Fourth Quarter Final Exam Flashcards
Postmortem Changes
- Algor mortis
- Dehydration
- Hypostasis
- Livor mortis
- Increased blood viscosity
- Endogenous invasion of microorganisms
Postmortem Changes (Chemical)
- Postmortem caloricity
- Change in body pH
- Rigor Mortis
- Postmortem stain
- Decomposition
Complications from time delay between death and embalming
- Nonuniform distribution
- Tissues easily swell
- Increased preservative demand
When to use hypotonic solutions
- Dehydrated cases
- to prevent livor from staining
When to use hypertonic solutions
Edematous cases to reduce moisture
When to use high-index solution
-Delayed embalming
-Extended refrigeration/frozen
-Extensive drug treatments
-Trauma
-Decomposition
-Gangrene/Tissue Gas
-Edema
-Obese
-Renal failure
-Difficulty firming
-Bloodstream infections
Instant Tissue Fixation
- Embalming technique that uses a very strong arterial solution (often waterless)
- The solution is injected under high pressure in spurts into a body area
- This technique is used to limit swelling
Rigor Mortis Definition
- Postmortem stiffening of the body muscles by natural processes
- Begins 2-4 hours after death
- Fully established 6-12 hours after death
- Passes 36 hours after death
What are the three stages of rigor mortis?
- Primary Flaccidity: the period in which the rigor develops and is hardly noticeable
- Active Period: muscles noticeably stiffen
- Secondary Flaccidity: rigor has passed from the body
What causes rigor mortis?
- Rigor mortis is a natural process that occurs in all the dead
- It affects all muscles in the body (unequally)
- Begins when the body cannot replenish adenosine triphosphate (ATP)
What are the complications associated with rigor mortis?
- Higher preservative demand if embalmed during rigor
- Body absorbs little preservative
- Higher strength solutions will be needed to compensate for the poor absorption
- Positioning challenges
- Difficult setting features
- Poor fluid distribution
- Poor drainage
- Tissues easily swell
- Tissues may not firm well after the passage of rigor due to poor absorption during rigor and lack of sufficient volume of arterial solution injected
- Tissue firmness caused by rigor can be a false sign of tissue fixation by the preservative
Classifications of Discolorations According to Cause
- Blood discolorations
- Drug and therapeutic discolorations (pharmaceutical agents)
- pathological discolorations
- Surface discoloring agent discolorations
- Reactions to embalming chemicals on the body
- Decomposition changes
Classifications of Discolorations According to Time of Occurrence
- Antemortem
- Postmortem
Intravascular Discolorations
- Discoloration of the body within the blood-vascular system
- These discolorations can be removed through arterial injection and drainage
Extravascular Discolorations
- Discoloration of the body outside the blood-vascular system
- These discolorations can not be removed through arterial injection; must be bleached and cosmetized over
Antemortem, Intravascular Blood Discolorations
- Hypostasis of blood (blue-black discoloration)
- Carbon Monoxide (CO) poisoning (cherry-red color)
- Capillary congestion (hypostatic, active or passive)
Antemortem, Extravascular Blood Discolorations
- Ecchymosis: large bruise caused by the escape of blood into the tissues
- Purpura: flat, medium-sized hemorrhage beneath the skin
- Petechia: small pinpoint skin hemorrhages
- Hematoma: swollen blood-filled area within the skin
Postmortem Intravascular Blood Discolorations
Livor Mortis: (Cadaveric Lividity) red-blue discoloration resulting from hypostasis of blood
Postmortem Extravascular Blood Discolorations
- Postmortem Stain: blood discolorations as a result of hemolysis
- Tardieu Spots: Tiny petechial hemorrhages result from small vessel ruptures as blood pools in dependent body areas; accompanies livor mortis
Formaldehyde Gray
- A gray discoloration that occurs after embalming due to the creation of methemoglobin (HCHO and blood)
- Can be intravascular or extravascular
What are the signs of embalming diffusion?
- Dye in tissue
- tissue firming
- drying of tissue
- rounding of fingertips, tips and toes
- mottling of tissue (bleaching)
Anaerobic Bacteria
bacteria that do not need oxygen; involved with putrefaction
Aerobic Bacteria
Bacteria that do need oxygen; involved in decay
Desquamation
- “Skin Slip”
- The separation of the superficial layer of the skin (epidermis) from the deeper dermal layer
- Can be a sign of early decomposition
Restricted Cervical Injection
- Method of injection where both the common carotid arteries are raised
- Recommended to use when varied solution strengths need to be used for the face and trunk
- Recommended to give better control over the fluid entering the face
Skin
- The cutaneous layer of tissue forming the natural outer covering of the body
- Two Layers:
1. Epidermis: superficial layer
2. Dermis: inner layer
Treatments for Skin Discolorations
- Intravascular discolorations are resolved through thorough arterial embalming and drainage
- Extravascular discolorations are resolved through the use of hypodermic and surface embalming (bleaching)
Different Types of Embalming
- Arterial Embalming
- Cavity Embalming
- Surface Embalming
- Hypodermic Embalming
Jaundice
- A condition characterized by an excessive concentration of bilirubin in the skin and tissues and a deposition of excessive yellow bile pigment throughout the body
Pharmaceutical Discolorations
- Antemortem discolorations as a result of continued use of pharmaceutical and chemotherapeutic drugs
- Wet Gangrene: bright red to black
- Dry Gangrene: dull reddish to black
- Jaundice: yellow
- Addison Disease: bronze darkening
- Leukemia: skin hemorrhages
- Meningitis: reddish purple rash of petechia and purpura
- Tumors: local discolorations
- Lupus: malar butteryfly rash over the bridge of the nose and cheeks
Treatments for Jaundice
- Jaundice Fluid
- Pre-Injection
- Mild Arterial Solution
- Non-formaldehyde Fluid
- Bleaching Co-Injection Fluid
- Cavity Fluid
Histoplasmosis
- Disease caused by Histoplasma capsulatum
- Infection can be flu-like to severe
- 4 types: acute pulmonary, chronic pulmonary, acute disseminated, chronic disseminated
Chronic Pulmonary Histoplasmosis
- Progressive form
- Can cause granulomatous inflammation and caseation necrosis and cavitation
- Usually misdiagnosed as pulmonary tuberculosis
- Can be deadly
Acute Disseminated Histoplasmosis
- Can be either benign or progressive
- Rapidly fatal
- Usually occurs in children or immunosuppressed adults
Chronic Disseminated Histoplasmosis
- Usually occurs in elderly healthy
- May be fatal
- The clinical features vary according to the organ most severely involved
Mycotic Infection
Fungal infections that can spread by direct contact
Stomach Purge
- Liquid/semi-sold
- Coffee grounds appearance
- Foul odor
- Acid pH
- Contents: stomach contents, blood, arterial solution
Lung Purge
- Frothy
- Blood remains red
- Little odor
- Contents: respiratory liquids, residual air, blood arterial solution
Esophageal Varices Purge
- Bloody liquid
- Contents: blood, arterial solution
Brain Purge
- White semisolid
- Contents: brain tissue, blood, arterial solution
Anal Purge
- Semisolid/liquid
- Contents: fecal matter, blood, arterial solution
True Tissue Gas
- Gas created by clostridium perfringens
- Can also cause: Very strong odor of decomposition, skin slip, skin blebs, increase in intensity and amount of gas
- Spores can transfer to instruments
Gas Gangrene
- Antemortem form
- Gas created by clostridium perfringens
- Causes: foul odor, infection
Subcutaneous Emphysema
- Caused by a punctured lung or pleural sac
- Causes: no odor or skin slip, gas can reach distal points, intense swelling, rises to highest body areas
How to embalm a radioactive body
- The body is not released until the level of radioactivity has dropped below 30 millicuries for unautopsied bodies, 6 millicuries or below for autopsied remains.
- Three precautions are followed, protection, time of exposure, and distance from the body.
- Use universal precautions and an extra pair of gloves over standard gloves
- Task share to reduce time exposure
- Have instruments and equipment prepared prior to embalming
- Avoid raising vessels used for radioactive treatment
- For every 3 feet of distance from the body, exposure is reduced
- Remain at distance when not physically embalming
- Keep flow of water on table
- Use body bridges to not hinder water flow
- After embalming, sterilize instruments, dispose of everything in a biohazard bag, wash your reusable ppe, towels etc, document radioactive body in Decedent Report
Millicurie (mCi)
That amount of radioactive material which 37 million atoms disintegrate each second
Antibiotics (Chemotherapeutic Agents)
- Penicillins, aminoglycosides, tetracyclines
- Cause: cotton-like circulatory blockages (fungal overgrowth), jaundice, bleeding into skin, poor penetration
Corticosteroids (Chemotherapeutic Agents)
- Cortisone
- Cause: cell membranes to be less permeable, retention of fluids, mild to severe waterlogging in tissues, protects proteolysis enzymes (more rapid breakdown of body proteins)
Cancer Chemotherapy (Chemotherapeutic Agents)
- Antimetabolites, cytotoxic agents, radioisotopes
- Causes: Emaciation and dehydration, extensive purpura, jaundice, low protein, perforation of gut, brittleness of bone, nitrogenous waste retention
Tranquilizers (Chemotherapeutic Agents)
- Phenothiazines
- Causes: Dehydration, weight loss and emaciation, low protein, kidney dysfunction and retention of nitrogenous waste products
Stimulants (Chemotherapeutic Agents)
- Amphetamines, cocaine
- Causes: weight loss, emaciation, low protein, mucous membranes bleed easily, other problems as for tranquilizers
Sedatives
- Barbiturates, meprobamate
- Causes: emaciation, dehydration, low protein, difficult to firm
Oral Anti-diabetic Agents (Chemotherapeutic Agents)
- Tolbutamide
- Muscle atrophy, mild to severe jaundice, some emaciation and edema
Circulatory Drugs (Chemotherapeutic Agents)
- Antihypertensives, anti-clotting agents
- Causes: Blood clots, impairment of circulation, poor distribution of fluids, purpura, urine retention and spongy nitrogenous waste-filled tissues
Embalming Complications of Congestive Heart Failure
- Blood is congested in the right side of the heart
- The neck veins are engorged with blood
- Facial tissues are discolored due to blood congestion
- Lips, ears, and fingertips are cyanotic (blue)
- Generalized pitting edema, ascites, and edema of the legs and feet
- Blood may be more viscous due to an increase in red blood cells
- Salt is retained in the body fluids
Arteriosclerosis
- A pathological condition causing the arterial walls to thicken, harden, and lose elasticity
- Different severities: type 1, type 2, type 3
Type 1 Arteriosclerosis
- The intimal wall of the artery is thicken, the lumen is well defined
- Use a standard cannula and unrestricted injection
Type 2 Arteriosclerosis
- Vessel walls are thickened and/or hardened
- Lumen is reduced and off-center
- Use a smaller gauge cannula
Type 3 Arteriosclerosis
- The lumen is completely occluded and the artery cannot be used for injection
- Collateral circulation (anastimoses) can circumvent the blockage
- Canalization: a creation of tiny pathways or canals within the vessel to allow the passage of blood
When to use a low-index fluid
-Dehydration
-Jaundice
-Intravascular blood discolorations
How to correct swelling complications (distension)
-Use a minimum amount of a stronger, hypertonic arterial solution (Pg 277)
-Avoid pre-injection fluids (pg 284)
-Inject trunk w/ a very slow rate of flow (pg 285)
-Instant tissue fixation (pg 278)
When to use restricted cervical injection
-Edema (of hands)
-Purge
-Jaundice
-Delayed embalming
-Postmortem bruising
-Hanging/Strangulation
-Drownings
-Un-autopsied gunshot wounds (face/head)
-Aortic Aneurysm
-Congestive Heart Failure
-Diabetes
-Obesity
How to use restricted cervical injection
- Inject the trunk and limb areas
- Ensure arterial tubes directed toward the head remain open during trunk injection
- inject left side of head
- inject right side of head
How to fix unbroken but discolored skin
Use a strong arterial solution or use phenol injection
How to fix broken skin (Abrasion, blisters)
Abrasion - Dry, put massage cream AROUND (not on) the abrasion, and let embalming do the work. A phenol compress can also be used.
Blisters - Lance and drain, debride loose skin, cauterize, and dry. A stronger-than=average solution should be used to embalm the area.
How to fix scaling skin
Remove loose skin, clean, and use massage cream.
How to fix skin-slip
- Apply disinfectant
- Open and drain fluid filled blisters
- Remove loose skin
- Apply surface compress
- Sectional embalming may be necessary. Use strong arterial solution.
- Check preservation
- Allow time for chemicals to take effect
- Clean chemicals
- Dry area with hairdryer
Intravascular Resistance
Internal changes within an artery or a vein.
Ex. arterial coagula
Types of Burns
First degree - Superficial; affects epidermal layer only
Second degree - Deep; affects the posterior dermal layer
Third degree - Full-thickness; destruction of both the epidermal and dermal layers.
Fourth degree - Most severe. Destroys all skin layers and underlying tissues.
Extravascular Resistance
External pressure upon an artery or a vein causes the lumen to narrow or escape.
Ex. Rigor mortis, ascites, gas, bandages, contact pressure, tumors, swollen lymph nodes, hydrothorax
Types of Jaundice
Prehepatic, hepatocellular, posthepatic
Types of skin alterations
Abscess, concussion, contusion, abrasion, ulceration, incision, laceration, razor burn, and bullet.
Embalming complications with death by hanging
Extensive blood discoloration (tardieu spots and petechial hemorrhages), cyanosis, autopsy likely, and ligature markings on the neck may appear.
RCI is recommended, and a moderate to strong solution is typical.
Embalming complications with burned bodies
Burns may affect large regions of the body, and odor may be noticeable. Brushing these areas with autopsy gel ensured preservation and reduces odor. A unionall with embalming powder is recommended, except for hands and face.
Embalming complications with carbon monoxide poisoning
Cherry red discoloration (Antemortem, intravascular blood discoloration). Lengthy postportem intervals can lead to hemolysis and postmortem staining.
Delay and refrigeration necessitate use of a stronger-than-average solution. Extra dye should be used.
Embalming complication with death by drowning
Intense livor mortis, petechia, and possibly cyanosis. May exhibit severe decomposition, and purge is very common. Pack throat with liberal amounts of cotton, and selection of vessels should depend on the condition of the body, but use of the common carotid and internal jugular is recommended. Strength of fluid depends on decomp state.
Embalming complications with gunshot wounds
Autopsy is expected, ecchymosis and swollen eyelids, torn or bruised tissue swells, fractures of the bones. Brain purge may also happen.
Clean, pack, protect surrounding area, align bone(s), bridge or glue torn tissues, apply compresses, and inject head with a strong, well-coordinated, arterial solution or a waterless arterial solution.
Antemortem Dehydration
- Dehydration that may be caused by hemorrhage, febrile diseases, kidney diseases, diabetes, some cancers and localized neoplasms, and some burns.
- Medical care incorporates hydrating therapies to lessen dehydration.
Postmortem dehydration
Dehydration following death. Liberally apply massage cream.
Solid Edema
Edema within body cells; Must be excised for reduction
Pitting edema
Edema in tissue spaces, between the cells; Strong arterial solutions, co-injection fluids
Anasarca
Generalized edema in all body tissues; May be gravitated, use strong arterial solutions, may be punctured and drained, use plastic garments to protect from leakage
Edema of the face
Edema in facial tissues;
RCI, strong solution, elevate head, channel with trocar, surface and hypodermic embalming to ensure preservation
Edema of hands
Edema in tissues of the backs of the hands;
Sectional injection from axillary artery, surface pack with cavity fluid, bleach discolorations
Edema of the Legs
Edema in thighs and lower legs;
- sectional injection of legs from femoral or external iliac artery, strong solution, hypodermic injection with cavity fluid, plastic stockings containing embalming powder and autopsy gel
Pulmonary edema
- Edema in the alveoli of the lungs
- strong arterial solutions, hypodermic and surface embalming, plastic garments, gravitation, puncture and drain
Hydrothorax
- Edema in the thoracic cavity
- Aspiration and injection of lungs
Hydropericardium
- Edema of pericardial cavity
- Aspiration and injecting of undiluted cavity fluid, pre-embalming draining via trocar or drainage tube, re-aspiration and re-injection
Ascites
- Edema in abdominal cavity
- Aspiration and injecting of cavity fluid, draining prior to arterial injection
Hydrocele
- Edema of scrotum
- Aspiration and injection of undiluted cavity fluid
Hydrocephalus
- Edema of cranial cavity;
- Channel with trocar to drain into abdominal cavity, surface coating with autopsy gel, use of plastic garments and embalming powder
Parts of a vessel
Tunica intima, endothelium, subendothelial layer, internal elastic lamina, tunica media, external elastic lamina, tunica externa, vasa vasorum
Traumatic tissue injuries
Mutilation, ischemia, hemorrhage, gunshot wounds, gangrene, hanging
Gas gangrene vs tissue gas
Gas gangrene is a wound infection, tissue gas is the accumulation of gas in tissues or cavities, although both are caused by clostridium.
Renal failure embalming complications
Sallow color of the skin, uremic pruritus, increase in the amount of urea, acidosis, edema, anemia, gastrointestinal bleeding
Mold
- The growth of mold on the surface of the body occurs after lengthy refrigeration.
- Darkness and moisture encourage mold growth.
