Agonal Period and Pre-embalming Changes Flashcards
Agonal Period
Period immediately BEFORE somatic death.
The body experiences an expanding inability to sustain the physiologic and metabolic processes necessary for life. Considered to be moribund or actively in the process of dying
Moribund
Actively in the process of dying
**TEST QUESTION**
Physical observations during agonal period
Presence of death rattle, respiratory gurgling caused by excessive mucous accumulated due to loss of cough reflex.
Semi-convulsive twitches called a death struggle.
Somatic Death
Death to the organism as a whole.
When the body can no longer support vital life functions.
First in a series of events resulting in postmortem cellular death.
Clinical Death
Cessation of spontaneous respiration and heartbeat heralds the beginnings of clinical death.
A person can still be resuscitated during this phase
THIS IS THE ONLY PHASE OF SOMATIC DEATH THAT IS REVERSIBLE test question
Brain Death
A result of prolonged cessation of respiration and heartbeat.
Brain and nervous system cells begin to die within 5 min w/out oxygen.
Biological Death
When simple life processes of various organs and tissues of the body cease, it is referred to as biological death.
Restoration of respiration and circulation are impossible at this point.
Postmortem Cellular Death
Begins when…
- individual cells have used up stored elements, or
- When they’re overcome by automatic processes and die.
Cells which are more specialized and/or active will respond more quickly to decreases level of O2 or nutrients.
Changes During the Agonal Period
Will dictate which measures the embalmer must take to establish effective preservation
Agonal Changes include:
1) Temperature of the body
2) Ability of the body to circulate blood
3) Moisture content of tissues
4) Translocation of microorganisms within the body
Agonal Algor
Cooling off the body just prior to death
test question
- Often seen in elderly people dying slowly
- A result of metabolism and circulation slowing
Agonal Fever
Increase in body temperature just before death.
- Common in persons dying of infections, toxemia, or certain types of poisoning
- Elevated temperatures stimulate microbial growth
Agonal Hypostasis
Involves the settling of blood into dependent tissues of the body.
-A result of slowing down circulation and gravitation of fluids to lower places
Agonal Coagulation
Clotting of formed blood elements due to the lack of movement within the vascular system.
Agonal Capillary
Expansion happens when the body, in an attempt to obtain more oxygen, opens the pores in the walls of capillaries to let more O2 rich blood into tissues.
Agonal Moisture Changes
Best to consider in terms of a “shift” in moisture from one place in the body to another.
One of two things happen:
1) Agonal Edema
2) Agonal Dehydration
Agonal Edema
Causes an increase in the amount of moisture or fluids into the tissues and body cavities.
Translocation of Microorganisms
Begins as an organism loses its ability to keep them in check. Normally contained to specific body areas by natural body defenses.
Microorganism move for 3 reasons:
1) They have natural motility
2) They’ve entered the blood stream and circulate to other areas of the body
3) Gravity moves them to other places during hypostasis or other shifts in tissue moisture
Postmortem Physical Changes
Changes in the body brought about by physical forces such as gravity acting upon it.
Postmortem Chemical Changes
Changes in the body that occur when chemicals react with other chemicals to form new compositions (i.e. the autolytic processes of cells)
Algor Mortis
Postmortem cooling of the body
Rate of algor mortis cooling depends on intrinsic or extrinsic factors such as:
1) Ratio of surface area of the body to body mass
2) Body temperature at the time of death
3) Some combination of the first two
Algor Mortis
Intrinsic factors:
Circumstances that affect the body that originate from within the body itself
1) Body size
2) Elevates or depressed body temperature at the time of death
Algor Mortis
Extrinsic factors:
Things that are in the environment that affect the body from the outside.
1) Body coverings
2) Temperature of the environment
Postmortem Hypostasis
Process of settling of the blood AFTER death. It’s the PROCESS, not the discoloration itself.
1) Can be affected by ligatures or other restrictions that inhibit free movement of blood within vascular system, known as contact pallor
2) Thinner blood moves more easily
Factors influencing postmortem hypostasis:
- Temperature
- Medication
- Disease processes
Livor Mortis
1) Postmortem intravascular discoloration
2) Appears within 1/2 to 2 hours after death
3) Result of hypostasis
4) aAlso called postmortem lividity or cadaveric lividity
5) Begins as a dull reddish patch that turns reddish-blue
6) Can be removed using the embalming process
Two factors that affect the degree of livor mortis:
1) Blood volume
2) Blood viscosity
What is postmortem dehydration?
Loss of water from body tissues and fluids by surface evaporation
Factors involved with postmortem dehydration
1) Surface evaporation
- Passage of air currents over the surface of the body
2) Gravity or Hypostasis
- Movement of fluids from higher areas of the body to lower areas of the body.
Postmortem edema
- Fluids which have gravitated downward within the body have engorged some part of that body
- Typically lower extremities and distal portions of the arms
Imbibation
The process whereby dependent cells draw moisture into themselves, becoming edematous
Sludge (Cake batter!)
- Extremely viscous blood that results from postmortem dehydration
- Formed blood elements that clump together and are very difficult to remove
Dehydration causes
- Surface discolorations
- Increased blood viscosity
- Causes when liquid portion of blood gravitates down and leaves the more solid portion residing within the vessels
- Agglutinated blood cells can clog smaller vessels during injection and hinder blood removal.
Translocation of microorganism factors:
1) Chemical and physical changes
2) Movement and positional changes in the body
3) Passive recirculating of blood from contaminated body sites
4) Thrombus (blood clot) fragmentation and relocation
5) Inherent true mobility of many intestinal bacilli
Clostridium Perfringens**
- Most troublesome organism to the embalmer
- Gas producing anaerobic bacillus responsible for the production of true tissue gas (embalmers worst nightmare)
- If present, tissue distention to a point beyond recognition can occurs within 1 to 2 hours
- All instruments used on C.perfingens cases must be thoroughly decontaminated
Postmortem Caloricity
Heat produced after death due to a sustained metabolism which occurs when there’s still oxygen available for cells to use
Two phases of caloricity are:
1) Anabolism: the building phase
2) Catabolism: the breakdown phase
Postmortem Stain
- Extravascular discoloration due to hemolysis after death
- Red blood cells that have settled due to livor mortis breakdown that release their hemoglobin and decomposes into globin and heme
-Begins between 6 to 10 hours after death
What cannot be removed via arterial injection?
**
Postmortem stain.
The heme that moves through the walls and pores of capillaries and stains the tissues a reddish color
Normal body pH is? ***
7.4 pH (slightly alkaline)
Rigor mortis happens between 2 events:
**
1) Primary flaccidity: total muscle reaction after death
2) Secondary flaccidity: muscle relaxation after rigor has passed
Rigor will usually pass between ______ from the unembalmed body
36 and 72 hours
First muscle to have rigor mortis
Eye
Rigor mortis won’t happen below ____ and above ____
32F and 120F
Rigor mortis ideal temperatures
Between 98 and 100 degrees Fahrenheit
Order of Decomposition
- Cells
- Tissues
- Organs
- Vascular
Classic signs of decomposition
1) Color
2) Odor
3) Skin slip
4) Gases
5) Purge
Can be preset to without all 5 signs being present
Types of purge
- Stomach purge
- Lung purge
- Brain purge
What is decomposition?
A breakdown of the peptide linkages between proteins via catalytic enzymes
