid tissue: blood and lymph

2. Soft tissues: parenchyma of organs

3. Firm tissues: muscle and stroma of organs

4. Hard tissues: cartilage and bone

Five stages of decomposition

1. Fresh, 1-2 days

2. Bloated, 2-6 days

3. Decay, 5-11 days

4. Post decay, 10-25 days

5. Dry, 25+ days

Color complications of decomp cases

Green discoloration, petechia (can be bleached), post mortem stain / hemolysis if found face down

Gas complication controls

• Stop bacteria and clostridium perfringens with cavity work

• Relieve gas in abdomen w puncturing

• Continuous drainage relieves distention

• Use air/water collars on face and hands if swelling persists

Desquamation/skin slip controls

• Spray area w dis spray or tri san

• Saturate cotton w cauterant like Dryene

Maggots

Potential issue with bodies found outside in 50+ degree weather

Overall decomp complications

Poor distribution and drainage, swelling and distention, ammonia and nitrogenous products that raise the preservative demand

Cannizzaro's reaction

Lack of cross linking in proteins. Causes poor tissue fixation because of protein breakdown.

Protocols for embalming decomp

Multipoint or restricted cervical injection for face distention. Use a strong solution or near anhydrous arterial injection, or waterless. Hypodermic injection. Perfuming agents or kitty litter for odor. Use cauterant or drying agent before waxing and cosmetizing so that the wax and makeup will stick.