Lecture Notes - Exam 3 MORS 113

Question 1

The sum total of those considerations given the case at hand, beginning before the embalming procedure is begun and continuing throughout the operation.

Answer 1

Case Analysis (Embalming Analysis)

Question 2

1. Pre-embalming analysis
2. Analysis during arterial embalming
3. Analysis after arterial embalming

Answer 2

Case Analysis Will Occur in Three Overlapping Stages (List Question)

Question 3

• Should be documented in report form.
• Should be stored in a 3-ring binder - O.S.H.A.
• If the body is being shipped, no matter where, a duplicate copy of the report should accompany the embalmed body.
• Translation to a foreign language may be required when shipping internationally.

Answer 3

The Case Analysis Should:

Question 4

If the organs were returned or not in these cases should be included in the case report.

Answer 4

Autopsy

Question 5

To perscribe and apply the proper embalming technique.

Answer 5

Purpose of Embalming Analysis

Question 6

• General condition of the body after death
• Effects produced by disease processes
• Effects produced by drugs or surgical procedures
• Effects that occur during postmortem interval

Answer 6

4 Major Factors the Embalmer Must Consider in Making a Pre-embalming Analysis

Question 7

The time lapse between death and embalming or to disposition.

Answer 7

Postmortem Interval

Question 8

It can take weeks or months for this to happen.

Answer 8

To Move the Body to Another Country

Question 9

Occur within the body.

Answer 9

Intrinsic Factors

Question 10

• Cause and manner of death
• Bodily conditions
• Presence or absence of postmortem discolorations or stains.
• Postmortem chemical or physical change
• Pharmaceutical agents including illegal drugs - antemortem exposure
• Age
• Gender
• Weight

Answer 10

Intrinsic Factors

Question 11

• Pathological conditions
• Microbial influence
• Moisture content
• Thermal influences - fever
• Nitrogenous waste products
• Gase in tissues or cavities

Answer 11

Bodily Conditions (Intrinsic)

Question 12

IV needles (illegal drugs) are known for:

• Transmitting HIV
• Transmitting Hepatitis C

Answer 12

Pharmaceutical agents including illegal drugs- antemortem exposure (Intrinsic)

Question 13

An example would be that females typically have more adipose tissue.

Answer 13

Gender (Intrinsic)

Question 14

Emaciated, obese, condition of the muscles.

Answer 14

Weight (Intrinsic)

Question 15

Occur outside the body, have direct influence on the condition of the body.

Answer 15

Extrinsic Factors

Question 16

• Environmental
• Postmortem interval
• Embalmer

Answer 16

Extrinsic Factors

Question 17

• Atmospheric conditions - climatic (Humid, moist, dry).
• Thermal influences (Ideal temp. for bacteria = 98.6^oF
• Microbial influences
• Vermin and insects
• Humidity

Answer 17

Environmental (Extrinsic)

Question 18

Aptitude and attitude.

Answer 18

The Embalmer (Extrinsic)

Question 19

This is the very foundation of professional embalming.

Answer 19

Case Analysis

Question 20

In a case analysis, cause of death is not as important as this.

Answer 20

Manner of Death

Question 21

Circumstances surrounding the body at the time of death.

Answer 21

Manner of Death

Question 22

• Cause and manner of death
• Bodily conditions
• The presence or absence of pathological discolorations.
• All of the postmortem physical and chemical changes
• Age
• Weight
• Medication, drugs and other therapeutic agents
• Gender

Answer 22

Intrinsic Variable Factors

Question 23

Generally considered unreliable most of the time because the death certificate is often not obtained until after the embalming has been done and/or it is just stamped ASCVD or MI which is little help.

Answer 23

Cause and Manner of Death (Variable Intrinsic)

Question 24

Are much more important and will indicate what procedure the embalmer will follow.

• Pathological conditions
• Anaerobic bacterial influence
• Moisture content in tissues
• Thermal influence

Answer 24

Bodily Conditions (Variable Intrinsic)

Question 25

Those conditions in which there has been damage to the tissue due to disease.

Answer 25

Pathological Conditions

Question 26

Dependent on how much bacteria there is present in the colon (e-coli).

Answer 26

Anaerobic Bacterial Influence

Question 27

* Edema * Dehydration * Average Case

Answer 27

Moisture Content in the Tissues

Question 28

In this case, there is an abundance of moisture in the tissue and you would use a strong solution. (36 index, 1 or more bottles per gallon).

Answer 28

Edema

Question 29

In this case, you would use a weak solution. (About 22 index, lanolin-based, 6 ounces to a gallon).

Answer 29

Dehydration

Question 30

In this case, you would use a middle index fluid (20-25). This has medium firming capabilities, contains lanolin and active dyes (femoral vein is good to use).

Answer 30

Average Case

Question 31

An example would be high fever produced by a febrile disease. There will be scanty and clotted drainage.

Answer 31

Thermal Influence

Question 32

This is a reliable indicator of the degree of the postmortem changes: * Green spot over the cecum * Yellow Cast to the tissue * Livor mortis or postmortem stain * Golden yellow color

Answer 32

The presence or absence of pathological discolorations (variable intrinsic)

Question 33

Caused by e-coli, anaerobic bacterial.

Answer 33

A green spot over the cecum

Question 34

This is due to dehydration (not to be confused with jaundice yellow).

Answer 34

A yellow cast to the tissue

Question 35

This is due to hemolysis or hemostasis. The colors tend to be red, purple, blue.

Answer 35

Livor Mortis or Postmortem Stain

Question 36

Associated with hepatic failure causing jaundice.

Answer 36

Golden Yellow

Question 37

Infant, child, adult, elderly- will demand different embalming procedures- injection sites, drainage sites, strength, quantity, and chemical mixture of fluids- posing features, etc.

Answer 37

Age

Question 38

Emaciated, obese, musculature (muscle development), will demand different embalming procedure- posing features, injection and drainage sites, strength, quantity, and chemical mixture of fluids.

Answer 38

Weight

Question 39

* This factor is of limited value in case analysis because the embalmer is unaware of the chemicals involved prior to death. * Many drugs used in surgery will impact the embalming process negatively. * I.E., Chemotherapeutic agents are toxic to the body and will have an adverse effect on tissue structure.

Answer 39

Medication, drugs and other therapeutic agents

Question 40

Injection and drainage sites, exposure of incisions as they relate to burial garments, and texture of surface tissue which may demand milder strength solutions.

Answer 40

Gender

Question 41

* Environmental Conditions * The postmortem Interval * The Embalmer

Answer 41

Extrinsic Variable Factors

Question 42

* Atmospheric Conditions: Such as humidity * Thermal Influence: Such as Temperature * Bacterial Influence * Vermin and Insects

Answer 42

Environmental Conditions (Variable Extrinsic)

Question 43

May reduce dehydration but it will favor early decomposition because heat and moisture are favorable for rapid bacterial growth.

Answer 43

A high atmospheric humidity

Question 44

Will extract moisture from the body causing early dehydration (and may lead to mummification) but it will deter decomposition. It will however, cause problems with cosmetics due to discolored surface tissues.

Answer 44

A low atmospheric humidity

Question 45

Will deter early decomposition, but extreme cold will cause the tissue to burn, as in freezer burn where the tissues will be dark, discolored and crusty (fingertips, earlobes, chin, tip of nose, lips- lips are first).

Answer 45

Cold

Question 46

Will hasten decomposition, but in extreme cases, will alter the growth of the bacteria.

Answer 46

Heat

Question 47

This will depend on the amount of aerobic bacteria in the air causing early decay.

Answer 47

Bacterial Influence

Question 48

Will affect the surface tissues of the body and may require restorative artwork.

Answer 48

Vermin and Insects

Question 49

This is, with all things being equal, the most important variable factor in case analysis. It is the time lapse from death to embalming, and it is during this time that the postmortem physical and chemical changes occur. **It is the most significant factor determining the embalming chemistry and technical procedure**.

Answer 49

The Postmortem Interval (Variable Extrinsic)

Question 50

* Reverent respect for the dead because they can no longer demand it for themselves. * Education in the field of embalming including continuing education courses throughout their careers. * Patience- problem solving * Lifestyle free from fatigue, depression, and anxiety. * Pride in workmanship

Answer 50

The Embalmer (Variable Extrinsic, list question)

Question 51

In this, we have what could be called a "hypothetical normal case" having the best set of characteristics at death.

Answer 51

Case Analysis

Question 52

* No mutilations * No blood coagulation * No antemortem or postmortem discoloration * No comminucable disease * No blockages or breaks in the blood vascular system * No excessive rigidity * No cardinal signs of decomposition * Minimum physical and chemical postmortem changes

Answer 52

Hypothetical Normal Case

Question 53

No breaks or destruction of any internal or external surface which would require special treatment restorative art. Example- surgery.

Answer 53

No Mutilations

Question 54

Free flowing drainage- clot free.

Answer 54

No Blood Coagulation

Question 55

Which lead to postmortem stain.

Answer 55

No Antemortem or Postmortem Discoloration

Question 56

That could cause danger to the embalmer. Example: C.J.D.

Answer 56

No communicable Disease

Question 57

Example: ASCVD

Answer 57

No Blockages or Breaks in The Blood Vascular System

Question 58

Rigor Mortis

Answer 58

No Excessive Rigidity

Question 59

* Color * Odor * Purge * Desquamination (skin slip) * Accumulated gas

Answer 59

No Cardinal Signs of Decomposition (list question)

Question 60

In case analysis, these factors in operative embalming are the most important.

Answer 60

Variable and Fixed Factors

Question 61

This is the greatest single problem encountered in operative embalming. It is because of this that no single inflexible embalming procedure can be expected to produce satisfactory results in more than a very small percentage of the cases involved.

Answer 61

Variation

Question 62

* The remains * The operator * The instruments and equipment

Answer 62

Variable Factors Involved in Case Analysis

Question 63

These are of primary importance. It is the degree to which the protein of the body has been broken down into amino acids; it is further complicated by the degree to which the amino acids are broken down into amines and other by-products of putrefaction. * It is the extrinsic factor (postmortem interval) in case analysis that must be on the mind of the embalmer.

Answer 63

The remains (Variable factor)

Question 64

His or her ability varies according to: * Educational background * Natural, inborn ability * Attitude towards this art * Degree of efficiency

Answer 64

The Operator (Variable Factor)

Question 65

These are of third most important importance. It is poor economy to attempt to operate an embalming room with those that are obsolete or insufficient. The per-case cost is the cheapest expenditure of the funeral home.

Answer 65

Instruments and Equipment (Variable Factors)

Question 66

This is the only fixed factor in case analysis.

Answer 66

The Concentrated Fluid Used

Question 67

* All remains recieve the same chemical formulation (type and volume) including cavity treatment regardless of condition of the body. * All remains recieve the same injection and drainage site- same artery and vein. * All remains recieve the same mouth closure method. * All embalmed remains recieve the same cosmetic- no variation whatsoever.

Answer 67

Characteristics of a Non-thinking Anacephalic- Robot Embalmer (List Question)

Question 68

In case analysis, this basic principal is the most important.

Answer 68

How the Tissue is to be Saturated

Question 69

* Arterial * Cavity * Hypodermic * Surface

Answer 69

4 Basic Types of Embalming

Question 70

Arterial and Cavity Embalming

Answer 70

Required Embalming

Question 71

Hypodermic and surface embalming.

Answer 71

Supplemental Embalming

Question 72

**There is no substitute for this**. Hypodermic and surface embalming are an adjunct to (or act of desperation following) this. Cavity treatment is a separate operation from arterial embalming but is of equal importance.

Answer 72

Arterial Embalming

Question 73

During life, this is the center of blood circulation. In death, the arch of the aorta becomes the center of the arterial embalming process.

Answer 73

The Heart

Question 74

The most effective type of supplemental embalming.

Answer 74

Hypodermic Embalming

Question 75

The heart is ordinarily excluded as the center of embalming circulation because of the \_\_\_\_\_\_\_\_, which prevent the solution from entering the heart. The only tie arterial fluid solution will enter the chambers of the heart is when the valves of the heart are diseased.

Answer 75

Aortic Semi-Lunar Valves

Question 76

Cause the blood vascular system to contract, forcing the blood into the capillary bed. Because of hypostasis, this blood will eventually fall into the veins in short time. (Articulo-Mortis)

Answer 76

Muscular Contractions at Death

Question 77

* 85% of blood is in the capillaries * 10% of blood is in the veins * 5% of blood is in the arteries

Answer 77

Articulo-Mortis

Question 78

The average capillary has a diameter of this.

Answer 78

1/3000 of an Inch

Question 79

During life, the blood content is sufficient to fill only about ___ of the capillaries at any one time.

Answer 79

1/3

Question 80

In life, the human body has a blood volume of 6 quarts (5.5 liters); in death, an embalmer can inject up to 20 quarts of arterial fluid solution without drainage loss or swelling because the surplus fluid will fall into the remaining 2/3 of the capillary bed.

Answer 80

Embalming Signifiance - Articulo-Mortis

Question 81

In life is the congestion of blood within the superficial capillaries of the immediate area of an infection of irritation.

Answer 81

Hyperemia

Question 82

In life is the congestion of blood in the superficial capillaries of the face and neck because of nervous or emotional tension.

Answer 82

Blushing

Question 83

In embalming is the congestion of arterial fluid solution in the superficial capillaries during the embalming process. It is a cauliflower effect on the tissue, usually with staining as a result of arterial dye (active). * Can be induced by clamping off the corresponding vein, creating a backpressure.

Answer 83

Mottling

Question 84

The removal of blood drainage from the vascular system or even livor mortis, but not postmortem stain. As the arterial fluid solution is forced into the arterial system, it flows out to the capillaries. There it comes into contact with the congested blood and pushes it ahead into the veins and eventually out into the drainage.

Answer 84

Flushing

Question 85

The removal of at least 1/2 of the blood volume from the vascular system as a result of pressure and rate of flow induced by injection of the arterial fluid solution.

Answer 85

Venous Drainage

Question 86

The point of injection is not as significant as this.

Answer 86

The point or points of drainage

Question 87

No matter where you inject from, the body will not begin to be embalmed until the _____ is filled with arterial fluid solution. The ____ must be filled from its origin in the left ventricle of the heart up, around, and down to the bifurcation of the decending abdominal ______ at the iliac arteries.

Answer 87

Aorta

Question 88

One superior to the heart via the right axillary vein or the right internal jugular vein, and the other inferior to the heart via the femoral vein or the right common or external iliac vein.

Answer 88

It is Recommended That the Embalmer Establish Two Points of Drainage

Question 89

Because veins have these, with the exception of the vena cava, it is necessary to insert a drain tube, forceps or drain hose far enough into the vein that all of these leading to the superior or inferior vena cava are bypassed.

Answer 89

Valves

Question 90

The aorta is the main trunk artery, and the main trunk veins are \_\_\_\_\_\_\_\_\_. Minimum standard is one-point injection and two point drainage.

Answer 90

Inferior and Superior Vena Cava

Question 91

It is the formaldehyde gas, liberated from the arterial fluid solution, that effects and fixes the tissue cell protoplasm, not the fluid itself. The fluid is mearly a vector (carrier), which carries the gas.

Answer 91

Tissue Structure

Question 92

The arterial solution will pass through the thin capillary wall to unite with protoplasm of the tissue cells, changing this soluble hydrophilic (water attracting) or albumin into an insoluble compound called an \_\_\_\_\_\_\_, which is highly resistant to bacteria.

Answer 92

Albuminoid

Question 93

CH₂OÎ, HCHOÎ | (the arrows refer to a gas)

Answer 93

Formaldehyde Gas

Question 94

This forces the blood out and the arterial solution into the tissues.

Answer 94

Pressure