Embalming III 2306.2 - Exam 2

- antemortem

- postmortem

all discolorations can be classified by their occurrence; either:

- blood

- pathological conditions

- surface discoloring agents

- decomposition

- embalming

- pharmaceuticals

causes of discolorations:

- antemortem intravascular

- postmortem intravascular

- antemortem extravascular

- postmortem extravascular

the four types blood discolorations:

antemortem intravascular

- carbon monoxide (cherry red)

- capillary congestion

- hypostasis of blood (blue-black)

postmortem intravascular

livor mortis

antemortem extravascular

- ecchymosis

- purpura

- petechia

- hematoma

postmortem extravascular

- postmortem stain

- tardieu spots

true

intravascular discolorations usually clear via arterial injection and drainage (t/f)

- flush the vascular system

- elevate the head and shoulders during embalming (for face discolorations)

- ensure clots are removed with drainage

- use pre-injection

- massage and manipulate the limbs

- use an active dye

- use sectional embalming if necessary (localized discolorations)

intravascular discoloration treatments:

false

extravascular discolorations clear well from arterial injection and drainage (t/f)

- arterial embalming (will lessen but not clear)

- hypodermic injection (bleaching agents)

- surface embalming (bleaching agents)

- topical application

- surface packs

- puncture and/or channel the affected area

extravascular discoloration treatments:

pathological conditions

antemortem discolorations that occur during the course of certain diseases or as a result of certain medical conditions (ex: lupus, Addison's disease, jaundice, gangrene)

biliverdin

when embalming a jaundiced case it's best to avoid using a moderate to high strength solution to avoid the chemical reaction of bilirubin turning into ______________

surface discoloring agents

antemortem or postmortem discolorations that occur due to the deposit of matter on the body surface (ex: blood, tape, grease, oil, ink)

true

most surface/discoloring agents clear with soap/water or a solvent (t/f)

decomposition

postmortem discolorations due to action of bacteria and/or autolytic enzymes

- odor

- skin-slip

- gas

- purge

- color change

the five signs of decomposition:

begins with green on the surface of the right inguinal (iliac) region

where does decomposition color change begin at?

- hypodermic injection of bleaching agents

- surface embalming (bleaching compresses)

• Cavity fluid

• Phenol

• Autopsy gel

decomposition treatments:

- use a strong solution

- ensure adequate drainage

- surface embalming

- hypodermic embalming (bleaching)

- cosmetics

- wax (think razor burn)

treatment of embalming-related discolorations:

pharmaceuticals

antemortem discolorations resulting from prolonged use of certain drugs and therapeutic agents

skin lesions

traumatic or pathological change in the structure of the skin

- unbroken

- broken (abrasions, blisters, skin-slip)

- scaling

- pustular or ulcerative (boils, ulcers, pustules, etc.)

the 4 categories of skin lesions:

unbroken skin

- use a strong arterial solution

- use surface or hypodermic embalming if needed

- cosmetize

broken skin

- ensure areas are firm and dry

- treat topically if needed

- use wax if needed

- cosmetize

skin scaling

- clean and remove any loose skin

- use an abrasive device and a solvent

- use massage cream (hydration) or autopsy gel (preservation) if needed

- cosmetize (and use wax if needed)

pustular or ulcerative lesions

- disinfect thoroughly

- open, drain, and clean

- use autopsy gel for additional treatment

- dry thoroughly after embalming

- cosmetize (and use wax if needed)

- stillbirths, infants, and children

- elderly

cases on either end of the age spectrum that require special considerations, treatment, and care:

preterm

live birth before 37 weeks gestation

stillborn

death occurs before or during delivery

infant

birth to 18 months

toddler

18 to 48 months

child

4 to 12 years

adolescent

12 to 18 years

young adult

18 to 25 years

adult

25 years to mid-70's

advanced age

mid-70's and beyond

preterm and stillborn

- not often viewed in the traditional sense

- rarely embalmed with normal arterial and cavity injection

toddlers

- use case analysis to determine the best embalming and treatment options.

- when the case is smaller, embalm using infant methods

- when the case is larger, embalm using child methods

children

- arteries will be larger but not yet adult sized (consider cannula size)

- recommended arteries for injection (common carotid and femoral)

- use a mild strength solution

- use sufficient pressure and rate-of-flow but not too high

- positioning may resemble that of an adult but more relaxed

adolescent - adult

- normal embalming

- use case analysis

- be mindful of trauma and/or pathological conditions with adolescent cases

advanced age

- common conditions that may affect embalming (arthritis, bedsores, tumors, diabetes, etc)

- some or all teeth may be missing; suture methods are recommended in lieu of needle injectors

- skin is thinner

- hypodermic treatment of facial tissues may be needed

- discolorations are common

case analysis

factors concerning weight need to be included in _________ _____________

obesity

- very common (40% of Americans are obese/overweight)

- contributing factor in many deaths

- may present embalming issues

- common carotid (perhaps restricted cervical)

- internal jugular vein

recommended vessels for obesity patients:

intermittent

___________________ drainage is recommended for obesity patients

40%

what percentage of Americans are obese?

back

tilt head ________ when embalming obese patients to reduce "fullness" in the neck and it's easier to raise vessels

false

for obesity cases, purge is uncommon (t/f)

true

for obesity cases, re-aspiration is recommended (t/f)

• Normal

• Excessive (swollen, i.e. edema)

• Dehydrated (lack of moisture, e.g. emaciation)

with regard to remains, moisture level is one of the following:

abrasion

antemortem and/or postmortem injuries resulting from friction of the skin against a firm object resulting in the removal of the epidermis

hypostasis

process of blood and/or other fluids settling to the dependent portions of the body that can occur in the antemortem, agonal, or postmortem period

dessication

extreme dehydration often resulting in post-embalming discolorations

emaciation

a wasted condition resulting in sunken surfaces of the face

- abrasions

- desiccation

- emaciation

- hypostasis

conditions associated with dehydration:

antemortem dehydration

before death, caused by conditions such as disease and certain types of trauma

• Hemorrhage

• Febrile diseases

• Emaciating diseases

• Burns

• Refrigeration

• Infection diseases

common predisposing conditions (antemortem dehydration):

postmortem dehydration (pre-embalming)

physical change, most often caused by refrigeration and gravitation of body fluids and blood

refrigeration

considered the most common cause of pre-embalming dehydration

postmortem dehydration (post-embalming)

often this is the result of embalming itself, may occur regardless of precautions taken by embalmer

• Strength of embalming solution

• Lack of humectant in fluid

• Lack of massage cream use

• Refrigeration (Even embalmed bodies may dehydrate when refrigerated)

causes of postmortem dehydration:

• Drying of the skin

• Darkening of the skin/discolorations

• Wrinkling (of lips, fingertips, and/or eyelids)

• Desiccation with severe cases

• Thickened blood

• Peeling/flaking of the skin

issues/problems with dehydrated cases:

localized dehydration

similar to general dehydration but localized to one or more areas; often found where the epidermis has been removed and the area below (dermis) has dried

edema

the abnormal accumulation of fluids within the tissues and/or cavities of the body

anasarca

generalized, whole body edema

solid edema (intracellular)

cells absorb and retain interstitial fluid

pitting edema (intercellular)

fluids accumulate between the cells

ascites

edema in the abdominal cavity

hydrothorax

edema in the pleural (thoracic) cavity

hydropericardium

edema in the pericardial sac

hydrocephalus

edema in the cranial cavity

hydrocele

edema in the scrotum

• Distention of tissues

• Decomposition may speed up

• Increased secondary dilution

• Distortion of the body contour (RA concern...)

• Possible leakage

• Possible desquamation

• Extravascular resistance (impede distribution/drainage)

• Dilutes cavity fluid (if unaspirated)

embalming challenges due to edema:

• Case analysis to determine type, strength, and quantity of fluid and solution

• Use a strong or waterless arterial solution (hypertonic)

• Use physical removal of edema is possible/necessary

• Use an edema-reducing chemical (co-injectant)

• Use a restricted cervical injection or sectional embalming

embalming treatments for tissue edema:

• Aspiration

• Injection of cavity fluid

• Re-aspiration and re-injection

• Close and seal all incisions tightly

• Use plastic garments for leakage protection

• Use absorbent and/or preservative powders

embalming treatments for cavity edema:

• Sectional embalming

• Hypodermic injection (direct)

• Elevation and gravitation

• Wicking and channeling

• Lancing and draining

generalized treatments of localized edema:

lymphedema

a long-term condition caused by the collection of excess fluid in tissues; the obstruction prevents lymph fluid from draining from the area, fluid buildup leads to swelling and hardened tissues

wicking

a post-embalming process to remove edema from body regions; a scalpel is used to create one or more openings in the dependent area of edematous tissue