Quarter 2 Final Exam Study Guide Flashcards
Scalpel
Make incisions; superficial dissection; incise the artery or vein
Surgical Scissors
Make incisions; cut ligatures; incise the artery or vein
Arterial Scissors
Incise a vessel; some styles cut needle injector wires
Aneurysm Hook
Dissects fat and fascia; elevates and secures vessels
Separator
Elevates and secures vessels
Arterial Tube/Cannula
Inserted into artery for injection of embalming solution
Drain Tube or Angular Spring Forceps
Inserted into vein for drainage of blood and body fluids
Arterial Hemostat (forceps)
Secures arterial tube in artery
Spring Forceps
Passes ligatures around vessels
Groove Director
Expands vein for insertion of the drainage device or guides an arterial tube into an artery
Common Carotid Artery
- Vessel most commonly used for arterial embalming.
- Is large in diameter and is
- accompanied by the internal jugular vein.
- Supplies fluid directly to the head and the face.
Internal Jugular Vein
- The right internal jugular leads directly into the right atrium of the heart through the right brachiocephalic and superior vena cava.
- The right internal jugular vein is a favorable drainage site for that reason.
Facial Artery
Usually reserved for when the common carotid is either damaged or unavailable. (Pretty sure Ben said not to use this when possible.)
Axillary Artery
- The artery beings at the lateral border of the first rib after passing through the cervicoaxillary canal.
- Used to be the preferred site to inject the entire body.
- Now commonly used as a secondary point of injection when the solution isn’t reaching the arm. (Near the armpit.)
Brachial Artery
- Continuation or the axillary artery.
- Is also used as a secondary injection to reach the forearm or the hand. (Extending from the armpit.)
Radial Artery
Originates at the bifurcation of the brachial artery and supplies solution directly to the lateral side of the hand (thumb.) (Near the wrist.)
Ulnar Artery
Also originates at the bifurcation of the brachial artery and supplies solution directly to the medial side of the hand (little finger.) (Near the wrist.)
Femoral Artery
- Continuation of the external iliac artery, and is located superficial and lateral to the femoral vein.
- Is a frequent selection for arterial embalming.
Popliteal Artery
- A continuation of the femoral artery
- can be used as a secondary injection site when solution has not been distributed below the knee.
- (Is located behind the knee.)
Anterior and Posterior Tibial Arteries
Supplies the arterial solution directly to the portion of the leg below the knee and into the foot. (Lies at the superficial margin of the tibia.)
Abdominal Aorta and Thoracic Aorta
- Largest ARTERY in the body,
-travelling the length of the torso along its midline. - Either can be used for injection following PARTIAL AUTOPSY or ORGAN DONATION.
External Iliac Artery
- Passes beneath the inguinal ligament and lies on the lateral side of the external iliac vein.
- Following a complete trunk autopsy, the external iliac is accessible from the pelvic cavity. Supplies solution to the lower extremity and anterior abdominal wall.
Internal Iliac Artery
- Supplies embalming solution to the external genitalia, gluteal muscles, and the peroneal regions.
- Following a complete trunk autopsy, the external iliac is accessible from the pelvic cavity.
Inferior Vena Cava
Largest vein in the body.
- It is located to the right of the aorta at the posterior abdominal wall.
- It is primarily used for blood drainage in cases of partial autopsy or organ donation.
Right Atrium of the Heart
- Direct heart drainage is recommended for infectious cases to eliminate contact with blood and bodily fluids.
- It is done by piercing the right side of the heart with a trocar and guiding the tip of the instrument directly into the right atrium.
Intrinsic Factors
- Cause and manner of death
- Body conditions (pathological conditions, microbial influence, moisture, hermal influences, nitrogenous waste products, weight, gas in tissues or cavity)
- Presence or absence of discolorations
- Postmortem physical and chemical changes
- Effects of pharmaceutical agents
- Illegal drugs
- Age, weight
( think about what information a medical examiner would look for during an autopsy)
Extrinsic Factors
- ENVIRONMENT (Atmospheric conditions, thermal influences, microbial influences, vermin)
- TIME intervals (between death and prep, between prep and disposition)
- EMBALMER preferences
How Are Vessels Affected by Arteriosclerosis?
Thickens and hardens the walls of the arteries, occurring typically in old age.
How Are Vessels Affected by Liver Failure?
Edema, increase in ammonia, jaundice, hair loss, purges caused by rupture of esophageal veins
How Are Vessels Affected by Renal Failure?
1) Increase in ammonia in the tissues, 2) edema in tissues
3) gastrointestinal bleeding, 4) pulmonary edema
5) congestive heart failure,
6) discoloration of the skin
(renal failure is kidney failure: kidneys, lose ability to remove waste and balance fluids)
How Are Vessels Affected by Damage to Blood Vessels?
Skin hemorrhage
(think of purpura)
How Are Vessels Affected by Damage to the Walls?
Breakdown of skin; skin-slip often present
How Are Vessels Affected by Jaundice?
- Edema, drainage difficulty
- Color changes
How Are Vessels Affected by Congestive Heart Failure?
Facial discoloration, death of the superficial cells, protein degeneration
Types of Fluid
1) Active Dyes
2) Anticoagulants
3) Buffers
4) Formaldehyde/Formalin
5) Humectants
6) Phenol
7) Surfactants
Active Dyes
Cosmetic fluid
Anticoagulants
Water conditioner
(antiCOagulant=COnditioner)
Buffer
serve to control the acid-base balance of fluid and tissues (balances pH)
Formaldehyde and Formalin
Preserving solution
Humectants
Controls tissue moisture
Phenol
Preservative and germicide
Surfectants
Wetting agent
Effects Of Long-Term Use Of Medication
JAUNDICE, discoloration, EDEMA, difficulty in establishing tissue firmness, loss of hair, internal bleeding, RENAL FAILURE causing an increase in nitrogenous wastes in the tissues, changes in the cell wall, swelling of facial tissues.
Livor Mortis
- Discoloration Of the Skin
- Is removed by blood drainage
Postmortem Stain
- Discoloration Of the Skin
- Not removed by blood drainage
Alternate Drainage
- Type of Drainage
- The arterial solution is never injected while drainage is being taken
Concurrent (Continuous) Drainage
- Type of Drainage
- Injection and drainage are allowed to proceed at the same time throughout the embalming
Intermittent Drainage
- Type of Drainage
- Method of drainage in which the drainage is stopped at intervals while the injection continues
Direct Heart Drainage
- Type of Drainage
- Used when vein cannot be used, right atrium of heart can directly drained using a trocar
Closed Drainage
- Type of Drainage
- A strong arterial solution is injected at a very slow rate of flow without taking any blood drainage from a vein.
Steps in the Embalming Process
Step 1: wash, massage, and position the body
Step 2: setting the features
Step 3: drain/injection of embalming fluid
Step 4: Aspirate
Step 5: Cavity Treat
Steps in Transferring a Decedent
Know your limit,
use the squat lift/Lift from your legs transfer from surfaces that are level
Pull, not push
Use equipment and machinery, when possible
Mouth Closure Options
Needle injector,
musculature suture,
sublingual suture,
mandibular suture,
dental tie,
drill and wire,
gluing the lips,
and chin rest
Eye Closure Options
Eyecap
Cotton
glue
What Should and Shouldn’t Be Removed Prior To Embalming
- Any TUBES (Air passageway, endotracheal, nasopharyngeal, tracheostomy, abdominal feeding tube), CASTS, and URINARY CATHETERS.
- Pacemakers, staples, surgical drains, colostomies, and instravenous catheters can be removed before OR after
Different Skin Conditions and Injury
1) Visible Discoloration - Livor mortis, postmortem stain, ecchymosis, purpura
2) Skin lesions and ulcerations - rashes, lesions, infected areas, and skin cancers
3)Lacerations and fractures - jagged tears in skin and fractures
4) Abrasions - Wearing away of skin due to force - Skin-slip, blisters, pustules, and scabs
Subcutaneous Emphysema (Gas)
- Caused by puncture of lung or pleural sac, no odor or skin slip, but can be extreme
- May be confused with tissue gas
True Tissue Gas
Caused by anaerobic bacteria, has a strong odor of decomposition and spreads quickly
Gas Gangrene
Caused by anaerobic bacteria, foul odor and infection
- antemortem form of tissue gas
- Caused by clostridium perfringens
One-Point Injection
Uses the same site for both arterial injection and blood drainage
Types Of One-Point Injections
Right common carotid artery and right internal jugular vein;
Right femoral artery and femoral vein; Right axillary artery and axillary vein
Multipoint Injection
Injection from two or more sites
Six-Point Injection
Isolates each extremity (both arms; both legs) and both sides of the head.
Split Injection
Injection of solution from one site with drainage from a different site.
Restricted Cervical Injection
Method of injection where both common carotid arteries are raised.
Instant Tissue Fixation Injection
- Embalming technique that uses a very strong arterial solution in a BURST-SUPPRESSION PATTERN
- Is combined with restricted cervical injection.
Postmortem Coagula
- Not actual clots, but congealed blood that has stuck together
Postmortem Clots
Multicolored; Bottom portion of the clot is dark, as it was formed by red blood cells that gravitated to the dependent part of a vessel.
Antemortem Clots
Clots such as thrombosis form in LAYERS— a layer of platelets, followed by a layer of fibrin, followed by another layer of platelets, and so on
Intravascular Resistance
- Can be caused either by NARROWING or obstruction of the LUMEN of a vessel.
- The lumen can be obstructed by blood, antemortem emboli, antemortem thrombi, and postmortem coagula and thrombi.
Extravascular Resistance
- PRESSURE PLACED OUTSIDE THE BLOOD VESSEL
- includes rigor mortis, tumors, and other gas in the cavities.
Injection Pressure vs. Rate Of Flow
- Injection pressure: amount of pressure produced by an injection device to overcome initial resistance within the vascular system. (pressure the machine makes to mimic the vascular system to get the fluid through.)
- Rate of flow: the amount of embalming solution injected in a given time period, also called the SPEED OF DELIVERY
Osmosis
The passive transport mechanism involved with liquid movement. It involves the passage of a solvent (such as water) through a semipermeable membrane from a dilute to a concentrated solution
Dialysis
A mechanism responsible for the DIFFUSION of the dissolved CRYSTALLOID solutes of a solution through a SEMIPERMEABLE MEMBRANE
Diffusion
MOVEMENT OF MOLECULES from an area of HIGH concentration to an area of LOW concentration.
Contents Of/Purge From the Lungs, Trachea, Bronchi
Blood, edema, purulent material, gases (Comes out the nose and mouth; frothy with little odor)
Contents Of/Purge From the Stomach☕️
Hydrochloric acid, undigested food, blood, gases (Comes out the mouth as liquids, semisolids, dark brown “COFFEE GROUND” appearance)
Contents Of/Purge From the Small Intestine
Gases, undigested food, partially digested food, blood
Contents Of/Purge From the Large Intestine
Gases, fecal material, blood
Contents Of/Purge From the Urinary Bladder
Urine, pustular material, blood
Contents Of/Purge From the Gallbladder
Bile
Contents Of/Purge From the Kidney
Urine, pustular material, blood
(remember: similar to purge from the bladder)
Contents Of/Purge From the Heart
Blood
Contents Of/Purge From the Inferior Vena Cava
Blood
Contents Of/Purge From the Brain
Blood, semisolid brain matter (Comes out nose/ear/eyes; are a creamy white or bloody)
What Are the Nine Quadrant Map Of Internal Organs?
Right hypochondriac region, epigastric region, left hypochondriac region;
Right lumbar region, umbilibal region, left lumbar region;
Right iliac region, hypogastric region, left iliac region
Hydroaspirator
Installed in the prep room on the supply line for the cold water, and then a vacuum is created by turning on the water supply.
Electric Aspirator
Stand-alone motorized devices. An inlet for the water supply leads to the impeller on the motor shaft; the impeller spins to create suction.
Hand Pump Aspirator (Historical)
A dual-purpose handheld device used for both arterial solution injection and cavity aspiration.
Air Pressure Machine (Historical)
Operates just like the hand pump except it is motorized. Machine only provides the air pressure
Trocar Guide For the Right Side Of the Heart
- insert and points toward the earlobe
- Direct the trocar to intersect a line drawn from the left anterior-superior iliac spine and the right earlobe. After the trocar has passed through the diaphragm, depress the point and enter the heart
Trocar Guide For the Stomach
- insert; point toward the mid lower ribs in the mid arm (elbow)
- Direct trocar point toward the intersection of the fifth intercostals space and the left midaxillary line; continue until the trocar enters the stomach
Trocar Guide For the Cecum
- Cecum: A pouch that forms the first part of the large intestine
- Direct the trocar point toward a point one-fourth of the distance from the right anterior-superior iliac spine to the pubic symphysis; keep the point of the trocar well up near the abdominal wall until within 4 inches of the right anterior-superior iliac spine; then dip the point 2 inches and insert it forward into the color
Trocar Guide for the Bladder
- insert, travel down to the pubic bone and press it, retract the trocar slightly, then insert slightly lower into the bladder
- Keep the point up near the abdominal wall directing the trocar to the median line of the pubic bone until the point touches the bone. Retract the trocar slightly, depress the point slightly, and insert into the urinary bladder
Different Types of Aspiration
Thoracic cavity, abdominal cavity, cranial
Bridge or Individual Sutures
Bridge sutures TEMPORARILY ALIGN tissue margins and secure them in position until permanent sutures replace them.
Baseball Suture
- The most commonly used suture to close incisions.
- It is considered the most secure and leak proof.
- It is best suited for closure of lengthy incisions like an autopsy, surgery, and long-bone donation.
Interlocking (Lock) Suture
- Creates a tight, leak proof closure.
- A disadvantage is a visible ridge that appears on the surface of the incision.
Single Intradermal Suture
“Hidden stitch,”
-✅ used on exposed areas of the body and is directed through the subcutaneous tissues only.
- Puckering will happen if pulled too tightly.
Double Intradermal Suture
Subcutaneous stitch which requires using a SUTURING NEEDLE ON EACH END OF THE LIGATURE with the suturing needles being CROSSED from side to side on each stitch.
Inversion or Worm Suture
Suture used to gather and turn under excess tissues; follows the margins of the incision.
Continuous or Whip Suture
- Is used to TEMPORARILY CLOSE LENGTHY INCISIONS
- Disadvantages include a visible ridge, visible suture thread, and leakage potential.
(think of the sutures the medical examiner makes)
Supplemental Embalming
This type of embalming consists of two types; surface and hypodermic.
Surface Embalming
Preservation of the body tissues by direct contact with embalming chemicals. This is usually done through compresses.
Hypodermic Embalming
Injection of embalming chemicals directly into the tissues through the use of a syringe and needle or a trocar.
What Are the 6 Types of Incisions?
Supraclavicular, anterior vertical, posterior vertical, anterior horizontal, semilunar (Flap incision), and strap line
Supraclavicular Incision
Made along the clavicle laterally
Anterior Vertical Incision
Made from a point near the SCM muscle
Posterior Vertical Incision
Made posterior to SCM
(these type of vertical incisions are centered around the SCM)
Anterior Horizontal Incision
Made at the base of the neck from a point on the SCM muscle and is directed posteriorly
Semilunar (Flap incision)
Extends from a point lateral and slightly superior the the sternoclavicular articulation and is directed inferiorly, crossing the upper chest in an ARC
Strap Line Incision
The incision is made approx. 2 INCHES lateral to the base of the NECK LINE
Manual Embalming Aids
Lowering the arms, massaging, squeezing of the fingers
Operative Embalming Aids
- Channeling (think of using drainage, instruments)
- incising,
- excising.
(think of operative=surgery= what do surgeons do?)
Arteries versus veins
- Arteries are used for injection
- Veins are used for drainage
Ecchymosis
a DISCOLORATION of the skin resulting from BLEEDING UNDERNEATH typically caused by bruising.
(think of a really bad bruise)
Purpura
A rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs.
Thrombosis
Thrombosis is the formation of a blood clot, known as a thrombus, within a blood vessel.
- It prevents blood from flowing normally through the circulatory system.
