Lab Manual 2- Factors for selection of arteries, techniques Flashcards
- Age
- Sex
- Weight
- Fat distribution
- Disfiguration
- Disease
- Edema, anasarca
- Location obstruction (congestion)
- Trauma
- Medico-legal requirements
- Cause of death
- Manner of death
Other factors governing selection of arteries to be used for injection
- Infant: Descending abdominal aorta, femoral, topically.
- Adult: Varies
Age
Females- if low cut shirt, not the carotid
Sex
May be a problem with raising the femoral.
Fat Distribution
- Arthritis
- Tumors
- Cachexia (wasting syndome)
Disfiguration
Abnormal accumulation of fluids in tissue or body cavities.
Edema
Severe generalized edema.
Anasarca
A.S.C.V.D. - Arteriosclerosis cardio vascular disease
Local Obstruction (congestion)
A physical injury or wound caused by external force or violence.
- Mutilation
- Accident
- Surgery
Trauma
- Autopsy protocol
- Medical Examiner/ coroner
Medico-Legal Requirements
- Hospital
- Medical Examiner
Types of Autopsies
- Needs signed permission.
- Concerned with cause of death.
Hospital Autopsy
- Does not need permission.
- Concerned with manner of death.
- Concerned with cause of death.
Medical Examiner Autopsy
- Medical Doctor
- Investigates death
Medical Examiner
- Makes a report to the Medical Examiner.
- Holds official inquests
Coroner
- Anoxia
- Cancer, etc
Cause of Death
- Natural
- Suicide
- Homicide
- Accidental
Manner of Death
- Shave area- if necessary
- Select instruments and prepare ligature
- Locate place of incision using linear guide
- Make proper incision though skin, superficial fascia and deep fascia.
- Blunt dissection though superficial fascia, fat, and deep fascia.
- Find vessels by use of anatomical guide and relative position of the vein.
- Clean off by blunt dissection and ligate vein loosely.
- Clean off and ligate artery loosely.
- Make an incision in vessels.
Proper technique for Raising Vessels
Preparation room item used with suturing needles to suture cuts and incisions.
Ligature
The separation and pushing aside of the superficial fascia leading to blood vessels and then the deep fascia surrounding blood vessels, utilizing manual techniques or round ended instruments which separate rather than cut the protective tissues.
Blunt dissection
To tie off an artery and vein upon completion of embalming.
Ligate
Lying at right angles to the long axis of the body.
Transverse vessel incision
A vascular incision made on vessels by cutting in an oblique or slanting direction.
Diagonal vessel incision
A vascular incision that is made length-wise on a vessel.
Longitudinal vessel incision
A vascular incision created by making a short transverse incision at a right angle to the long axis of the vessel; then with the point of the scissors inserted into the original opening, a second incision is made parallel to the long axis of the vessel.
T-shaped vessel incision
A vascular incision which is made by cutting a small triangular wedge from the wall of a vessel.
Triangular (wedge) vessel incision
- Triangular (wedge) incision
- T-shaped incision
Allows us to better be able to insert the cannula
- Avoid the use of veins which require the abrupt turning of a curve by the drain tube, as the rupturing of the vein may result.
- Be sure the tube is well lubricated to insure easy insertion and prevent the rupture of the vessel wall. Oiling the inside of the drain tube will help prevent blood coagulation within the tube.
- Always use the largest tube the vein will accommodate. This insures the most copious flow of both liquid blood and clots.
Precautions during insertion of the drain tube
The process of converting soluble protein into insoluble protein by heating or contact with a chemical such as an alcohol or an aldehyde. The solidification of a solution into a gelatinous mass. This is a specific form of agglutination.
Coagulation
- The vessels are tightly ligated and the free ends of the ligatures are cut off with utility scissors.
- The incision is dried with cotton.
- The incision is cauterized
- The incision is dried with cotton again
- Powder incision sealer is used to inhibit subsequent leakage.
- The incision is sutured with stitches
Closing the Incision
In most cases, this stitch will be employed, but other types of incision closure are also available for special purposes.
i.e.- adhesives and staples.
Baseball Stitch
- Single suturing needle with a non-cutting edge
- Used on exposed areas of the body
- Suturing needle is brought though the surface and directed through the subcutaneous tissue.
- Small needle and thin ligature
- Nothing should show in the surface
- Does not hold well if used through fatty tissue.
The single Intradermal, Subcutaneous suture, Hidden Stitch
Made in the same manner as the single intradermal stitch, except that a suturing needle is used on each end of the ligature (two suturing needles) and the ligatures are crossed at each stitch, using crisscross motion just like tying shoes. This suture gives more protection against leakage in comparison with the single intradermal stitch.
The double intradermal or double Subcutaneous Suture
- Type of incision used by the Egyptians
- Usually an S shaped needle with a cutting edge and a heavy ligature
- Stitch is made from beneath, up through the skin and the needle is crossed from side to side with each stitch.
- Strong closure, but pulls the tissues adjacent to the incision upward into a ridge.
- Keep the ligature taut after each suture.
Baseball Stich, Sail Stitch
- Tight, leakproof Suture
- Creates unsightly ridge on the surface of the incision
- Large, full curve suturing needle and thick ligature
- Anchor or tie the ligature at one end of the incision and pull up the ligature which is anchored.
- Needle passes through both sides of the incision from the outside.
- Always keep the ligature tight
- Lock the stitch by looping it through the ligature, which is being held, releasing the ligature long enough to complete the loop; then catch the ligature and pull it tight again.
- Repeated until the incision is closed.
- Suturing needle insertion is always made from the same side of the incision.
The lock stitch, Half stitch, or Blanket Stitch
- Anchor the ligature around pins
- Considered as a temporary suture
- Holds the lips of the incision together during operation
- Assist in a permanent closure when an adhesive or sealer is used inside the incision to seal it permanently.
- Normally only used on exposed areas
The figure Eight Suture
Have the same basic suturing patterns.
The draw stitch and the worm stitch
The same as the single intradermal suture, except this stitch penetrates completely though the skin.
- Got its name because it draws the sides of the incision together.
The Draw Stitch
The same as the single intradermal suture, except the stitches are made parallel to the incision.
- Easily waxed over if used on exposed areas of the body.
- Used to turn under excess margins of the skin
- The opposite of the draw stitch in regards to the exposed areas of the ligature.
The Worm stitch
Used by passing the ligature through both sides of the incision from the outside going from one side to the other as the incision is sutured.
The Whip Stitch, Continuous Glover Suture, Roll Stitch
Individual stitch knotted at the tissue edge. This suture is normally used as a temporary stitch. It may be applied prior to the embalming to align tissues.
Bridge Suture, Temporary Interrupted Suture
A suture used to close small punctures or holes. A series of small stitches are made through the skin around the circumference of the opening. The ends of the thread are then knotted.
Purse String Suture
- Liquid Adhesive
- Spray sealing compound
- Cream sealing compound
Other methods of closure not using sutures
