Special Conditions

Question 1

Antemortem Blood Discolourations - Intravascular

Answer 1

a) Hypostasis of blood - blue-black discolouration
b) Result of CO poisoning - cherry red discolouration
c) Capillary congestion

Question 2

Antemortem Blood Discolourations - Extravascular

Answer 2

a) Ecchymosis
b) Purpura
c) Petechia
d) Hematoma

Question 3

Postmortem Blood Discolourations - Intravascular

Answer 3

a) Livor mortis

Question 4

Postmortem Blood Discolourations - Extravascular

Answer 4

a) Postmortem stain

b) Tardieu Spots

Question 5

Antemortem Discolouration Classifications

Answer 5

a) Blood discolourations
b) Drug and therapeutic discolourations
c) Pathological discolourations
d) Surface discolouring agent discolourations

Question 6

Postmortem Discolouration Classifications

Answer 6

a) Blood discolourations
b) Surface discolouring agent discolourations
c) Reactions to embalming chemicals on the body
d) Decomposition discolourations

Question 7

Jaundice complications and strategies to care for remains

Answer 7

Jaundice will turn the body yellow and when the oxidation reactions occurs with formaldehyde solutions it can turn the body green or in rarer cases black.

3 strategies to help are:

1. Counterstaining - Injecting large quantities of dye before introducing a formaldehyde product. The idea being if cells are stained their contents will be less visible when the conversion of bilirubin to biliverdin occurs.
2. Flushing - Injecting copious amounts of a weaker solution. The idea being the increased volume will flush much of the pigment out of the vascular system while the mild solution binds with proteins much of the by-product produced are washed away in the drainage.
3. Buffering - Using co-injection chemicals to slow down the reactions that cause the conversion of bilirubin to biliverdin

Question 8

Embalming management of Intravascular discolourations

Answer 8

Flushed out using pre-injection or co-injection solutions

Question 9

Embalming management for extravascular discolourations

Answer 9

Pre-injection, co-injection or special arterial fluids can help to bleach out the spots but will not remove completely
Followed by hypodermic and surface treatments.

Question 10

3 potential outcomes with ecchymosis

Answer 10

1. Arterial solution will penetrate the area, little distention and bleach it out some
2. Severe distention will occur
3. Nothing will happen - hypodermic and/or surface treatments must be used

Question 11

Pustular and Ulcerative lesions treatment

Answer 11

1. Disinfect surface of lesion
2. Open and drain - coat with autopsy gel or cotton compress saturated with cavity fluid or phenol cautery solution
3. Embalm body
4. Check for preservation. Hypodermic treatment at this time or surface treatment may be needed
5. Dry with solvent and force dry with hair dryer

Question 12

Embalming treatments for Burn wounds

Answer 12

• Fluid distribution can be a challenge - using dyes helps to see distribution
• Multiple point injection is preferred in non-autopsied bodies
• Use of a strong waterless solution for preservation
• Painting an autopsy gel over burns for preservation and odour control
• Unionall garment is necessary with ample amounts of embalming powder
• Moisture-absorbent kitty litter can be used within the garment for odour control

Question 13

Challenges created by edema

Answer 13

• Leakage through any punctures or skin dampening clothing and the casket
• Speed up decomposition
• Secondary dilution of arterial solution
• Potential of skin-slip increased
• Skin wrinkles and distorts when gravitation of anasarca edema

Question 14

Physical methods to reduce edema

Answer 14

• Massage
• Steep incline on prep table
• Making drainage punctures, channelling and wicking
• Higher pressures and lower rate of flow

Question 15

Chemical methods to reduce edema

Answer 15

• Establish circulation before introducing edema chemicals
• Drying punctures and incisions should be dried in order to seal tightly
• Hypodermic & Topical treatments with high-index fluids, cavity fluids, and cauterants
• Incision sealing powders or mastic compounds

Question 16

Challenges created by dehydration

Answer 16

Unable to achieve proper preservation due to lack of water required for osmosis and pressure filtration in the body

Question 17

Methods to reduce dehydration

Answer 17

Pre-injection with humectant
Topical humectant packs
Moderate arterial solution with intermittent or alternate drainage to help enhance distribution and diffusion

Question 18

Challenges with refrigerated remains

Answer 18

• Stops blood clotting process creating a greater stain and promoting hypostasis
• Surface and vascular dehydration

Question 19

Challenges with frozen remains

Answer 19

• Thawing too fast will cause skin-slip and excessive swelling
• Rigor is accelerated when thawing
• Decomposition is accelerated when thawing
• Reduced tissue firming because of crystallization of cells when frozen
• Lips will be thin and dry, possible cracks
• Eyes will be shrunken and wrinkled
• Nose shrinks

Question 20

Methods for embalming frozen remains

Answer 20

• Begin with topical or hypodermic treatments on all areas which show signs of decomposition.
• Multi-point or sectional embalming may be required because of visceral decomposition or distension
• Surface discolourations of the hands and face can be treated by adding topical moisture and using a humectant in arterial solution

Question 21

Challenges created by a senile purpura & corresponding embalming tx

Answer 21

• Often swell and fill during injection - multiple point injection as to inject the senile purpura will high index to dry out the area, low and slow
• Do not massage hard, can cause bruising.
• Use surface compress or autopsy gels or hypodermic tx prior to embalming
• After embalming the senile purpura will darken and separate tissues, can cause tearing.
• Leakage is possible, can use a drying agent and wrap the area.

Question 22

Embalming infant too small for arterial injection

Answer 22

• Hypodermic embalming with 8 inch needle injecting deeply along the bones from central point on chest and back. 1:1 ratio high index arterial solution to humectant, or diluted cavity fluid.
• Topical tx should include saturated cotton layer underneath and on top with a 1:1:1 ratio of arterial chemical, humectant and co-injection. Wrap in plastic and sit for 8 hours minimum
• Wash baby thoroughly and aspirate cavity with approx 4-6 oz of fluids.
• Preservative gels can be painted on the surface and covered.
• Use cavity fluid injections along with tissue builder for cranium preservation to firm, dry and prevent leaking.

Question 23

What are pustular lesions and provide examples

Answer 23

Local, clearly defined skin elevations containing pus ie: Boils, furuncles or carbuncles

Question 24

What are ulcerative lesions?

Answer 24

Localized necrotizing of the epithelium layer or mucous membrane

Question 25

Explain tissue gas in detail

Answer 25

Tissue gas is gas accumulated in the tissues and cavities caused by an anaerobic, spore-forming bacteria usually C. perfringens. It produces liquid gas and waste causing crepitation. Can begin in the agonal period.