Comps Embalming Listing Questions

Methods of stimulating distribution & drainage

Pressure

Massage

Instruments

Pre-injection

Alternative drainage site

Increase ROF

Considerations for selection of an artery

Superficial/Deep

Posing problems

Surrounding structures

Visibility

Prox. to Aorta

Size

Draining access vein

Advantages of Refrigeration

Rigor slowed

Decomp slowed

Low Blood Viscosity

Signs of Decomposition

Color

Odor

Purge

Gas

Skin Slip (Desquamation)

Major factors in a pre-emb. analysis

General Intrinsic Conditions

Effects of Drugs

Effects of Disease

Postmortem Changes

Advantages of the use of the restricted cervical injection

Decrease Swelling

Instant Fixation

Separate Solutions

Different ROF

Problems that may be encountered in the preparation in intense rigor

Positioning

False sense of preservation

Features hard to set

Poor distribution & drainage

Tissue Swelling

May not firm

Index

the number of grams of pure Formaldehyde gas dissolved in 100ml of water. Index usually refers to a percentage

an index of 25 usually contains 25% formaldehyde gas/ an index of 18 would indicate 18% HCHO

An embalming fluid with ____________________ (whatever the index is – that is the percentage of HCHO in the arterial fluid

I x A = S x V

Index x Amount of fluid = Strength of solution x Total volume

How much arterial fluid is needed to prepare a 1 gallon solution of 2% strength using a 25 index fluid?

I x A = S x V

25 x x = 2% x 1 gal. or (128 oz.)

25x = 256 oz.

x = 256 oz.

25

x = 10.2 oz. of arterial fluid

Approximately 10 oz. of arterial fluid & 118 oz. of water would be needed to make 1 gallon of 2% strength. (118 oz + 10 oz = 128 oz.)

What is the strength of the arterial solution when 7oz. of 25 index arterial fluid and 1 gallon of water are used.

I x A = S x V

25 x 7oz. = x x 135 (128 oz. water + 7oz. of fluid)

25 x 7 = 135 x x

175 = 135x

175 = 135 x

135 135

x = 175

135

x = 1.29% or 1.3% strength of solution

In order to obtain a 3% dilution of a 20 index arterial fluid, you would use:

A. 16 oz arterial fluid 90 oz of H20

B. 19 oz arterial fluid 109 oz of H20

C. 8 oz arterial fluid 128 oz of H20

D. 24 oz arterial fluid 104 oz of H20

I x A = S x V

20 x X = 3% x 128 oz

20X = 384

20X = 384

20 20

X = 19.2 oz arterial fluid (round to 19 oz.)

128 oz – 19 oz = 109 oz H20 added

2% dilution of 25 index

A. 8 oz arterial fluid 120 oz H20

B. 10 oz arterial fluid 118 oz. H20

C. 16 oz arterial fluid 112 oz. H20

D. 20 oz arterial fluid 108 oz. H20

2% dilution of 20 index

A. 10 oz arterial fluid 118 oz. H20

B. 13 oz arterial fluid 115 oz. H20

C. 17 oz arterial fluid 111 oz. H20

D. 21 oz arterial fluid 107 oz. H20

3% dilution of 20 index

A. 16 oz arterial fluid 90 oz of H20

B. 19 oz arterial fluid 109 oz of H20

C. 8 oz arterial fluid 128 oz of H20

D. 24 oz arterial fluid 104 oz of H20

3% dilution of 25 index

A. 6 oz. arterial fluid 122 oz of H20

B. 8 oz. arterial fluid 120 oz of H20

C. 13 oz. arterial fluid 115 oz of H20

D. 15 oz. arterial fluid 113 oz of H20

Determine the strength of the solution when 10 oz of a 20 index fluid is added to a full gallon of H20

A. 1.4%

B. 2.8%

C. 3.6%

D. 4.2%

(I x A = S x V) 30 x = 2 x 128 oz.

Given a 30 index fluid, 8.5 ounces of fluid is needed to make 1 gallon of 2% solution.

(I x A = S x V) 30 x = 1.5 x 256 oz.

Given a 30 index fluid, 12.8 ounces of fluid is needed to make 2 gallons of 1½% solution?

How many ounces of formaldehyde are contained in a 16 ounce bottle of 25 index arterial fluid:

4 ounces ( 16 x .25 = 4) the index is the percentage of HCHO in the arterial fluid.

If the index is 25, then 25% of the 16 ounces is HCHO

If the index is 20, then 20% of the bottle is formaldehyde gas.

The index gives the amount of formaldehyde in in the arterial fluid.

Strength of arterial fluids

Low index 5 – 15

Medium index 16 – 25

Strong index 26 – 36

Points of Natural Expression

Five arcs in the line of upper lip

Protrusion of the upper lip

Natural facial lines

Corners of the mouth slightly raised

cannot tell a family that a body has to be embalmed

The FTC states that you __________________ if it does not.

soap and water

In the pre-embalming period wash the body with

soap and water

In the pre-embalming period, the fingernails should be cleansed with

topical disinfectant

In the pre-embalming period, always use a

Chemical changes

Decomposition

Rigor Mortis

Postmortem Stain

pH changes

Postmortem Caloricity

Physical Changes

Hypostasis

Algor Mortis

Dehydration

Livor Mortis

Endogenous invasion of microbes

Increase in blood viscosity

Chemical

Is decomposition a physical or chemical change?

Chemical

Is rigor mortis a physical or chemical change?

Physical

Is livor mortis (cadaveric lividity) a physical or chemical change?

Physical

Is hypostasis a physical or chemical change?

it is the pooling of blood to the dependent areas that results in liver mortis)

0.5 ppm / 8 hours

Action Level is:

0.75 ppm / 8 hours

Permissible Exposure Limit (PEL) or (TWA) is

2 ppm / 15 minutes

Short-term Exposure Level is:

6 months; 12 months; 15 working days

If the HCHO level is above the PEL, the funeral home will have to retest every ________ and for the STEL (short term exposure level) they will have to retest every ________

The results of a formaldehyde test must be given to employees -within ________

annually

Backflow testing for the funeral home is done:

Stomach

Direct trocar point toward the intersection of the fifth intercostal space and the left mid axillary line; continue until the trocar enters the stomach.

Cecum

Direct the trocar point toward a point one-fourth of the distance from the right anterior-superior iliac spine to the pubic symphysis; keep point of the trocar well up near abdominal wall until within four inches of right anterior-superior iliac spine; then dip point two inches and insert it forward into colon.

Urinary bladder

Direct trocar toward intersection of median line and pubic bone (the symphysis pubis), keeping it well up toward abdominal wall until it touches the bone; then withdraw about one half inch, dip the point slightly and insert into bladder

Right side of Heart

Direct trocar point along a line from the left anterior superior iliac spine to the lobe of the right ear; keep point up against cavity wall until it has pierced diaphragm, then dip it downward and insert into the heart

Linear Guide

A line drawn or visualized on the surface of the skin to represent the approximate location of some deeper-lying structure

Anatomical Guide

A descriptive reference for locating arteries and veins by means of anatomical structures which are known

Anatomical Limits

Points of origin and points of termination in relation to adjacent structures; used to designate the boundaries of arteries

Medial & Deep

The Common Carotid artery lies _________ to the Internal Jugular vein

Lateral & Deep

The Axillary artery lies __________ to the Axillary vein

Lateral & Superficial

The Femoral artery lies ___________ to the Femoral vein

The Common Carotid Artery (Internal Jugular Vein, & Vegas Nerve)

Linear Guide- draw or visualize a line on the surface of the skin from a point over the respective sternoclavicular articulation to a point over the anterior surface of the base of the respective earlobes.

Anatomical Guide – the right and the left common carotid arteries are located posterior to the medial border of the sternocleidomastoid muscle, on their respective sides of the neck.

Anatomical Limit -

The right common carotid begins at the level of the right sternoclavicular articulation and extends to the superior border of the thyroid cartilage.

The left common carotid -begins at the level of the second costal cartilage and extends to the superior border of the thyroid cartilage.

Axillary Artery (Axillary Vein, & Brachial Plexus)

Linear Guide- draw or visualize a line on the surface of the skin from a point over or through the center of the base of the axillary space to a point over or through the center of the lateral border of the base of the axillary space. This line is parallel to the long axis of the abducted arm.

Anatomical Guide - the axillary artery is located just behind the medial border of the coracobrachialis muscle.

Anatomical Limit - the axillary artery extends from a point beginning at the lateral border of the first rib and extends to the inferior border of the tendon of the teres major muscle.

The Brachial Artery (Basilic Vein)

Linear Guide – draw or visualize a line on the surface of the skin from a point over the center of the lateral border of the base of the axillary space to a point approximately 1 inch below and in front of the elbow joint.

Anatomical Guide - the brachial artery lies in the bicipital groove at the posterior margin of the medial border of the belly of the biceps brachii muscle.

Anatomical Limit - the brachial artery extends from a point beginning at the inferior border of the tendon of the teres major muscle and extends to a point inferior to the antecubital fossa.

The Radial Artery

Linear Guide - draw or visualize a line on the surface of the skin of the forearm from the center of the antecubital fossa to the center of the base of the index finger.

Anatomical Guide - The radial artery lies just lateral to the tendon of the flexor carpiradialis muscle and just medial to the tendon of the brachioradialis muscle.

Anatomical Limit - the radial artery extends from a point approximately 1 inch below and in front of the bend of the elbow to a point over the base of the thumb (thenar eminence).

Ulnar Artery

Linear Guide - draw or visualize a line on the surface of the skin from the center of the antecubital fossa on the forearm to a point between the fourth and fifth fingers.

Anatomical Guide - the ulnar artery lies just lateral to the tendon of the flexor carpi ulnaris muscle. (It lies between the tendons of the flexor carpi ulnaris and the flexor digitorum superficialis)

Anatomical Limit - the ulnar artery extends from a point approximately 1 inch below and in front of the bend of the elbow to a point over the pisiform bone (hypothenar eminence)

The Femoral Artery (Femoral Vein, Femoral Vein)

Linear Guide - draw or visualize a line on the surface of the skin of the thigh from the center of the inguinal ligament to the center of the medial prominence of the knee (medial condyle of the femur)

Anatomical Guide - the femoral artery passes through the center of the femoral triangle and is bounded laterally by the medial border of the sartorius muscle and medially by the adductor longus muscle.

Anatomical Limit - the femoral artery extends from a point behind the center of the inguinal ligament to the opening in the adductor magnus muscle.

Popliteal Artery (Popliteal Vein)

Linear Guide - draw or visualize a line on the surface of the skin from the center of the superior border of the popliteal space parallel to the long axis of the lower extremity to the center of the inferior border of the popliteal space.

Anatomical Guide - the popliteal vessels are located between the popliteal surface of the femur and the oblique popliteal ligament.

Anatomical Limit - the popliteal artery extends from a point beginning at the opening of the adductor magnus muscle to the lower border of the popliteus muscle.

Anterior Tibial Artery (Anterior Tibial Vein)

Linear Guide - draw or visualize a line from the lateral border of the patella to the anterior surface of the ankle joint.

Anatomical Guide - the anterior tibial vessels are located in a groove between the tibialis anterior muscle and the tendon of the extensor hallucis longus muscle

Anatomical Limit - extends from a point beginning at the inferior border of the popliteus muscle to a point in front of the middle of the ankle joint on the respective sides

Posterior Tibial Artery (Posterior Tibial Vein)

Linear Guide - draw or visualize a line on the surface of the skin from the center of the popliteal space to a point midway between the medial malleolus and the calcaneus bone.

Anatomical Guide - the posterior tibial vessels are located between the posterior border of the tibia and the calcaneus tendon.

Anatomical Limit - extends from a point beginning at the inferior border of the popliteus muscle to a point over and in between the medial malleolus and the calcaneus of the respective foot.

Dorsalis Pedis Artery

Linear Guide - draw or visualize a line from the center of the anterior surface of the ankle joint to a point between the first and second toes

Right Subclavian Artery

Begins at the right sternoclavicular articulation and extends to the lateral border of the first rib.

Left Subclavian Artery

Begins at the level of the left second costal cartilage and extends to the lateral border of the first rib.

External Iliacs

The External Iliacs – are used to inject the lower extremities in an autopsied body.

(Lies along the medial border of the psoas major muscle.)

The Greater Saphenous Vein

the longest vein in the body, returns blood from the foot, runs medially from the foot and empties into the femoral vein in the femoral triangle.

The Lesser Saphenous Vein

returns blood from the foot laterally and empties into the popliteal vein

15 degrees

The head should be tilted ________ to the right

Obtain permission

from the family before removing a beard or mustache

the nasal spine

The superior anchor for the needle injector is:

the nasal septum

The superior anchor for the mandibular or musculature suture is

treatment of malignant diseases; occupational exposure.

High levels of radiation can occur ____________ and through ____________

37 million atoms disintegrate each second.

Patients receiving large doses of radioactive isotopes must be hospitalized until the isotope content is not more that 30 mc. The millicurie (mc) is that amount of radioactive material in which __________________

Outside the hospital; should not encounter

In individuals that die ___________, the funeral director _____________ more than 30 mc of radioactive isotope.

standard aspiration and injection methods

If such a body is embalmed without an autopsy, use ______________________; the hazard is minimal.

radiation protection officer.

If the body’s radioactivity is above the level of 30 mc and there is not to be an autopsy, the body should be embalmed in the hospital morgue under the direction of a ___________________

more than 5 mc

If a body contains appreciably ______________ of any radioactive isotope and there is to be an autopsy and embalming following the autopsy, it should be done only under the advice of a radiation protection officer

there will be no radiation hazard from external handling

If the body is to be interred or cremated without embalming ………

heavy rubber apron.

Rubber gloves should be worn throughout the entire embalming operation, as should a very _____________

large quantities of running water; flush drainage matter.

Utilize ___________ at all times during the embalming to ______________

Minimize the time of close contact

__________________________with the body

Special care should be taken to _____________________. Care should be taken that ___________________. In case of overflow or spillage, fluid ____________________ using disposable goods.

Instruments should be soaked in good soap

________________________ or detergent, then rinsed well with running water

Gowns, towels, clothing;

_________________ etc. should be ___________ for suitable decay before being sent to the laundry.

disposed of by incineration.

Disposable waste matter should be collected in a suitable garbage bag and __________________

Gloves

___________should be thoroughly washed before being removed from the hands, then placed in a container of soap and water and allowed to soak and then stored in a suitable place until the radioactivity has decayed to a safe level

wash the injured area copiously with running water; physician or a radiation officer.

If the embalmer suffers any introduction of material from the body into lesions, he should ___________________________ and thereafter consult with his _____________________

Examples of Radiation Substances Used in Diagnosis and Treatment:

Cobalt 60

Iodine 131

Phosphorus 32

Radium 226

Gold 198

SR 89

Any of these would indicate that the deceased has been undergoing radiation treatments with isotopes and the body could possibly be radioactive

High levels of radiation can occur during:

treatment of malignant diseases

occupational exposure

30mc

Patients receiving large doses of radioactive isotopes must be hospitalized until the isotope content is not more than:

30 mc

If the funeral director removes a body from the home that has received radiation treatment, the body should not contain more than:

use standard injection and aspiration methods

When the embalmer begins the embalming process on a body that has received radiation treatment but died at home and no autopsy was performed, he should:

embalm in the hospital morgue under the direction of a radiation protection officer

If the body’s radioactivity is above the level of 30 mc and there is no autopsy performed, the embalmer should:

embalm only under the advice of a radiation protection officer

If a body contains appreciably more than 5 mc of any radioactive isotope and there is to be an autopsy, the embalmer should:

know that there is no radiation from external handling

If a body contains appreciably more than 5 mc of any radioactive isotope and there is to be an autopsy, and the body is to be interred or cremated without embalming, the embalmer should:

Wear rubber gloves and a heavy rubber apron throughout the entire operation

Keep the water running to flush the drainage

Minimize the time of close contact with the body

When embalming a body that has received radiation therapy, the embalmer should:

soaked in a good soap or detergent and rinsed well with running water

After embalming a body that has received radiation therapy, the instruments should be:

washed thoroughly before being removed from the hands

soaked in soap and water

stored until the radioactivity has decayed to a safe level

After embalming a body that has received radiation therapy, the rubber gloves should be:

stored until the radioactivity has decayed to a safe level

After embalming a body that has received radiation therapy, the gowns, towels, & clothing should be:

wash the area with copious amounts of running water and consult a physician

The funeral director removed a body from the hospital that had received radiation therapy. During the removal, the funeral director came into direct contact with blood drainage from the body into a cut on his/her hand. The funeral director should:

Examples of substances used in radiation treatment include:

Gold 198

Iodine 131

Cobalt 60

SR 89

Fluid Distribution

The Aortic Arch is the center for

Venous Drainage

The Right Atrium is the center for