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common problems exhibited by bodies in which there has been a discernable time delay between death and embalming

Uneven Distribution; Swelling; Increased Preservative Demand

causes of uneven fluid distribution

Rigor Mortis; Post-mortem coagula; Increased viscosity of arterial & venous blood; Breakdown of portions of capillary system

Regarding delayed embalming, the main factor that brings about the body's increased fluid need

breakdown of tissues (proteins)

List the false signs of embalming in a refrigerated case

Firmness from swollen tissues; Pink coloration from hemolysis; Firmness from solidified subcutaneous body fats

In cases of delayed embalming or decomposition, what is the recommended arterial fluid index

fluids with an index of 25 or higher

What is the main purpose behind using a six-pinot injection on a delayed/decomposed embalming

It reduces the amount of coagula that may move into the smaller arteries and block distribution

What is the main reason rigor mortis should be relieved before embalming begins

During rigor, the proteins of the muscles are "locked" together and it is difficult for the preservative to attach to the proteins. This means there is little absorption of the preservative by the muscles during rigor mortis

What is the first "tell-tale" sign of decomposition

a green discoloration in the lower right quadrant of the abdomen

List several signs of decomposition

Color changes; Odors; Purge; Gases; Desquamation; Chemical Changes (though not visible, still a concern)

Describe the process of warming a body exhibiting frozen tissues

Allow the body to warm gradually by letting it sit in the prep room at room temperature

When there has been a delay between death and embalming, describe why a slow rate of flow/slow injection is necessary

to avoid distension or dislodged coagula

List some advantages of short-term refrigeration

Slows the progress of rigor mortis; Slows decomposition; Maintains blood in a liquid state

According to the lesson, what is one problem an embalmer may encounter with a refrigerated body

False signs of embalming (Firmness from swollen tissues, Pink coloration from hemolysis, Firmness from solidified subcutaneous body fats); Frozen Tissues (Ice crystals that form when tissue freezes will tear the tissue if manipulated)

Describe the term "Marbling"

Blood in superficial vessels breaks down and becomes greenish-black, taking on a spider web appearance

Why should manipulation of a body exhibiting frozen tissue be kept to a minimum

Because ice crystals that form when tissue freezes will tear the tissue if manipulated

This term describes the separation of skin layers and subsequent weakening of the superficial layer of skin

Desquamation or skin slip

What is the significance of nitrogenous products created during the decomposition process

they greatly increase formaldehyde demand

List four factors which speed the onset of decomposition

Elevated environmental heat; Elevated and retained body heat; High moisture content within the body; Translocation of intestinal bacteria

Describe how to prepare a solution which will reduce odors on a decomposed body

Mix two pints hydrogen peroxide, a half cup baking soda and a tablespoon of liquid soap (leave on the body several minutes before rinsing)

Describe the conditions that favor and hinder the formation of gas in the body tissues and cavities

Heat and Humidity favor the formation of gas; Cold and Dry environments hinder the formation of gas

List five ways to deal with a tongue that is swollen or protruding

Use digital pressure to force it back into the mouth; Cover it with a piece of cloth and apply firm pressure on the cloth; Force the tongue behind teeth or dentures and secure jaw; Excision of the tongue should be a last resort (and should generally not be done without the family's consent)

Why might an embalmer wait until after embalming is completed to close the mouth of a body in which decomposition is evident

Since the mouth area may swell during embalming, it may be easier to obtain a proper closure after injection (firming is not a problem in these bodies because it is delayed)

List five embalming complications generally encountered in bodies with early signs of decomposition

poor distribution, poor drainage, swelling, increased formaldehyde demand, little to no firming (Fluid distribution is poor because coagula are present in the arterial system; Drainage is poor because blood elements have decomposed; Tissues easily swell because capillaries have broken down or are easily torn by the pressure of the fluid, and tissue structure has been weakened by autolytic and putrefactive changes; Ammonia and nitrogenous products in the tissues greatly increase the preservative demand; Little or no firming is exhibited because of protein breakdown)

Describe the three meanings of discoloration as it pertains to embalmers

Color is removed or lost; To change color; "Any abnormal color appearing in or on the dead human body"

What are the three general types of jaundice

Toxic, hemolytic & obstructive

List and describe the three categories of burns

First Degree: Skin surface is red, only the epithelium is affected; Second Degree: The skin blisters and edema is present, destruction of deep layers of epidermis and upper layers of dermis; Third Degree: Tissues are charred

Define/describe cyanosis

A bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood

Define Exsanguination

Excessive blood loss to the point of death

List several different embalming for treating the jaundiced body

Use of a jaundice fluid; Use of a Pre-Injection Solution; Use of mild Arterial Solution; Use of a low index (special purpose) Cavity Fluid as Arterial Fluid; Use of Bleaching Co-Injection Fluids; Relative Counterstaining Method

What is meant by the term "reaction controlled fluids"

Arterial fluids that are able to be distributed throughout the body and diffuse into the tissue spaces before the chemical reaction with the proteins of the body occurs

Describe Tardieu spots

pinpoint hemorrhages seen in areas of advanced livor mortis

List some examples of extra-vascular blood discolorations

ecchymosis, purpura, petechia, hematoma, post-mortem stain, and Tardieu spots

Why should the head and shoulders of the dead human body always be elevated

to drain blood from these areas

How can livor mortis be an advantage to the embalmer

the breaking and clearing of livor mortis indicates that fluid has been distributed into those tissues

In a case of renal failure/jaundice, how is ammonia formed and what is its significance to the embalmer

ammonia, is formed in the gastrointestinal tract by bacterial action and digestive processes. Most ammonia enters the portal circulation and is effectively eliminated by the liver. In liver disease states, minimal removal of ammonia occurs and bypass collateral circulation, in addition to reduced ability for enzymic conversion of ammonia to urea, extremely elevated blood ammonia levels are possible. General alkalemia is the result as blood pH values rise and ammonia readily permeates cells and tissues and causes serious disease consequences with potentially lethal toxicities. The embalming consequence is sky high aldehyde demand and extreme formaldehyde neutralization resulting in poor or failed preservation

Define a Skin Lesion

Any traumatic or pathological change in the structure of the skin

What is one of the major problems encountered by the embalmer in preparing a body with diabetes mellitus

poor peripheral circulation - calling for strong arterial solution, a coinjection fluid to increase distribution and diffusion, and dye to indicate distribution

What are the four categories of skin lesions

Unbroken skin but discolored; Skin scaling as in exanthematous diseases; Skin that is broken or separated from the body; Pustular or ulcerative lesions

What is meant by the term "exanthematous" or "exanthema"

A skin eruption accompanying certain infectious diseases; or a disease, such as measles or scarlet fever, accompanied by a skin eruption

What is another term for skin slip

Desquamation

Describe the classic discoloration associated with carbon monoxide poisoning and its cause

"cherry red" color due to carboxyhemoglobin in blood

On a casketed body, what is a good way to detract from eye problems which may have occurred

the use of glasses

Describe the theory behind the conversion of yellow jaundice to green jaundice. Include the chemical process and compounds involved

when aldehydes combine with protein or amino acid, it increases the acidity in the local tissues by proton release. The hydrogen ions which produce the acid condition result from the chemical action between aldehyde and protein. The acid medium results in oxidation changes, and the bilirubin is converted to biliverdin.

Describe how Formaldehyde Gray occurs

Formaldehyde gray is due to inadequate amounts of blood being removed from the body. Remaining blood mixes with preservation fluids in the tissues and results in a dark gray color

List some examples of surface discolorations and when they should be cleaned (and why)

blood, betadine, adhesive tape marks, gentian violet (anti-fungal agent), paint, mercurochrome and tobacco tars- Should be cleaned prior to arterial injection because the pores in the skin are still open and easier to clean. After arterial injection the pores close and it is more difficult to completely clean off discolorations. The embalmer must also see the skin clearly to evaluate if arterial solution is present in a particular location while injecting

List four examples of pathological discolorations

Gangrene, Jaundice, Addison's, Leukemia, Meningitis, Tumors, Lupus

What are the classic colors of dehydration

yellow, brown and black

What are the "warm" areas of the hands and face

Lips, cheeks, base of the chin and nose, ears and joints of the backs of the hand

What are some causes of dehydration

Too much (or too strong) arterial solution; Continuous or concurrent drainage; Passage of air over the body; Loss of superficial layer of the skin; Drying of cut edges of skin

Why is cavity embalming important in cases of renal failure

Because, in addition to edema, there is a buildup of nitrogenous wastes in the tissues, which can neutralize the preservative solution, indicating a high preservative demand

Regarding generalized edema, what are the two main objectives of the embalmer

To inject a solution of sufficient strength and volume to counteract the secondary dilution that occurs in the tissues; To remove as much edema from the tissues as possible

What is one of the leading causes of a postmortem loss of moisture

Refrigeration

Generally speaking, will thoroughly embalmed tissues dehydrate more or less than under-embalmed tissues

Thoroughly embalmed tissues dry LESS than underembalmed tissues

Define Edema

Abnormal collection of fluid in tissue spaces, serous cavities, or both

Describe Pitting Edema

A condition in which interstitial spaces contain such excessive amounts of fluid that the skin remains depressed after palpation

What are three body sites where edema can be found

Intracellular - Edema within the individual cells; Intercellular - Edema within the spaces between the cells; Edema within the body cavity

What is another term for generalized edema

Anasarca

List five types of "body cavity" edema and describe where they occur. Ascites

abdominal (peritoneal) cavity; Hydrothorax - plural cavity; Hydrocephalus - cranial cavity; Hydropericardium - pericardial sac surrounding the heart; Hydrocele - tunica vaginalis testis of the scrotum

This type of edema does NOT respond to embalming treatments and is frequently seen in facial tissues when corticosteroids have been administered

Cellular (Solid) Edema

In a normal 160 lbs. adult male, what percentage of body weight does total body water constitute

55 to 60%

Under what conditions is edema said to be established

Increase of 10% in total body water

What is one simple way to maintain the proper moisture level during the embalming process

Follow the dilution recommendations on the label of the arterial fluid

Use of moderate arterial solution in large volume; Slow injection; Use of coinjection; Use of humectant; Use of large amounts of fluid; Intermittent or alternate drainage; Application of massage cream (or other moisture retainer) to exposed skin; Avoid excessive massage of hands, face, and neck; Avoid exposure to air currents

some recommended treatments that will maintain moisture or add moisture to dehydrated bodies.

Why should one avoid excessive massaging of the hands, neck & face on a dehydrated body

It removes tissue moisture and arterial solution from the area

After embalming, how could one use gravity as a method of treating edema of the head, face, and neck

Place the body on a cot for several hours with the head end fully elevated and the foot end fully lowered to allow the fluid to gravitate away from the head, face, and neck

What is the theory behind using a very large volume of a mild or average (standard) arterial solution to treat generalized edema

Ensures good distribution, large amount of preservative, washes out a good portion of edema

List five of the six types of arterial solutions recommended in treating edema

Very large volume of mild/average arterial solution; Very strong/astringent arterial solution; Special purpose, High Index fluid designed specifically for edema; Addition of dehydrating co-injection chemicals; Use of Epsom Salts in the arterial solution; (use of large amounts of humectant in the arterial solution)

How is ascites affected by the arterial solution and blood drainage

It is unaffected by arterial fluid and blood drainage because it is located within the cavity around the visceral organs

Briefly describe how Epsom salts work on edema

It creates a hypertonic solution which sets up an osmotic gradient that draws the edema from the tissue spaces toward this concentrated salt solution in the capillaries

Describe the suggested arterial solution/technique using Epsom salts.

Fill a container with a half gallon of cool water, Add as much Epsom Salt as can be dissolved, Add 4-6 ounces of high index (25-36) arterial fluid, Inject into affected area, Massage downward (massage is important)

In what situation does the Epsom salt solution work best - In what situation does it NOT work well

Works with Intercellular (Pitting) Edema; does not work with Cellular (Solid) Edema

How could a trocar be used to treat facial edema

To channel neck tissues during cavity treatment to provide a route for fluids to drain from the face, scalp and neck into the thoracic cavities

Describe the appearance of desiccated lips and fingertips.

Desiccated lips appear black, very wrinkled, and shrunken. Desiccated fingertips become parchment-like and turn yellow-brown

List some embalming techniques used to keep a good balance of moisture in the body

Avoid astringent or hypotonic arterial solutions; avoid continuous drainage; avoid rapid injection and drainage; delay aspiration; cover refrigerated bodies with plastic sheeting; avoid outdated fluids; use disinfectants that do not dehydrate the skin; use non-absorbent cotton to set features; pack mouth and nose to avoid drying fumes from cavity fluid; after embalming cover with plastic sheeting

What are the three layers of an artery

Intima - the inner lining, Media - the middle layer, Adventitia - the outer layer

Define canalization.

The formation of paths or canals in an occluded artery through which blood can pass

This term describes blood clots attached the inner wall of a blood vessel.

Thrombi

What is a mycotic infection

An infection caused by a fungus

What is an atheroma and how might it affect the placement of the cannula

A patchy or nodular thickening of the intima of an artery; incision should be made where the artery is soft, a smaller cannula should be used to avoid damage to the lumen

Describe a febrile disease and how it can affect the vascular system

A disease or condition accompanied by an elevation of body temperature; May speed decomposition, lead to dehydration, coagula, drainage difficulties, and swelling of small vessels and tissues on injection

This is the term for narrowing of a blood vessel

Vasoconstriction

What should be done if no drainage occurs in a case of an aortic aneurysm

stop the injection and begin a multi-point injection

What other problematic condition can occur when an aortic aneurysm has been surgically repaired

Severe facial edema

This term refers to pressure on the outside of an artery or vein.

Extravascular Resistance

How might an embalmer treat resistance brought about by visceral weight

Above- and below-heart injection and drainage points can be employed

This term describes hardening of the arteries.

Arteriosclerosis

The term used to describe inflammation of a vein.

Phlebitis

This is a disease caused by the spirochete Treponema pallidum.

Syphilis

List and describe the three types of arteriosclerosis.

Type 1, in which the inner wall is hardened and thickened but the lumen is well defined and large; Type 2, in which the lumen is quite reduced in size and pushed to one side of the artery; Type 3, in which the artery is completely occluded

The term used to describe a detached blood clot.

Embolus

What is ischemia

Restriction in blood supply generally resulting in damage or dysfunction of tissue

The term describing an increase in red blood cells.

Polycythemia

The condition in which the heart cannot pump enough blood to the organs of the body.

Congestive Heart Failure

When embalming a case of an aortic aneurysm, what would little or no drainage indicate

loss of embalming solution into the thoracic or abdominal cavity

Which artery is most likely to be affected by arteriosclerosis

Femoral

A condition caused by poor arterial circulation into an area of the body, causing death of body cells.

Dry gangrene

A condition caused by occlusion of veins draining a body area that becomes the site of bacterial infection.

Moist gangrene

A term describing the localized dilation of an artery.

Aneurysm

What is a main embalming concern of diabetes

Establishment of good fluid distribution

Of the two types of gangrene, which type cannot be treated arterially

Dry

List some potential complications of congestive heart failure.

Blood is congested in the right side of the heart; Neck veins become engorged with blood; Lips, ears and fingers are often cyanotic; Generalized pitting edema, edema of legs/feet and ascites may all be present; Blood may be more viscous because polycythemia; Salt is retained in body fluids

With regard to fluid injection, how might an embalmer avoid dislodging coagula in the vascular system

Inject with a slow rate of flow

The term which describes an endocrine disease affecting the control of blood glucose levels.

Diabetes

In cases of advanced decomposition, what are one of the last "organs" to decompose

Arteries

The term used to describe an agent having an affinity for metallic ions such as calcium and magnesium.

Chelating agent

The term defined as the amount of radioactive material in which 37 million atoms disintegrate each second.

Millicurie

What are the two main classes of chemotherapeutic agents

Cytotoxic, Antimetabolite

These are specialized proteins that break down other proteins.

Enzymes

What is the term for the treatment of disease with chemical agents and drugs

Chemotherapy

Which organ would a nephrotoxic chemotherapeutic agent adversely affect

kidney -cause a breakdown in kidney function

Describe how a chelating chemotherapeutic agent affects the cell membrane.

They have an affinity for metallic ions, (particularly calcium and magnesium) and tend to lodge in the cell membrane, creating an impenetrable layer of calcium around the cell

With regard to embalming complications, what is the main effect of corticosteroids

They block the cell membrane by decreasing its permeability

This is the term describing the physical wasting with loss of weight and muscle mass caused by disease.

Cachexia

Describe the difference between the two general classes of chemotherapeutic agents.

Cytotoxic drugs act directly on (tumor) cells to bring about their death. Antimetabolite drugs substitute for an essential metabolite required by (cancer) cells for growth (depriving tumor cells of nutrition)

What are the five general classes of tranquilizers and mood-altering drugs

Sedatives; Stimulants; Tranquilizers; Narcotics; Anti-depressants

What are the "market" names of the two types of chemotherapeutic agents used to control diabetes

Tolbutamide (Orinase);
Chlorpropomide (Diabinase)

List some problems caused by the use of corticosteroids.

Cell membrane less permeable; fluid retention; mild to severe waterlogging of tissues; "protects" proteolysis enzymes (more rapid breakdown of proteins); gastrointestinal ulcerations and perforations of the gut; disseminated tuberculosis

List some problems caused by antibiotics.

Cotton-like circularity blockages (fungal growth); jaundice; bleeding into skin; poor penetration

How might an embalmer restore permeability to cell membranes affected by corticosteroids

Use of a pre-injection will restore some permeability; the surface-acting chemicals (surfactants) will facilitate entry of the preservative into the cells

This is the body's main center of detoxification.

The Liver - the hepatic circulation system

What are two ways embalming renders proteins resistant to catalytic enzymes

treating the proteins so they aren't susceptible to enzymes; rendering the enzymes inactive so they cannot act on other proteins

gas in the tissue caused by a puncture or tear of pleural sac or lung tissue - not caused by microbe and does not intensify after death

subcutaneous emphysema

What are the five gases that are found in the dead human body and cause distension

Subcutaneous Emphysema, Air from the Embalming Apparatus, Gas Gangrene, Tissue Gas, Decomposition Gas

The term used to describe a blister filled with serous fluid which is usually caused by tissue gas.

Bleb

What are the two categories of facial trauma

Injuries in which the skin is broken; Injuries in which the skin is not broken

Sallow color to the skin; excoriations on the skin from repetitive scratching due to Uremic pruritis; distinct odor from increased amount of urea, ammonia, etc.; edema; (harder to observe: Acidosis, Anemia, and Gastrointestinal bleeding)

signs of renal failure

The term used to define the postmortem evacuation of any substance from any external orifice of the body

Purge

The term used to describe a severe systemic itching sensation affecting kidney dialysis patients

Pruritis

What are four ways that pressure responsible for purge can develop

Gas, Visceral Expansion, Arterial Solution, Ascites/Hydrothorax

What two factors are needed for purge to occur

A substance to purge, and pressure on an organ to evacuate the material

How should the embalmer proceed when arterial solution is present in purge and drainage has stopped

A sectional injection will need to be implemented because a major fluid loss is taking place and distribution is not happening

How should the embalmer proceed if arterial solution is present in purge and drainage is occurring

Continue injecting until the preservative demand is met

List three types of mycotic infections.

Aspergillosis, Phycomycosis, Histoplasmosis

List two precautions all embalmers should take when a mycotic infection is suspected

do not compress the abdominal or thoracic cavity, handle bodies with gloves, use a sporicidal arterial fluid

When positioning an obese case, why is keeping the head high important

Easier to raise vessels and helps prevent purge

This type of gas usually stops when tissues are properly embalmed

Decomposition Gases

With regard to renal failure, how much more preservative chemical than normal is needed to achieve preservation

Six times more preservative chemical

What ingredient of stomach purge can dry and discolor the skin

Hydrochloric Acid

Define saprophytic fungi

obtains nourishment from dead organic material

Why is disinfection of instruments so important after treating cases of tissue gas and gas gangrene

Clostridium perfringens can be passed from one body to another via contaminated instruments

In the dead human body, what two factors are responsible for decomposition

Bacterial and autolytic enzymes

How would an embalmer create a "barrier" between an extremity exhibiting tissue gas and the rest of the body

By hypodermically injecting undiluted cavity fluid after sectional embalming is completed [Jack Adams recommends Dryene be injected around wrists and neck to keep gasses from entering hands and head]

Why might an embalmer raise the iliac artery to inject the leg of an obese case

because it is bigger and more superficial than the femoral artery

When re-embalming the unautopsied body, why might a multi-point injection be required

because cavity embalming already completed disrupts vascular system

When storing a casketed body for delayed viewing, should the casket be sealed or unsealed and why

The casket should be left unsealed because sealing the casket encourages mold growth

List some reasons for a delayed viewing

Family of deceased needs to make travel arrangements; Difficulty in locating the family of the deceased; Remains are being shipped to a foreign country; Family members are waiting for someone to be released from the hospital or waiting for an imminent death of another family member (accident cases)

What are two major concerns in long-term storage at a medical school

Desiccation and mold

Define a common carrier

any carrier required by law to convey passengers or freight without refusal if the approved fare of charge is paid; travels according to a set schedule

What are the three categories of shipping

Intrastate, interstate, international

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