Embalming III Quiz 2 Flashcards

1
Q

What is OPTN?

A
  • The National Organ Procurement and Transplantation Network
  • A national computer registry for matching donor organs to waiting recipients
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2
Q

What is UNOS?

A
  • United Network for Organ Sharing
  • UNOS manages OPTN (the computer system for organ procurement)
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3
Q

What are OPOs?

A
  • Organ Procurement Organizations
  • UNOS cooperates with OPOs throughout the county to place organs at the local, regional, and national level
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4
Q

Who regulates tissue donation?

A

Tissue donation is regulated by the US Food and Drug Administration (FDA)

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5
Q

Procedure for Donation

A
  1. Hospital reports to OPO (all hospital deaths) and of the donor and their imminent death/ death within 1 hour of their passing. ME reports those who haven’t died in hospitals
  2. OPO assesses the potential donors suitability (history and medical examination)
  3. Donor registry is checked to see if the potential donor is already registered to donate
  4. If the potential donor has not signed to donate, the next-of-kin must consent
  5. OPO tell NOK how the donation process works asks what they want donated
  6. Donor organs/tissues are removed
  7. Organs/tissues are matched to potential recipients and sent to the institutions for transplantation or preservation
  8. Donor is released to the funeral home
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6
Q

What law allows one to donate themselves?

A
  • The Revised Uniform Anatomical Gift Act (UAGA)
  • Allows those 18 and up to donate their organs/tissues for medical purposes
  • A person who signs to have themselves donated signs a “first person consent”. It is legally binding
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7
Q

What can brain-dead, ventilated individuals donate?

A
  • Those brain-dead, on a ventilator with a beating heart can be an organ donor: heart, lungs, liver, kidneys, pancreas and intestines
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8
Q

What can individuals not on a ventilator donate?

A
  • One who was never on a ventilator and does not have any cardiac or respiratory activity can donate tissues only: eyes/corneas, blood vessels, cartilage, skin, bone, pericardium, and soft tissues
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9
Q

How is the preparation of organ donors and trunk autopsy individuals similar?

A
  • The incision for the median sternotomy is a U or V incision
  • Incision for an autopsy is a Y incision
  • Both the U/V and Y incisions allow for easy access to vessels for embalming
  • Hypodermic injection and surface embalming will need to be used
  • both require restoration of the trunk cavity
  • Leaking may be an issue for both
  • delay between death and embalming will require a higher index arterial
  • Tracer dye can be used to indicate distribution
  • Thorough blood drainage is expected
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10
Q

How is the preparation of organ donors and trunk autopsy individuals different?

A
  • Donors may still have some organs and internal structures intact in the trunk
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11
Q

How are eyes enucleated for donation?

A
  • Facial area is sterilized and draped
  • Head of donor is elevated to prevent blood pooling
  • specialist uses a speculum to open the eyelids
  • specialist removes the eye
  • Fills the orbital cavity with cotton and eye cap and closes eye
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12
Q

How will an embalmer treat the orbital cavity of a donor?

A
  • Apply a thin layer of massage cream/lanolin spray
  • Remove the packing the specialist put in
  • Put in cotton soaked in preservative
  • Put in an eye cap for natural form
  • Arterially embalm
  • Remove eye cap and cotton
  • Dry and cauterize the orbit
  • Put a trocar botton in the base of the orbit
  • Put incision powder over the base of the orbit
  • Fill orbit with mastic compound/cotton
  • Put in eye cap
  • Create natural eye closure
  • Secure eye closure with an adhesive cream or glue
  • Apply a thin amount of lanolin spray to prevent dehydration
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13
Q

How is skin removed for donation? (parital/split thickness)

A
  • A dermatome instrument is used: removes thin layers of skin
  • uses layers 10-20/1000 of an inch thick
  • Split thickness skin is removed from the anterior and posterior sides of the body
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14
Q

How is skin removed for donation? (full-thickness)

A
  • Free-hand method is used: dermal and adipose/fat tissue is removed
  • Donor is placed in a prone position (flat and face downward)
  • Recovery site is sterilized and shaved
  • Drapes cover parts not recovered
  • Specialist may cut down to the fat or muscle layer
  • After the recovery, the donor is bathed, absorbent pad placed under them, and put in a body bag
  • Skin removed from abdomen, back and thighs
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15
Q

Who receives full-thickness skin donations?

A
  • for children (better chance of skin living), those with hernias, extensive trauma, cancer
  • Full-thickness is used for facial, joint and hand wounds because the outer characteristics of the skin are available
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16
Q

Who receives partial/split thickness skin?

A
  • Split thickness donations are used to create a bandage to decrease fluid loss and infection.
  • for burn victims
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17
Q

How will an embalmer treat the skin recovery area of a donor?

A
  • Two people should help get the deceased on the table.
  • put an absorbent material under them because much leakage may occur.
  • Treat the recovery sites with a phenol-based liquid or gel
  • Arterially embalm: Use a high index fluid
  • After the embalming is complete, look for untreated areas and use hypodermic injection and/or surface embalm any untreated areas.
  • Apply a coating of preservative gel over the areas
  • After all the embalming is complete, be sure to prop the deceased up on body boards to allow airflow under them.
  • Airate the room and allow tissues to dry over night
  • Before dressing, apply an absorbent preservative pad to the deceased, wrap area with plastic and put on a plastic union-all.
  • you can add absorbent powder in the union-all if leakage is persistent
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18
Q

What fluid should be used for donor patients?

A
  • higher index fluid and mix in a moderate to strong concentrated solution
  • Hypertonic solution of 2% and above
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19
Q

Manual Aids to Help Distribution

A
  • Lowering hands below the table
  • Squeezing the sides of the fingers and the nailbeds
  • Bending, rotating, and flexing of limbs
  • Elevation of a swollen area
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20
Q

Mechanical Aids to Help Distribution

A
  • Drainage instruments
  • Injection pressure
  • Pulsation
  • Rate of flow adjustments
  • Diameter of the arterial tube help to control the speed and volume of embalming solution
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21
Q

Operative Aids to Help Distribution

A
  • Invasive treatments such as channeling, wicking, incising
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22
Q

What are special-purpose arterial fluids?

A
  • Fluids specifically formulated for special/distinct embalming cases/situations
  • High Preservative demand, jaundice (5 - 9 % & phenol), renal failure, extensive burns or decomposition
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23
Q

Non-hardening Index Arterial Solutions

A
  • under 5-15 index
  • Low index
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24
Q

Semi-hardening Index Arterial Solutions

A
  • between 16-25 index.
  • Mild Index
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25
Q

Hardening Index Arterial Solutions

A
  • over 26-36 index
  • Strong index
    Embalming fluids with high formaldehyde content for use on extremely difficult cases or where the embalmer desires a great degree of rigidity.
26
Q

what is jaundice fluid?

A

A fluid used in special conditions that is phenol based, has a low HCHO index and doesn’t cause much coagulation (firming)

Low HCHO
Phenol - Bleaching Agent
Reducing Agents
Cosmetic Dyes (usually alot)

27
Q

What type of arterial solution is needed for delayed embalming

A
  • 30+ index
  • special purpose fluids
  • co-injection fluids
  • normal solution for first half gallon and all proceeding should be hypertonic 2% strength of higher
28
Q

What is rigor mortis?

A
  • a postmortem change resulting in the stiffening of the body muscles due to chemical changes in their myofibrils
  • Begins 2-4 hours after death
  • Fully established 6-12 hours after death
  • Passes 36 hours after death
  • affects all muscles in the body (but not equally; some places can have more/less rigor than other parts)
29
Q

Pre-Rigor Stage Embalming

A
  • Great absorption of preservatives
  • Firming is good
  • Preservatives and proteins easily link
  • Tissue is alkaline- best pH range for embalming
30
Q

Active Rigor Stage Embalming

A
  • Little absorption of preservative
  • firming is due to tissue swelling
  • Proteins are engaged in rigor mortis
  • Vessel lumens are reduced, deceased distribution
  • Muscles contracted, so fluid doesn’t reach muscle fibers well
  • Acidic pH retards absorption of preservative
31
Q

Post-Rigor Stage Embalming

A
  • Great Preservative Demand
  • Firming is difficult to achieve
  • Proteins are disarranged and broken, many places for preservative attachment
  • Alkaline pH increases preservative absorption
  • Nitrogenous wastes increase the need for preservative
32
Q

Skatole

A

Odor of feces

33
Q

Putrescine

A

Odor of rotting fish

34
Q

Cadaverine

A

odor of rotting fish

35
Q

Dimethyl Disulfide

A

odor of foul garlic

36
Q

Dimethyl trisulfide

A

odor of foul garlic

37
Q

Hydrogen sulfide

A

odor of rotten eggs

38
Q

Methanethiol

A

odor of rotten cabbage

39
Q

What odor does formaldehyde and ammonia make

A

odorless hexamethylene

40
Q

Clostridium perfringens

A
  • Anaerobic bacterium
  • causes tissue gas
  • causes foul odor
41
Q

Advantages to short-term refrigeration

A
  • Slows the progression of rigor mortis
  • Slows decomposition
  • Maintains blood in a liquid state
42
Q

Disadvantages of long-term refrigeration

A
  • Body bags trap heat and moisture from leaving the tissues causing condensation in the bag
  • Desquamation, discolorations, gas accumulation
  • increased capillary permeability
  • rupture of capillaries during arterial injection
  • tissue structure breakdown (result of autolysis and bacterial enzymes)
  • Increased coagula in the vascular system; increased blood viscosity
43
Q

Postmortem caloricity

A

A slight elevation of body temperature after death because (catabolic phase) metabolism continues until the oxygen surplus in the body is exhausted

44
Q

Petechiae

A
  • small pinpoint skin hemorrhages
  • extravascular stain
45
Q

Purpura

A
  • Widespread areas of hemorrhage into the skin or mucous membranes
  • extravascular stain
46
Q

Liver Mortis

A
  • purplish-blue discoloration of the skin in the dependent parts of the body due to the collection of blood in skin vessels caused by gravitational pull.
  • Intravascular stain
47
Q

Tardieu Spots

A
  • Pinpoint petechial hemorrhages visible in the areas of advanced livor mortis
  • extravascular stain
  • will see signs of petechiae and purpura
48
Q

Autolytic Enzymes and their products

A
  • The body’s own digestive enzymes (e.g. lysosyme) that are capable of destroying body cells (autolytic decomposition.)
  • Autolytic enzymes cause: 1. capillaries to break down
    2. tissue structure weakening
49
Q

How do you clear intravascular stain?

A
  • Arterial injection and blood drainage
  • Massaging/pressing
50
Q

What are 3 problems associated with delayed embalming?

A

-poor or uneven distribution
-swelling and distention
-increased preservation demand

3D’s of delayed embalming
Distribution
Distention
Demand

51
Q

What are the conditions that predispose a body to the problems associated with delayed embalming?

A

-bodies embalmed in a state of rigor mortis
-bodies that have been refrigerated for a long period of time (long-term refrigeration)
-bodies displaying early signs of decomposition

52
Q

Hyperglycemia

A

Excess sugar in the blood

53
Q

Hypoglycemia

A

Not enough sugar in the blood

54
Q

Linen suture cord vs cotton suture cord

A

Linen suture cord is much stronger than cotton suture cord

55
Q

Best Suturing Practices

A
  • use a double curved postmortem needle and linen suture cord
  • when pulling the cord to tighten the stitches, pull on the thread, not the needle
  • the thread may weaken or break from repeatedly running against the eye of the needle
56
Q

Suturing Autopsies

A
  • start the suture at the pubic synthesis
  • the a knot at the end of the suture
  • use baseball suture
  • suture tight enough that no ligature can be seen
  • pull sutures tightly after 2-3 stitches
  • single or double thread cotton suture thread can be used or single linen suture thread
  • use a lock stitch every 4-5 inches
  • when you reach the middle, remove the gathering forceps/ temporary suture and suture up both sides
  • apply incision seal powder
  • you can use the inversion/worm suture for those who have died from wasting diseases and the skin tears with the baseball suture
57
Q

Fontanelles

A

soft spots on an infant’s head where the bony plates that make up the skull have not yet come together

58
Q

Positioning Practice when embalming for those who had arthritis

A
  • retracting limbs can cause abrupt positional changes during embalming
  • use body bridges, head blocks or towels under the shoulders and legs
  • because some areas may be limited, The common carotid may be the best option.
59
Q

Positioning Practice when casketting for those who had arthritis

A
  • The casket bedding and pillows can provide support and create comfortable positioning
  • The neck may be difficult to position
  • Apply firm pressure to the arthritic areas to alter positioning
  • Tear tendons in atrophied muscles for severe conditions (not recommended)
  • Leave the arms and legs in original positions could be acceptable
60
Q

Types of partial autopsies

A
  • pulmonary embolism: exploratory incisions made along the medial and posterior areas of the lower legs
  • Overdose: tissue excision of keloid scars/fibrous tissue forms from repeated use of hypodermic needles
  • Cranial only: cranial cavity is open and examined, and the brain is removed
  • Abdominal cavity only: one or more organs may be removed
  • Thoracic cavity only: one or more organs may be removed