Embalming II Midterm

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(Lessons 1.1 - 2.2)

1. List the 4 divisions of vascular embalming

(1) Delivery of the arterial solution into the artery - from the embalming machine through the connecting tubing and arterial tube; (2) Distribution of arterial solution - the movement of arterial solution from the point of injection throughout the arterial system and into the capillaries; (3) Diffusion of arterial solution - movement of arterial solution from inside the vascular system (intervascular) through the walls of the capillaries into the tissue spaces (extervascular); (4) Drainage - the discharge or withdrawal of blood and blood clots, embalming solution, interstitial and lymphatic fluids and blood from the body during vascular embalming

2. The general term which describes the passage of some components of the injected embalming solution from an intravascular to an extravascular location; or the movement of the embalming solutions from the capillaries into the interstitial fluids

Fluid Diffusion

3. The term which describes the movement of embalming solutions from the point of injection throughout the arterial system and into the capillaries

Distribution

4. What percentage of the drainage from a body, may be embalming solution

About 50%

5. What are the components of drainage

Blood, arterial solution, interstitial fluid

6. Explain why/how interstitial fluid effects dehydration

Embalming solution present in the capillaries draws some tissue fluid with it into the drainage causing dehydration when more tissue fluid is being removed than is being replaced by embalming solution

7. List 2 examples of the physical application of arterial embalming

Filling the arterial system with forced injection under pressure; Control of drainage; Filtration (injected solution forced through walls of capillaries)

8. Is arterial solution hypotonic or hypertonic to tissue

Hypotonic

9. List examples of intravascular resistance -

Obstructions: antemortem emboli and thrombi, postmortem coagula and thrombi;
Narrowing: arteriosclerosis, vasoconstriction, arteritis, intravascular rigor mortis

10. List examples of extravascular resistance -

~Rigor mortis ~Gas in the cavities ~Expansion of the hollow viscera during injection ~Tumors and swollen lymph nodes ~Ascites and hydrothorax ~Contact pressure ~Visceral weight ~Bandages ~Skeletal edema ~Inflammation

11. Briefly list 5 embalming procedures to follow for intravascular problems

Start with slow rate of flow to prevent coagula from floating free and clogging branches ~Inject from right common carotid when coagula are anticipated (to push coagula away from head and arms) ~Avoid sclerotic arteries (iliac and femoral) ~Use largest artery (common carotid, external iliac, femoral) ~Use proper size arterial tube

12. What is the result of resistance, as discussed by the author

Little or no resistance: tissue dehydration, reduced filtration, uneven distribution ~Total or great resistance: tissue distension, uneven distribution ~Movable resistance: blood removal is more complete, distribution is more uniform, more embalming solution is retained by the body with minimum tissue distension

13. List the 3 indicators that embalming solution is being distributed throughout the vascular system

Drop in volume; Differential pressure; Drainage

14. When the embalming solution is in the embalming machine and the rate of flow valve is closed, the pressure gauge reads 20 psi of pressure. When the valve is opened, the pressure gauge reads 13 psi of pressure. What is the Potential Pressure in this case

20

15. When the embalming solution is in the embalming machine and the rate of flow valve is closed, the pressure gauge reads 20 psi of pressure. When the valve is opened, the pressure gauge reads 13 psi of pressure. What is the Actual Pressure in this case

13

16. When the embalming solution is in the embalming machine and the rate of flow valve is closed, the pressure gauge reads 20 psi of pressure. When the valve is opened, the pressure gauge reads 13 psi of pressure. What is the Differential Pressure in this case

7

17. The term which describes the amount of embalming solution injected in a given period, or the speed at which the solution enters the body

Rate of Flow

18. What is the center of arterial distribution

The ascending aorta and aortic arch

19. List the signs of arterial solution distribution

Fluid dye; Distension of superficial blood vessels; Blood drainage; Leakage from intravenous punctures ;Clearing of intravenous blood discolorations

20. List the signs of arterial solution diffusion

Dye in the tissues; Firming of the tissues; Clearing of intravascular blood discolorations; Loss of skin elasticity (beginning firming);Drying of the tissues; Rounding of fingertips, lips, and toes; Mottling of the tissues (bleaching); Fluorescent dye observed using black light;

21. According to the author of the textbook, what is very important to do during the injection of the first gallon of arterial solution to establish good distribution

Firm massage and exercise of the extremities

22. List procedures which could be tried in order to improve distribution

Increase rate of flow; Increase pressure; Inject using pulsation; Restrict drainage; Massage; Inject adequate volume; Relieve extreme abdominal extravascular pressure with trocar; Use another drainage site;

23. List the 7 types of movement solution experience while moving from the capillaries to the cell body

Diffusion; Osmosis; Pressure Filtration; Ultra Filtration; Gravitational Filtration; Dialysis; Absorption;

24. The term which describes the spreading or scattering of embalming solution -

Diffusion

25. List the terms which describe movement of solution from the capillaries to the interstitial space

The Passive (or Physical - as opposed to chemical) transport processes of Pressure Filtration, Ultra Filtration, Osmosis, and Dialysis

26. The term which describes the passage of solvent from an area of lower concentration to an area of higher concentration

Osmosis

27. The terms which describes the process of using pressure to force solution through the pores in the membrane, this is done usually from the capillaries to the interstitial space

Pressure Filtration

28. The term which describes the extreme form of the pressure filtration, where the embalmer uses a high pressure to destroy the membranes of the cells

Ultra Filtration

29. The term which describes the use of gravity to help settle the embalming solution to dependent parts of the body

Gravitational Filtration

30. Why do embalmers place cavity fluid high in the body cavity

To allow it to slowly settle to the dependent parts as the solution moves through the interstitial space

31. The term which describes the process of separating solutes by using a semi-permeable membrane

Dialysis

32. What is the purpose of dialysis in the movement of embalming solution from the interstitial space to the cellular spaces

To enable some of the solutes to enter cells, while keeping other solutes, like humectants, in the interstitial space

33. What are the two types of solutes in embalming fluid

Large Colloids, and Small Crystalloids

34. The term which describes the small solutes that can pass through a semi-permeable membrane

Crystalloid

35. List the types of solutes which are crystalloidal

Preservatives, salts, and germicides, dyes

36. The term which describes large solutes that can not pass through semi-permeable membranes without the process of ultra filtration

Colloidal

37. List the types of solutes which are colloidal

Humectants, (also enzymes and proteins)

1. According to the text, what are the aspiration procedure and subsequent perfusion with cavity fluid designed to do

Reach the substances and microbes found in the spaces within the thoracic, abdominopelvic, and sometimes cranial cavities; hollow viscera & their contents and organs that may not have been reached by arterial injection... It creates an unfavorable environment in the internal organs and destroys the media on which these microbes can grow and multiply

2. In relation to arterial embalming, when does cavity embalming occur

Following arterial embalming

3. List two occasions when cavity treatment is not employed

1. Donation to medical school 2. Embalming prior to autopsy.

4. List the solid organs that are treated by cavity embalming

Pancreas, spleen, kidney, brain, liver & lungs

5. Describe the type of purge that originates in the stomach.

Liquids, semi-solids, dark brown "coffee ground" appearance; odor; acid pH

6. Purge that is frothy with possible red blood and very little odor would emanate from which source

Would come out the nose or mouth from the lungs

7. List several conditions under which reaspiration would be strongly advised

A noticeable amount of gas when the trocar button is removed; ship-outs; ship-ins; decomposition; recent abdominal surgery; corpulence; evidence of gas, e.g. distention of neck or backs of hands; death involving infections of blood or abdominal cavity; drowning; ascites; distention of facial tissues from edema or gas

8. An instrument installed on a water line that uses water to create a vacuum for cavity aspiration is

Hydroaspirator

9. What items are required to accomplish the process of aspiration

A pointed trocar, tubing, a device to create a suction or vacuum (such as a Hydroaspirator)

10. What are the two commonly-used types of instruments used to create a vacuum

Hydroaspirator and electric aspirator

11. A long hollow needle (metal tube) with a removable sharp point that is used to pierce the wall of the abdomen and internal organs for the purpose of removing the contents of the organs and fluid that has pooled in the cavities

Trocar

12. Why is a complete disinfection/sterilization of the trocar important

To prevent the transfer of microorganisms (such as Clostridium perfringens) from one body to another

13. Besides the trocar, name two other types of aspiration instruments

Nasal tube aspirator and autopsy aspirator

14. List the main organs of the thoracic cavity

Heart and lungs

15. List the main organs of the abdominal cavity

Stomach, small intestine, large intestine, gallbladder, liver, pancreas, spleen and kidneys

16. This is the largest glandular organ in the human body

The liver

17. List and number the areas of the abdomen using the 9-Region method (R to L and top to bottom)

Right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right inguinal, hypogastric, and left inguinal

18. Describe the dividing lines of the Four Region Plan

A horizontal line drawn from left to right through the umbilicus, and a vertical line drawn down the midline of the body

19. Using the four main trocar guides, which organ will you pierce if you move the trocar along a line from the left anterior-superior iliac spine and the right earlobe and depressing the point after you have passed through the diaphragm

Right side of heart

20. Using the four main trocar guides, which organ will you pierce if you direct your trocar along the abdomianl wall to the symphysis pubis, pull it back slightly and depress it while moving it forward

Urinary bladder

21. As a rule, cavity treatment follows arterial embalming. What is one exception to this rule

When the abdomen is tightly distended with gas or edema

22. What are the two periods during which cavity aspiration and injection can take place

Immediately following arterial injection and several hours following arterial injection

23. According to the text, why is it wise to suture incisions after aspiration

Because, aspiration takes the pressure off the vascular system and thus decreases the chances of leakage from the incision should some small vessels leak

24. List some advantages of aspirating shortly after arterial injection

Large numbers of microbes are quickly removed; translocation of microbes is less likely; risk of gas and purge from microbes is minimized or prevented; removes materials that could purge; eliminates bacterial medium from hollow viscera; removal of blood helps prevent blood discolorations (most importantly); decreases swelling where neck or facial tissues have distended during arterial injection

25. According to the text and the lesson, what is the theory behind having a long delay prior to aspirating

Delay of aspiration maintains the pressure within the vascular system and allows a more thorough distribution of the arterial solution into the tissues

26. Describe the standard point of trocar entry

Two inches to the left of and two inches superior to the umbilicus

27. Why isn't the trocar inserted on the right side of the abdomen near the umbilicus

Because the trocar would become entangled in the solid tissue of the liver

28. According to the text, what is the suggested order of cavity treatment

Thoracic cavity, abdominal cavity, then pelvic cavity

29. Why is clear tubing helpful in the aspiration procedure

It permits visual examination of the material being removed and aids in determining which organ or space is being aspirated

30. As a general rule, the text suggests keeping the trocar in constant motion. What is the exception

When an area is filled with liquid (such as bodies with ascites, hydrothorax, or ruptured vessels such as the aorta), the trocar should sit until the area is thoroughly drained

31. According to the lesson, aspiration also creates more "surface area" within the thorax and abdomen. What is the significance of this

It increases the amount of tissue upon which the cavity fluid can act.

32. This is the bony plate/bone through which the trocar is pushed to aspirate the cranial cavity

The cribriform plate of the ethmoid bone

33. Describe how a gravity injector is used

The gravity injector is attached directly to the 16-ounce bottle of cavity fluid. A hose connects the injector to the trocar. The higher the bottle is raised, the faster the fluid flows into the body. A small opening on the side of the gravity injector allows air to flow into the cavity fluid bottle. By placing a finger over the opening, the embalmer stops the flow of cavity fluid. This can be done when the trocar must be withdrawn to change its position within a body cavity.

1. List several post-embalming treatments that are generally carried out after arterial and cavity embalming

Surface Embalming; Hypodermic Embalming; Closure of Incisions; Removal of Invasive Devices; Surface Embalming; Hypodermic Embalming; Closure of Incisions; Removal of Invasive Devices; Final Washing & Drying of the Body; Treatment of Ulcerations, Lesions & Discolorations; Treatment of Purge; Treatment of distension/swelling in visible areas; Inspection of mouth for purge/moisture & resetting features; Plastic Garments;

2. What are the two types of supplemental methods of embalming

Surface Embalming Hypodermic Embalming

3. What types of chemicals are used for surface embalming

Liquids, gels, and powders

4. When applying surface preservative gels, what should be done to reduce fumes and prevent evaporation

treatment should be covered with plastic

5. List two different ways embalming powders can be used and compare their effectiveness in relation to gels and liquids

Powders can be placed in plastic garments, they can also be used to treat the interior walls of the abdomen and thorax in the autopsied body, though they are not as effective as gels or liquids for this purpose.

6. What are the two common methods of incision closure today

sutures and super adhesives

7. List several steps that the text suggests must be taken before incisions are closed

cavity aspiration; vessels tied; force edema from surrounding tissue; dry incision; make a "pocket" for the sealing powder

8. Why should one pull on the thread and not the needle when tightening the suture

pulling on the needle weakens the thread

What is the suggested suture direction for the incision of the Common carotid artery (anterior parallel incision)

from inferior to superior

What is the suggested suture direction for the incision of the Common carotid artery (supraclavicular incision)

from medial to lateral

What is the suggested suture direction for the incision of the Axillary artery

from medial to lateral

What is the suggested suture direction for the incision of the Radial and ulnar incisions

from distal to medial (proximal)

10. What will need to be done to a body that has purged after dressing/cosmetics

The body should be reaspirated and the cavities re-injected with cavity fluid. The mouth and nasal cavities should be checked for dryness and tightly packed

11. List several different types of sutures

Individual (Bridge) Sutures; Baseball Suture; Single Intradermal (Hidden) Suture; Double Intradermal Suture; Inversion (Worm) Suture; Interlocking Suture; Continuous Suture ("Whip Stitch")

12. What is the most common type of suture

Baseball Suture

13. Which suture is normally used by autopsy technicians to close long incisions

Continuous Suture ("Whip Stitch")

14. How is the Single Intradermal suture "hidden"

It is directed through the subcutaneous tissue only

15. Why does the text suggest that invasive devices such as IV needles or venous catheters be left in place until after arterial injection

To reduce the risk of swelling and discoloration of the area from which the device is removed

16. Using the text and the lesson, explain how and why a pacemaker must be removed before cremation

A small incision is made over the device and the leads to the heart are cut. Due to radioactive material, a pacemaker can cause a minor explosion in the cremation chamber if incinerated.

17. According to the lesson, when should a colostomy bag be removed and what type of suture should be used to close the opening

a colostomy bag should be removed after arterial injection and an "N" or purse-string suture can be used to close the opening.

18. According to the LESSON, when should orifices such as the nasal passages, throat and rectum be packed

after embalming and cavity treatment is completed as cavity treatment can alleviate any pressure which may be causing the purge in the first place

19. List several different ways that pitting edema can be moved out of an area

gravitation, massage, channeling, application of pressure

20. What problem can arise in removing edema from the facial tissues or hands

very wrinkled skin

21. Define Crepitation

the spongy feel of gas as it moves through tissues when they are pushed on

22. Define Stoma

The exposed portion of the bowel

23. List some ways that wrinkled lips can be corrected

gluing, waxing, tissue building

24. What is a Capri garment

a single unit plastic garment that combines pants and stockings

25. Describe a Unionall

a plastic garment that covers the arms, trunk, and legs

26. Describe the recommended care of the embalming machine after each use

it should be flushed with warm water, and possibly a solvent or cleaning solution followed by warm water. It should not be left dry

27. List some possible post-embalming problems that may need addressed

Cosmetic Corrections; Separated Tissues; Leakage; Purge;

28. List some potential areas of leakage cited by the text AND the lesson

Undetected point where trocar broke through; Cranial autopsy suture/staples; IV sites; Incisions/Autopsy sutures; Skin slip or edema; Trauma to face or hands; Surgical sutures; Edematous areas; Broken skin;

1. List four age categories that influence embalming technique

Infant to Young Child (Birth to age 4); Child to Young Adult (Age 4-12); Young Adult to Adult (Age 12 to Mid-70's); Old Age (Mid-70's to 90's);

2. List some factors other than age that will influence embalming technique

Size & Weight, Moisture, Postmortem changes, Discolorations

3. List four injection sites for the unautopsied infant

Common carotid artery, external iliac or femoral artery, abdominal aorta, ascending aorta

4. What legal ramifications should one consider with respect to use of the abdominal or ascending aorta

The family may have refused an autopsy and think that the hospital did one anyway because the incisions are so similar.

5. In this type of autopsy, only one cavity is opened (cranial, thoracic, abdominal or spine)

Partial

6. Define Senile Purpura

An extravascular irregularly shaped blood discoloration that often appears on the arms and backs of the hands

7. List several treatments that can be used on areas of an autopsied infant not reached by arterial injection

Hypodermic injection, Internal compresses, Preservative gels, External compresses

8. List some causes of death in the 4-12 year old age group -

Infectious/Contagious Disease: Meningitis or pneumonia; Childhood viral diseases; Systemic diseases: leukemia or cystic fibrosis

9. With regard to children, what should be done to ensure good cosmetic treatment

Facial hair should be removed to facilitate good cosmetic application

10. With regard to pressure & rate of flow, which does the text (and instructor) feel is of greater concern

Rate of flow is of much greater concern than pressure

11. List some examples of supplemental embalming fluids -

Preinjection fluids, coinjection fluids, humectants, dyes, and water conditioners

12. What condition is common in the lower extremities of diabetes cases

In cases of diabetes, gangrene is common in the lower extremities

13. Describe preinjection fluid and why it is used

A chemical containing very little or no preservative, used for preparing the vascular system and body tissues for the injection of the preservative solution, to clear intravascular blood discolorations, remove blood in the vascular system, and adjust the pH of the tissues.

14. According to the text, what is the average life expectancy for men and women

72.6 years for men, 77.6 years for women

15. This term describes the use of coinjection chemicals as a substitute for water

Waterless solution

16. What is the biggest problem with mouth closure in an elderly case

The maxilla can atrophy and be soft or "mushy" making it very difficult to attach a needle injector barb

17. What is the best primary injection point for a cardiac patient

The common carotid artery (and the internal jugular vein for drainage)

18. Which vessel commonly used for injection most frequently exhibits sclerosis

The femoral artery

19. What would an extensive incision down the inner leg indicate

The Greater Saphenous Vein has been taken for transplant in a coronary bypass operation

20. This disease may be defined as both an acute and a chronic metabolic disorder characterized principally by hyperglycemia (an excess of sugar in the blood) resulting from a deficiency of insulin

Diabetes Mellitus

1. What is an autopsy

A postmortem examination of the dead human body

2. What are the two types of autopsies

Medical (Hospital) Autopsy, and Medicolegal (Forensic) Autopsy

3. List several reasons why a hospital would perform/require an autopsy

No firm diagnosis;
Unexpected medical complications;
Following diagnostic procedure not under jurisdiction of M.E. or coroner;
Sudden, unexpected, or mysterious circumstances and not under jurisdiction of M.E. or coroner;
Suspected environmental or workplace hazards; Possible contagious disease;
Insurance settlements;
Quality of nursing home care in question

4. What are the goals of a coroner/Medical Examiner autopsy

Discovering the cause of death and the manner of death

5. What is the Sella Turcica

A saddle-shaped depression in the sphenoid bone at the base of the human skull. The internal carotid arteries are found on the lateral edges of this depression.

6. Is it necessary to insert drainages devices when embalming an autopsied body

No drainage instruments are necessary

7. List some typical cases that would be reported to a coroner or medical examiner

Sudden
Suspicious
Violence or trauma
Fetal, stillborn, baby within 24 hours of birth (mother not under physician care)

8. List several cases on which an autopsy must be performed

Homicide; Workplace; Motor vehicle driver; Pedestrians; Passengers lacking clear evidence of trauma; Intra- and perioperative accidental; Epileptics; Possible S.I.D.S; Infants or children with evidence of bodily injury; Inmates of correctional facilities, nursing homes, or medical institutions; Trauma; Nontraumatic, sudden, unexpected; Anorexia nervosa; Multiples of coincidental, unexplained death at one location; Possible poisoning or overdose; Bona fide discretion of pathologist

9. Generally speaking, with regard to fluid selection, what type of solution should be used on an autopsied case

Somewhat stronger than average

10. Regarding an autopsied body, what factors influence the need for a stronger arterial solution

Delayed preparation, refrigeration, pathologic conditions

11. Because refrigeration can cause hemolysis and hardening of tissue, what is the best way to detect actual arterial solution distribution

Use dye in the arterial solution

12. Describe a partial autopsy

Generally, only one body cavity is opened to examine one specific item - usually medical

13. The text lists two reasons why it is important to support the scalp while the head is being injected. What are they

To prevent a crease from forming in the middle of the forehead and to assist distribution of fluid through the scalp.

14. In an autopsied case, what are the ideal vessels to use for injection of the lower extremities

Right and left common iliac

15. In an autopsied case, what are the ideal vessels to use for injection of the upper extremities

Right and left subclavian arteries

16. List some ways to secure the calvarium and prevent it from moving

Suture; through temporalis muscles and up across calvarium; Separately suture cut temporalis muscles on either side; Calvarium clamps; Drill calvarium and temporal bone, wire together; Superglue; Plaster of Paris; Needle injector wire

17. What distribution problems does one encounter if it becomes necessary to inject the axillary artery rather than the subclavian artery of an autopsied body

The shoulder, upper portions of the back, and deep muscles of the neck will not receive distribution

18. List the main steps in the suggested order of preparation of an autopsied body

1 Unwrap and disinfect; 2 Shave and set features; 3 Open cavities; 4 Locate and ligate vessels; 5 Prepare arterial solution; 6 Inject; 7 Supplemental treatments; 8 Drain and treat cavities and internal surfaces; 9 Prepare abdominal and thoracic cavities and neck area; 10 Suture thoracic and abdominal cavities; 11 Dry cranial cavity; 12 Suture scalp; 13 Wash and dry body; 14 Apply sealing agent to incisions; 15 Dress in coveralls with powder to surface of abdominal and back areas; 16 Prepare embalming report

19. List three reasons why it is important to inject the left side of the head first

Because a certain amount of fluid will flow to the right side via anastomosis, to see the effects of the fluid/dye on the left side, and to prevent over injection of the right side of the face

20. What is the Circle of Willis

An arterial circle at the base of the brain - receives all the blood that is pumped up the two internal carotid arteries that come up the front of the neck and that is pumped from the basilar artery formed by the union of the two vertebral arteries that come up the back of the neck

21. Define Anastomosis

The connection of normally separate parts or spaces so they intercommunicate

22. After the completion of arterial embalming, what areas should be supplementally injected with a hypo-valve trocar

Buttocks, Breasts, Shoulder & neck regions, All "flaps" surrounding the "Y" incision; left & right and the triangular flap below the neck

23. How much cavity fluid does the text suggest should be used to treat the viscera

At least two bottles

24. When embalming a thoracic autopsy, where is drainage taken for the lower extremities and abdomen

Inferior vena cava

25. What are the three types of partial autopsies

Cranial, Thoracic, and Abdominal

1. What are the four types of tissue in the body

Epithelium, connective (bone blood cartilage), muscle, and nerve

2. This is defined as any part of the body exercising a specific function

An organ

3. Describe the Uniform Anatomical Gift Act

The act allows any person 18 years or older to donate all organs and tissues of their body for transplantation, research or educational purposes after their death

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