Embalming Techniques and Discoloration Management

Antemortem

before death

Postmortem

after death

Intravascular Discoloration

are still in the vascular system and WILL be removed with arterial embalming

EXTRAVASCULAR discolorations

broke through the vascular system and is now in the interstitial space, it WILL NOT clear with arterial embalming

Blood discolorations

discolorations caused by blood

Drug and therapeutic discolorations

discolorations caused by drugs or therapies

Pathological discolorations

discolorations caused by diseases

Surface discolorations

discolorations on the surface of the skin

Reactions to embalming chemicals

discolorations resulting from embalming chemicals

Decomposition changes

discolorations due to decomposition

INTRAVASCULAR BLOOD discoloration

will clear with embalming

Liver Mortis

bluish purple color caused by the gravitation of blood into the dependent capillaries

EXTRAVASCULAR BLOOD DISCOLORATIONS

will not clear with embalming

Ecchymosis

discoloration of the skin caused by the escape of blood into the tissues

Purpura

reddish purple discoloration medium in size

Petechiae

reddish small pinpoint discolorations

Hematoma

a swelling or mass of blood caused by a ruptured blood vessel confined to an organ or space

Postmortem stain

heme that is released by hemolysis of red blood cells, seeps through the vessel walls and into the tissues

Tardieu spots

petechiae caused by blood settling into tissues, accompanied by liver mortis; often from asphyxia or strangulation

Elevation of the head and neck

letting gravity do the work in treating intravascular conditions

Pre-injection of anticoagulant

using a low index solution before embalming

Vascular injection

use low pressure to start to avoid rupturing the vascular integrity until the stain starts to clear

Hypodermic Treatment

treatment with phenol or cavity fluid by puncturing the swollen area and injecting solution

Surface embalming

coat surface with gel or cotton soaked phenol or cavity fluid

Overnight treatment

best option for treating discolorations

Addison's disease

bronze colored skin

Leukemia

petechiae

Tumors

discolorations surrounding the tumor

Meningitis

cyanosis, blotchy erythematous rash of the skin, petechiae and purpura

Lupus

chronic skin condition, scaling, red, butterfly rash

Jaundice

yellowing of skin

Bilirubin

Healthy blood has 1-1.5mg of bilirubin; anything higher than 1.5 will begin to yellow the body

Biliverdin

formed when bilirubin interacts with an acidic environment

Formaldehyde

A reducing agent that can easily lose electrons causing other chemicals to be reduced.

Reducing agents

Release hydrogen and LOWER PH (more acidic).

Acidic environment

Changes bilirubin to biliverdin and is the reason for the main green color.

Main goal with jaundice

The goal is PRESERVATION.

Restricted cervical injection

A good place to start for preservation.

Six methods to battle jaundice

Use jaundice fluid or LOW INDEX, use as directed if preservation is weak, follow up with an injection of a higher index fluid after the body clears.

Pre-injection solution

Used to flush the body of color; do not use excessive edema or decomposition is present.

Mild arterial fluid

Use a significant amount of fluid; do not use excessive edema or decomp, can result in an under embalmed body.

Cavity fluid

Can be used as arterial fluid; contains a bleaching agent, counterstain with dye.

Bleaching as co-injectant

Use bleaching chemicals in co-injection with arterial solution; best for mild jaundice cases.

Gangrene

Wet = venous obstruction; Dry = caused by arterial insufficiency.

Moist gangrene

Necrotic tissue resulting from inadequate venous drainage accompanied by the invasion of saprophytic bacteria.

Blood stain removal

Use soap and water.

Adhesives stain removal

Use rubbing alcohol.

Tar stain removal

Use kerosene.

Grease/Oil stain removal

Use Dawn dishwashing liquid.

Iodine stain removal

Use bleach.

Ink stain removal

Use acetone, lemon juice, or some hair sprays.

Paint stain removal

Use soap and water.

Oil-based paint stain removal

Use turpentine.

Nicotine stain removal

Use bleach.

Dehydration

Caused by using too much arterial fluid that is too strong with continuous drainage; looks yellow, brown, black, hard, dry, and leathery.

Yellow to Green Jaundice

Looks like yellow and green skin discoloration; caused by acidic reaction with bilirubin.

Formaldehyde Grey

Also called embalmers grey; looks like greyish tissue caused by lack of drainage.

Flushing

Looks like swelling and cyanosis; caused by poor drainage and clotting.

Razor Burn Abrasions

Looks like brownish skin, dehydrated and leathery; caused by careless aggressive shaving.

Post Mortem Bruising

Looks like ecchymosis with potential swelling; caused by careless, aggressive manipulations of tissues.

Formaldehyde Burn

Looks like a raised rash; causes capillary leakage.

Decomposition Discoloration

Brought about by actions of bacterial and/or autolytic enzymes.

Skin Lesions

Any pathological or traumatic change in the structure of the skin.

Unbroken Discolored Skin

Allergic reactions, inflammation, trauma due to increased blood flow.

Scaling Skin

Diseases such as chicken pox, scarlet fever.

Broken Skin

Abrasions caused by friction.

Blisters/Boils/Carbuncles/Furuncles/Ulcers/Fever Blisters

Clean, drain, remove loose skin, cauterize with phenol or cavity fluid.

Pustular or Ulcerative Lesions

Topical disinfectants; open and drain.

Bed Sores

Remove bandages and disinfect; temporary pack.

Desquamation

Separation of the epidermis from the underlying dermis as a result of putrefaction.

Burns

First Degree - surface is red; Second Degree - deep, affects dermal layer; Third Degree - full thickness; Fourth Degree - very severe.

Carbon Monoxide Poisoning

Bright cherry red color due to carboxyhemoglobin.

Drowning

Technical COD is asphyxia; cyanosis, intense liver mortis, petechiae on the face and neck.

Electrocution

Treat like a burn victim; strong rigor mortis is possible.

Exsanguination

Extreme blood loss, characterized by loss of color.

Gunshot Wounds

Often a typical RA case if it's on the face, head, or hands.

Instant Tissue Fixation

Strong fluid solution or waterless; use dye; close rate of flow.

Hanging

Petechiae discoloration in face; livor mortis in face if unfound.

Mutilation

Blunt force trauma, crushed, lacerated, punctured, abraded, torn, missing.

Poisons

May affect liver causing jaundice; may cause shock causing deep vein coagulation.

Refrigeration

Livor mortis is very common; blood becomes more viscous.

Decomposition

Conditions affecting decomposition include edema, burns, gangrene, trauma.

Purge

Lung: frothy, little odor; Stomach: coffee grounds, strong odor.

Gas

Can form anywhere in the body; they get worse with heat and humidity.

Advanced Decomposition

Main goal is odor control; inject waterless embalming gallon into R carotid.

Extreme Dehydration

Desiccation; complete moisture loss from the tissues.

Localized Dehydration

Can be caused by razor burn, skin slip, epidermis removed.

Edema

Abnormal collection of fluids in tissue spaces, serous cavities, or both.

Pitting Edema

Can be easily manipulated by the embalmer; treated with gravity methods and/or arterial injection.

Channeling

The trocar is directed into the affected tissues from the cavities to create channels.

Wicking method

Using a scalpel to create openings in a dependent area of the edematous tissue.

Associated diseases and conditions of edema

Alcoholism, burns, liver cirrhosis, CO poisoning, allergic reactions.

Disinfection

Apply topical spray on body orifices.

Positioning

Properly position the decedent on head and shoulder blocks.

Suture cranial cavity

Start behind right ear and suture to the left ear.