Embalming II Final (3.1-3.7)

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
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
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
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.
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
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.
The term used to describe inflammation of a vein.
This is a disease caused by the spirochete Treponema pallidum.
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.
What is ischemia
Restriction in blood supply generally resulting in damage or dysfunction of tissue
The term describing an increase in red blood cells.
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
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.
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
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.
In cases of advanced decomposition, what are one of the last "organs" to decompose
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.
What are the two main classes of chemotherapeutic agents
Cytotoxic, Antimetabolite
These are specialized proteins that break down other proteins.
What is the term for the treatment of disease with chemical agents and drugs
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.
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.
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
The term used to describe a severe systemic itching sensation affecting kidney dialysis patients
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
Define a private carrier
an individual or company that transports only in particular instances and only for those with whom it chooses to contract
What are some occasions in which re-embalming would be necessary
Fluid not distributed to all areas; Too little solution was injected; Concentration of fluid was too low and preservative demand not met; Injected solution was neutralized by body chemistry; Rigor mortis was mistaken for tissue fixation
What are three major factors that affect the degree and length of preservation
Condition of body at time of preparation; Embalming thoroughness and chemical formulations; Aftercare
What are some objectives accomplished by long-term preservation
Families have assurance of professionally prepared loved one and subsequent peace of mind; Greater value, function and purpose of protective products surrounding the deceased
Describe the differences between and air tray and a combination air tray
an Air Tray is for casketed remains, only the bottom is wood, sides, ends and top are made of heavy-grade cardboard. A Combination Air Tray is a wood-based container with sides, ends and inside top all made of wood with an exterior cardboard covering
List some responsibilities of a shipping funeral home
Removal from place of death; Embalm and thoroughly preserve remains; Prepare an embalming case report; Secure necessary documents; Arrange for private or common carrier transportation; Communicate to receiving funeral home condition of remains and time schedule of carrier
Why should a casket not be completely sealed before shipment on a commercial airliner
to allow for air pressure changes inside the cargo hold of the airplane
How would a funeral director obtain the regulations required to ship a body to a foreign country
Through the local consulate of the foreign country
According to the text, how long might a funeral director expect the processing of international shipping to take
Anywhere from 5 to 14 business days
This is the term used to describe a container that is airtight and impervious to external influence; or one that is completely sealed by fusion or soldering
Hermetically sealed
What are some (generally) required documents needed for international shipping
Certified copy of the Death Certificate; Non-contagious disease letter; Embalmer's affidavit; Non-contraband letter
List some responsibilities of a receiving funeral home
Avoid making promises to family about time/date of funeral services; Cooperate with shipping funeral home in providing statistical information ; Be prepared for unexpected delays
What are some embalming restrictions when shipping to Israel
Israel does not require embalming, but if embalmed, the remains must be embalmed by the gravity method and no drainage taken