Embalming Theory II

What is an autopsy?

the postmortem examination of the dead human body

What does a medical autopsy require that a medicolegal autopsy doesnt?

family consent

What are different manners of death?

natural, accident, suicide, homicide, and undetermined

What is used to ID a body?

visual ID, dental, DNA

What are the kinds of unnatural death?

accident, suicide, homicide

What are the guidelines for when autopsies should be performed?

homicides, workplace deaths, children under a certain age, and incarceration deaths

What is the suggested order of operation for autopsy cases?

disinfection, shave & set features, remove sutures & viscera, mix fluids(apply case analysis), inject at proper rates and pressure, and supplemental treatments and drainage when needed then suture and close

What is phenol used for?

dry and cauterizing the area

Why would you use a stronger solution strength?

delayed embalming and more trauma

Where do you start your embalming and where do you end at?

from legs to arms to head

What are some supplemental treatments for autopsies?

hypo-inject sidewalls, flabs, shoulders, neck (with topical gels or sprays)

What parts of an autopsy case are the most likely to leak?

shoulders & behind the ears (lowest point of liquid)

What is the first choice when embalming the legs of an autopsy case?

the common liliacs

What do the external iliacs feed into?

the legs

What do internal iliacs feed into?

the buttocks, perineal, and anal tissues

Why should drainage be removed via postmortem aspirator?

prevent HCHO exposure

What should you do is the vessels in the leg were sclerotic (hardened/thickening)?

hypodermic treatments

How many gallons should be injected into the legs?

.5 - 2 gallons

What is the first option you should use to inject upper extremities? if not what is the next

the arch of aorta, if not do the left side first (carotid/subclavian)

Why are subclavian arteries injected?

distribution to arms

Why must you set features before subclavian injection?

you get collateral circulation to the head (vertebral)

What must you dissect through to get to axillaries?

pectoralis major muscle

What do you inject when the common carotids are unavailable?

external carotids

What must you remember to do when injecting the head?

clamp off internal carotids

What tool is used to inject cavity sidewalls and flaps?

a hypo-valve trocar

What is the minimum amount of cavity fluid used for viscera in a bag?

32 oz of cavity fluid

When should viscera treatment be started?

at the end, (more practically at the beginning)

what type of ligate should you use?

#5 twist ligate

Why is a posterior neck incision done?

to determine if the neck was borken or for any muscle damage

What is the biggest problem with posterior neck incision?

leaking!!!

How do you prevent posterior neck incision from leaking?

Baseball suture, putty/drying incision powder, glue and cotton (have a cranial cap absorbant behind the head incase)

How do you embalm a cranial autopsy?

restricted cervical injection (control of the head going in from left side)

How do you clamp off the LCCA for restricted cervical?

cannula up the LCCA, tie off the lower portion

How does a femoral injection work?

cannula down the right leg then up (more likely to clot)

How do you treat thoraicic autopsy cases?

injecting arms (subclavian), head(carotids), abdomen/legs(thoracic aorta and asporate) w/ drainage from superior vena cava

Why do we clamp off leaks?

pressure, so it gets into capillaries

How do you treat an abdominal autopsy?

drainage from inferior vena cava; injections in common iliacs, abdominal aorta, RCCA (aspirate thoracic)

How do you cavity treat a partial autopsies?

hypo injection, hardening compoound, cotton soaked in cavity fluid, baseball suture

What are potential problems for organ/tissue remains?

Delay, compromised vascular system, adequate preservation, leaking

What does a donation mean for the embalmer?

more time, work, knowledge, materials, liability

What tissues are donated?

skin, bone, connective tissue, heart valves, tendons, veins, corneas

What organs are donated?

heart, lungs, kidneys, pancreas, liver, intestine

What is external access when selecting vessels?

making incisions and raising vessels through those incision sites

What is internal access when selecting vessels?

utilize existing procurement site incisions for locating, raising, and injecting vessels available to us

What is a thoracic cavity midline incision?

runs from base of the neck to the bottom of the sternum (retrieves heart and lungs)

What is an abdominal cavity midline incision?

runs from base of sternum to the pubic bone (retrieve liver, kidney, pancreas, intestines, etc)

What is a full recovery midline incision?

runs from base of the neck to the pubic bone (retrieve both abdominal and thoracic organs)

how do blood thinners effect embalmers?

better drainage, but lividity and post mortem stain occurs more quickly

What are some problems an embalmer might face with eye enucleation?

potential swelling, ecchymosis, and lacerations of the lateral eye

How to control swelling for eye donors?

restricted cervical, avoid pre-injection, strong solution, low rate of pressure and flow, allowing fluids to run out of the eye, cold compress

How to close an eye donor post embalming?

remove packing, add incision seal(cauterize), insert cotton/putty, stretch upperlid over eye cap and check if they are at a good height

What are the advantages of an anterior incision recovery for the vertebral body? disadvantages?

less leaks, internal vessels can be injected and viscera in correct position; the aorta is cut in two places and more rigidity

What are the advantages of a posterior incision revoery for the vertebral body? disadvantage?

vasculature is not disrupted, and can embalm normally; Leaking! and rigidity

What is the instrument used to remove skin for donation?

a dermatone

What is the main issue with skin donors? how do you fix it?

weeping or leaking; treat areas with phenol, autopsy gel, cavity fluid, etc (elevating bodies to help dry them out)

What are the common area for partial skin removal?

back, thighs, calves

Long bone conation can include what removed?

Leg (femur, Tibia, Fibula, Hemipelvis); Arm (Proximal Humerus, scapular)

What are some real complications/considerations for long bone donation?

time-consuming, requires alof of fluid and material, strong fluid due to delay

What is the open internal approach to long bone donors?

remove suture, locate arteries, hypodermic treatment of muscular tissue, cauterize, and supplemental techniques

What is the free flow method approach to long bone donors?

leave sutures in place, injecting via illiacs (osmosis embalm for a bit); make small holes in the ankles to relieve any fluid, surface glue sutures and cotton (have stockings/plastics with absorbant powders)

What is the saturated packing method approach to long bone donors?

saturate absorbant packing which is placed inside and then closed

What is different about proximal humerus in long bone donation?

no real reason for arteries to be disrupted(tho they often are); add hardening compounds and perservative powder)

When/how often are mandibles recovered?

not recovered often; not really viewed, (consequences in embalming and RA)

What do you need to know about rib recovery?

same incision as vascular organ recovery, every other rib is removed, and intercostal arteries can be disrupted (leaking!!)

What do you need to know about middle ear or temporal bone donors?

internal approach normally done after embalming, but can be done during or after autopsy (normally shouldnt pose a circulatory problem; the external approach leads to not alot of fluids to the upper head

What are the 6 discolorations that can be identified?

blood(intra/extra), drug/therapeutic, pathological, surface coloring agents, reactions to embalming chemicals, and decomp

What can be mistaken for jaundice?

build up of nitrogenous waste

How does gangrene effect coloration?

wet is a deep green/black; dry is more dark brown to black

What is jaundice also called?

icterus

What bile pigment amount indicates jaundice?

1.5 mg of bilirubin (starts to turn yellow)

What are the considerations for a jaundice bodies?

restricted cervical, with focus on the viewable areas, water conditioner(balance pH)

What converts bilirubin to biliverdin?

acidic environment and the oxidation

What are the 6 methods for treating jaundice?

jaundice fluid, preinject solution, mild arterial solution w/ dye, cavity fluids, bleaching coinject, relative counterstaining

What are the pros and cons for jaundice fluid?

specifically designed for treatment, can add more dyes; con - low formaldehyde = poor preservation (would need to reinject)

What are the pros and cons for pre-injection in jaundice cases?

“washes out” as much discoloration as possible, with dye to counterstiain; con- requires alot of solution which can make swelling

What is the problem with using cavity fluid as an arterial solution?

it ruins the machine, but it could be a bit useful for mild jaundice cases

What are the pros and cons of coinjecting for jaundice?

bleaches multiple discolorations, adds dye and preservative, good for mild jaundice only

What is the advantages of counterstaining for jaundice cases?

has proper preservation, considers the true stain theory, treats even extreme cases, more natural end result thats solid (can end up green)

What kind of treatment is needed for renal failure discolorations?

strong solution, with dye, a proper co-injection, with good distribution

what are antemortem discolorations?

discolorations that are present in life and remain after death

what are postmortem discolorations?

discolorations that occur after death

What are intravascular discolorations?

PM physical change that is sped up by refriferation; can be cleared by injection, it blanches with pressure

What does not respong to arterial injections?

ecchymosis, purpura, petechia, pm stain

How do you treat ecchymosis?

injection with phenol or cavity solution to have a better cosmetic experience, (can distend); also surface embalming application (set for 2hrs ish)

What is the treatment of a postmortem stain?

a strong solution with a minimum amount of volume to avoid distension (use dye to mask the gray hue, avoid preinjection

How can you treat surface discolorations (like blood, adhesive, stains, grease)?

soap and water; or acetone (mold can be scrapped off and treated with phenol or methanol/acetic acid)

How to treate razor burns?

thin layer of massage cream to ease darkening; wax over the area and apply cosmetics

how to treat abrasion discolorations?

let them dry out and treat with arterial fluid; massage cream in unaffected area, cphenol can be applied later

How to treat finger tips?

injecting tissue builder into the fingers Post embalming

How do you treat leatherized lips?

rehydrate the lips, wax over, or in the most extreme cases excise and do a wax restoration

how do you treat HCHO gray?

6hrs after embalming (stronger embalming fluid); aspiration and elevation should lessen effects; with active dye for internal cosmetic affect

What is flushing?

when arterial fluid is distributed but is blocked

What leads to formaldehyde fluid burn?

remains with delay and some of the capillaries have been broken

How do you treat hangings?

restricted cervical is the best option while avoiding pre-injection and large volume due to protrusions and facial discoloration

how do you treat burned bodies?

high preservation demands(infection, kidney failure, blood flow), normally with less to little blistering and circulation problems

How do you treat carbon monoxide poisoning?

prepare them right away to get rid of intravascular discoloration, may use dye and cosmetics if it becomes a PM stain

What is the vascular system?

the route of delivery for embalming solutions

What are the layers of arteries

the 3 tunics; intimae, media, adventitia

What is lumen?

the opening or cavity in the vessel

What is arteriosclerosis?

artery becomes narrow due to plaque buildup