Discolorations(Exam 2) Flashcards
Only those which normally are removed during routine embalming procedures and those which may be altered sufficiently during routine embalming procedures
Discolorations
A discoloration which appears on the human body during life
Antemortem Discoloration
A discoloration which makes its appearance on the human body only after the death of the body
Postmortem Discoloration
The fact that it may remain after life is extinct will not cause change of its classification
Antemortem Discoloration
Discoloration resulting from changes in blood composition, content, or location
Blood Discoloration
List the Classifications of discolorations according to occurrence
Antemortem
Postmortem
Easily removed by vascular injection and drainage
Intravascular Blood Discolorations
Not substantially reduced by vascular injection and drainage
Extravascular Blood Discolorations
Occurs within the vascular system
Intravascular Blood Discoloration
List the Antemortem Intravascular Blood Discolorations
Hypostasis
Carbon Monoxide Poisoning
Capillary Congestion
Occurs during the agonal period which results in a bluish purple; most noticeable in the elderly
Hypostasis
A cherry red blood discoloration on the body surface
Carbon Monoxide Poisoning
Blood will lose its ability to coagulate
Carbon Monoxide Poisoning
Blood tends to be in a liquid state causing the cherry red blood discoloration to be more intense
Carbon Monoxide Poisoning
If not embalmed soon after death, hypostasis will turn to hemolysis, causing postmortem stain
Carbon Monoxide Poisoning
List the progression from Hypostasis to Postmortem Stain
Hypostasis - Livor Mortis - Hemolysis - Postmortem Stain
Occurs during the agonal period, just prior to death
Capillary Congestion
Occurs when the arterial supply to an area of the body is increased
Active Capillary Congestion
Occurs when venous drainage from an area is decreased
Passive Capillary Congestion
Livor Mortis is what
A postmortem intravascular blood discoloration
The most common postmortem intravascular blood discoloration
Livor Mortis
Livor Mortis is also called
Cadaveric Lividity
Occurs outside the vascular system
Extravascular Blood Discoloration
List the antemortem Extravascular Blood Discolorations
Purpura
Ecchymosis
Petechia
Hematoma
Weak, diseased Vascular System
Purpura
Bruise from trauma
Ecchymosis
Extravasation of blood under the surface tissue
Ecchymosis
Pinpoint bleeding
Petechia
AKA Hemorrhagic Effusion
Petechia
A blood filled swelling
Hematoma
A collection of blood in a tumor like mass
Hematoma
A blood blister
Hematoma
Hemoglobin Decomposition
Postmortem Stain
AKA Laking
Postmortem Stain
If the postmortem interval is long enough and the blood remains liquid, especially aided by refrigeration, the body will from from livor mortis to this much faster
Postmortem Stain
How do you determine the difference between intravascular and extravascular blood discolorations?
Palpation - If the color changes at touch, it is intravascular; if not, it is extravascular
For an intravascular blood discoloration, _______ the vascular system of the discolored blood
Flush
To ensure the correct type and strength of the injection chemical to clear an intravascular blood discoloration, use
Anticoagulants
The quantity of the injection chemical to clear an intravascular blood discoloration should do this
Fill and flush all parts of the vascular system
You do not want the injection chemical to do this
Cause rupture of the vascular system, converting the intravascular discoloration to an extravascular
How is clearing an intravascular blood discoloration accomplished?
Low flow and low pressure
List the two things that will assist in increasing the flow to the discolored area and to assist the drainage from the discolored area
Raise and lower the part
Manually massage
The direction of the massage should always be
Towards the heart
If the discoloration is localized, this may be used
Sectional Arterial injection and venous drainage
This may be used to ensure vascular filling of injection chemicals
Increased pressure and Limited Drainage
This may aid in the removal of the blood
Distention of the vessels
Not removed without special treatment
Extravascular Blood Discolorations
These may help drain the discolored area of blood
Operative Aids during embalming
When the discolored areas are swollen, it may be
Incised directly or punctured and channeled
Channeling the discolored area will induce this
The direct outflow of extravasated blood and accumulated serums
___________________ of chemicals designed to bleach and preserve may be necessary
Sectional or local hypodermic injection
What chemical can be used to bleach and preserve the discolored areas of extravascular blood discolorations?
Phenol
What does phenol do?
Bleach and discolor
Discoloration may be lessened in intensity by applying surface compresses saturated with this
Phenol
A phenol saturated compress is also called
Surface Pack or Cavity Pack
Can you substantially reduce an extravascular blood discoloration?
NO
Examples of antemortem discolorations resulting from the administration of pharmaceuticals or chemotherapeutic agents include
Radium
Methylene Blue
Atabrine
Sulfa
Causes burns that will give red discolorations
Radium
Causes a distinct blue discoloration
Methylene Blue
How would the Methylene Blue discoloration be converted into green?
Too Strong Formaldehyde
Where will the Methylene blue discoloration first show if it is present in the vascular system?
In the sclera of the eye
Causes a brown discoloration
Atabrine
Causes a yellow discoloration, not jaundice
Sulfa
Drugs that affect or damage the liver will result in what?
Jaundice
Why would drugs affecting or damaging the liver result in jaundice?
Because of their toxicity
All drug discolorations are ___________
Antemortem
All drug discolorations are caused by
Specific drugs or dombinations of drugs
Most common drug discolorations
Jaundice over the entire body
Hemorrhagic Discolorations on the arms
Antemortem discolorations which occur during the course of certain diseases
Pathological Discolorations
Necrosis of tissue cells that undergo bacterial decomposition
Gangrene
Caused by venous congestion
Wet Gangrene
The affected part becomes becomes moist, dark, and putried
Wet Gangrene
Has the Odor of rotting flesh
Wet Gangrene
This type spreads rapidly
Wet Gangrene
Caused by the interference of the arterial supply of the blood
Dry Gangrene
Can result in a bluish black discoloration
Dry Gangrene
Has little odor as the bacterial activity is limited by dryness of the tissues
Dry Gangrene
The most common form of dry gangrene
Senile Gangrene
Frequently seen in the extremities of the body
Senile Gangrene
If odor is present with Gangrene, use
Spray Disinfectant
With gangrene, undamaged or unaffected tissue requires this
Regular strength injection, regular venous drainage procedures
With gangrene, it is possible to inject strong solution utilizing high index fluid or injectable cavity fluid in the affected area through
Multiple Injection Sites or hypodermically
This should be used for Gangrene, over the entire area
Cavity or topical preservative jelly
A cavity pack should be of a higher index, and should never contain this
Active Dyes
What makes Cavity Fluid uninjectable?
Phenol
Always use these with a Gangrene case
PLASTICS
What is the primary treatment purpose of gangrene?
To preserve, prevent leakage, and the escape of odor
Results in a yellowish discoloration of the body
Jaundice
Where is jaundice first detected?
Sclera of the eye
The yellow stain of jaundice is due to the present of this in the bile
Bilirubin
What does a strong formaldehyde arterial solution do to the jaundiced body?
TURNS IT GREEN
A strong arterial solution converts the bilirubin to what?
Biliverdin
The higher the HCHO index is, the ____________
Greener the body
In the embalming of all jaundiced bodies, this takes precedence over clearing the discoloration
PRESERVATION
Jaundice chemicals are
low index
What kind of injection/drainage is used for Jaundice?
Restricted Cervical Method
With injecting a Jaundiced case, there is a minimum of
Two Drainage Sites
If preservation demand is high with a jaundice case, use this
Restricted Cervical Method
If preservation demand is low with a jaundiced case, what are the sites to be used?
Femoral artery as injection
Right jugular and Right femoral for drainage
In which cases do you definitely not use the femoral artery?
Obese or Arteriorsclerosis
If you are using these chemicals, use the femoral artery
Active Dyes and Humectants
Excessive amounts of active dye are used to counter stain shades of
Green
Excessive amounts of active dye must enter these uniformly
Both Common Carotid Arteries
In a jaundiced case, this should be used to flush out as much blood drainage as possible
Pre-Injection
What kind of fluid should be used on a jaundiced case?
Jaundice Fluid
Often called two-step fluids augmented with an abundance of active dye
Bleaching Co-Inejection
What active dye is usually added to a bleaching co-injection
Eosin
These may be necessary to conceal discolorations
Opaque Cosmetics
A bronze discoloration resulting from loss of function of the adrenal glands
Addisons Disease
What is the treatment for Addisons Disease?
Low index or specialized arterial fluid
What would a high index fluid do to a body with Addisons Disease?
turn surface tissue dark
Chronic or acute disease of unknown etiology characterized by unrestrained growth of leukocytes
Leukemia
The embalming problem with leukemia is
Capillary Congestion and extensive Thrombosis
The capillary congestion and thrombosis involved with Leukemia is a problem because they may
limit drainage
Start with the right carotid artery and jugular, followed by multiple injection and drainage sites when necessary with this disease
Leukemia
With leukemia, this is not recommended because of the risk of water logging
Pre-Injection
What strength fluid should be used on a leukemia case?
Stronger with co-injection
Why use a co-injection on a leukemia case?
To assist distribution of fluid solution
Inflammation of the peritoneum due to the invasion of infectious organisms
Peritonitis
A bright red color is characteristic of the infected peritoneum lining the abdominal cavity
Peritonitis
The embalming problem for peritonitis?
Hypostasis to hemolysis will occur rapidly
Because of bacterial invasion, what was going on with the blood of a peritonitis case antemortem?
Unable to coagulate
Describe the blood of a peritonitis case?
Odor and dark in color
What injection method should be used for a peritonitis case?
Restricted Cervical Method
Utilization of this may be necessary for peritonitis
Multiple injection and drainage sites
For the national board, what is the cavity fluid formula?
1 16 oz bottle per 50 lbs
The Historical formula for Arterial fluid is…
1 Gallon per 50 lbs
1% index
Today’s standard for Arterial fluid is…
No set volume
2% index
70% tissue saturation
When should you aspirate a peritonitis case?
Immediately
What kind of cavity fluid should be injected immediately after aspiration for a peritonitis case?
Undiluted
Prior to dressing a peritonitis case, what should you do?
Re-aspirate and inject additional undiluted cavity fluid
If areas are not receiving fluid for a peritonitis, what should be done?
Hypodermic injection of strong solutions
What should be used to cover any surface discolorations
Opaque Cosmetics
This should be avoided with a peritonitis case
Pre-injection
What should you do instead of preinjection of a peritonitis case?
Use strong solutions and co-injections
Each time you re-aspirate, what should you do?
Add fresh cavity fluid
Tuberculosis of the skin
Lupus vulgaris
Characterized by patches which break down and ulcerate, leaving scars
Lupus Vulgaris
In some cases, a red butterfly rash may appear across the nose and cheeks
Lupus Vulgaris
Ulcers may be contagious to the embalmer
Lupus Vulgaris
Routine arterial injection of a lupus vulgaris case would have little effect on what?
Ulcers
An infectious contagious disease which causes an inflammation of the membranes of the spinal cord and/or brain
Meningicoccal Meningitis
A clear danger to the embalmer who should follow proper procedures for contagious and infectious diseases
Meningicoccal Meningitis
Pathological discoloration of Meningicoccal Meningitis may be in what form?
Rash
What kind of treatment is involved for meningicoccal meningitis
Opaque Cosmetics
Pathological discoloration will vary in both benign and malignant tumors
Tumors
This may be a problem if the tumor is necrotic
Odor
The tumor will seldom be preserved by this
Arterial Injection
The tumor must be ________ completely
Excised
How would an excised tumor area be preserved?
Topical Jelly, Cavity Pack, and/or hypodermically treated
A sallow yellow color to the skin
Chronic Renal Failure
What causes the sallow yellow color from Chronic Renal Failure
The presence of urochrome in the tissues
Chronic Renal Failure often accompanies this
Diabetes Mellitus
Diabetes Mellitus adversely affects what?
Distribution and diffusion of arterial fluid solution
Poor peripheral circulation with Chronic Renal Failure leads to this
Gangrene of the lower limbs
Poor peripheral circulation with Chronic Renal Failure also converts urea in the bloodstream to this
Ammonia
What is the problem with ammonia?
Neutralizes Formaldehyde
This should be completely avoided with cases of Chronic Renal Failure
Pre-injection
What kind of solution would be used in chronic renal failure cases
Strong solutions with co-injection
How many injection and drainage sites will be necessary for chronic renal failure cases
Multiple
If an area does not receive arterial fluid solution in a chronic renal failure case, what should be done?
Hypodermic Injection
What should be used to offset the sallow yellow color of a chronic renal failure case?
Co-injection with an active dye
Antemortem or postmortem discolorations which occur prior to or during embalming due to the deposit of matter on the body surface
Surface Discolorations
What mechanical method of removal is used to remove a surface discoloration
Using an abrading device and washing with suitable cleaning agents
What side of the sponge should be used to clear a surface discoloration?
SOFT SIDE
Why should the soft side of the sponge be used to clear a surface discoloration
Danger of desiccation marks
If the surface discoloration cannot be cleared mechanically, what should be done
Proper solvent and waterless hand cleaner or dry wash
Why should a surface discoloration be removed before embalmed
They may conceal signs of fluid distribution or diffusion
Most are more difficult to remove after tissues have firmed
Caused by the dehydrating effects of the air to damaged epidermis
Razor Burns
Razor burns have what kind of discoloration
Reddish brown
Razor burns become progressively __________
worse as time passes
The chemical combination of formaldehyde with hemoglobin results in the formation of a substance called methemoglobin, or
Formaldehyde Grey
Formaldehyde Grey is a bigger threat to whom?
People of darker complexion
With the passage of time, the skin color changes from pink to a dark slate grey
Formaldehyde Grey
Fluid burns due to excessively strong solutions
Desiccation Marks
Desiccation Marks are what color
Reddish-brown
Desiccation marks are usually seen where?
On the face
How can a discoloration be counteracted?
Complete flushing of the venous system
Describe how the body should be positioned while flushing out the venous system?
Heep the head elevated above the chest, and the chest elevated above the stomach
What should be used to impart a more life-like appearance
Active Dyes
This is a commonly used active dye
Eosin
Results from high formaldehyde index solutions converting bilirubin to biliverdin in a jaundiced body
Green Discoloration
Sometimes caused by an acidic environment
Green Discoloration
What is the primary concern with embalming a jaundiced case?
Preservation
Result from damage to tissue and capillaries during the enucleation
Eye Enucleation Bruises
How would you correct Eye Enucleation Bruises
Cavity fluid pack with bleaching cavity fluid followed by opaque cosmetics
Postmortem discolorations which are due to the action of bacterial and/or autolytic enzymes on the body tissues
Decomposition Changes
May be progressive color changes in the tissues if these are not inhibited
Enzymes
Describe the decomposition discolorations
Yellow to light green to dark green to blue black to marbling
Signs of Decomposition
Color Odor Purge Skin Slip Accumulated Gases
Seen in the sclera of the eye due to postmortem dehydration
Tan Discoloration
Associated with livor mortis eventually followed by postmortem stain
Red to Purple
Decomposition of the arterial system causing the vasa vasorum to deteriorate changing the artery to this color
Maroon
A spot about the size of a silver dollar will appear over the cecum indicating the activity of E. Coli
Green
What is the only true sign of death?
Decomposition
Any sign of decomposition, what kind of arterial fluid should be used?
High Index
If not properly embalmed, what will happen to the green discoloration?
It will spread over the entire body
Any traumatic or pathological change in the structure of the skin
Skin Lesions
The skin lesion must first be disinfected. How?
Phenol gel, cavity pack, bleaching agents
To prepare a lesion for post embalming restorative treatment, what must be done?
Dry it!
For the purpose of embalming, what are the four classifications of skin lesions?
Skin unbroken but discolored
Skin scaling as in exanthematous disease
Skin broken separated from the body
Pustular or ulcerative Lesion
Examples of the skin unbroken but discolored lesion includes
Allergic Reaction, Trauma, Tumors
Recommended treatment for an unbroken but discolored skin lesion?
Strong arterial solution and surface compress
Examples of skin scaling as in exanthematous disease skin lesions include?
Acidosis, seborrhea, eczema, psoriasis, healing sunburn, measles, chicken pox
Recommended treatment for a skin scaling skin lesion during arterial injection?
Heavy coat of massage cream or petroleum jelly over exposed areas, face and hands
Recommended treatment for skin scaling skin lesion after arterial injection?
Remove massage cream
Use dry wash
Remove scaling skin
Topical Phenol Jelly
Examples of the skin broken separated from body skin lesion?
Abrasions, blisters, desquamation
Example of Pustular or Ulcerative Lesions?
Boils, carbuncles, furuncles, ulcers, pustules, fever blisters
What is the most dangerous Pustular or Ulcerative Lesion?
Herpes, Decubitus Ulcers
Initially decubitus ulcers are aseptic. Eventially, what do they become?
Streptococcus or staphylococcus
If there is a blockage in the ARTERY, what would you use?
Preservative Powder
If there is a blockage in the VEIN, what would you use?
Hardening Compound
This is the most important goal in embalming ALL bodies
Preservation
Redness of the skin
First Degree Burn
First Degree Burn is AKA
Hyperemia
Blistering and redness
Second Degree Burn
Charred Tissue
Third Degree Burn
Disintegrated Tissure
Fourth Degree Burn
Initially intravascular but becomes extravascular quickly
Carbon Monoxide Poisoning
Bright cherry red color to the blood
Carbon Monoxide Poisoning
Low blood viscosity, intense livor mortis
Carbon Monoxide Poisoning
Rapid Postmortem Stain
Carbon Monoxide Poisoning
Low blood viscosity, intense livor mortis, head faced downward, livor and stain
Drowning
Point of contract, point of exit burn marks can be present
Electrocution
Blood will coagulate
Electrocution
Little livor mortis, paleness to skin surfaces
No blood discoloration
Exsanguination
Eyelids can show ecchymosis, swelling of eye area when injury is to head or face
Gunshot Wounds
Intensive livor mortis in facial tissues; some capillary rupture showing petechial discolorations; No blood present in facial tissues
Instantaneous Rigor Mortis
Hanging
Loss of blood, little livor mortis
Ecchymosis and bruising at affected areas
Mutilation - Trauma
Variable - from generalized conditions such as jaundice and cyanosis to localized discolorations such as caustic burns or petechial hemorrhage
Poisons
Low blood viscosity
Intense Livor Mortis
Postmortem Stain speeded
Dehydration of mucous membranes and skin surface after long exposure to cold air (circular)
REfrigeration
Because of medico-legal investigation, postmortem interval is usually longer. What are the 2 solutions recommended for these conditions?
Restricted cervical and drainage (non-autopsied)
Special purpose high index arterial fluids (30-38 index)
In an autopsy case, what arteries are raised?
Carotids
Subclavians
External Iliacs
What is the difference between a medical examiner and a coroner?
A medical examiner looks at the cause of death to find the manner of death. A coroner just wants the cause.
What should NEVER be done to an autopsied case?
Pre-Injection
In an full autopsy case, much of the blood discolorations will disappear. Why?
Because of the Evisceration process
List the major problems caused by refrigeration
Hypostasis to hemolysis occurs rapidly Fluid distribution and diffusion problems Surface dehydration Distension of the viscera, causing purge Capillary rupture
Where is surface dehydration most severe?
Fingertips, lips, eyelids, nose
Formation of high moisture content in some body tissues because the serum portion of the blood leaves the blood vascular system and gradually makes its way to the surface of the body
Postmortem Edema
List the major characteristics of refrigeration
Postmortem Edema
Blood thickens and agglutinates
Slow reaction between body proteins and preservative solution
Solidify subcutaneous fatty tissues
Light pink color will occur resulting from hemolysis
Slows postmortem chemical and physical change
What should be used to thaw a cold body?
Cold water
Why should you never use hot water to thaw a cold body
It could cause coagulation of blood and desiccation marks
What injection method should be used for a refrigerated body?
Restricted Cervical Method
What index should be used for a refrigerated body?
High index
