Special Conditions Flashcards
Antemortem Blood Discolourations - Intravascular
a) Hypostasis of blood - blue-black discolouration
b) Result of CO poisoning - cherry red discolouration
c) Capillary congestion
Antemortem Blood Discolourations - Extravascular
a) Ecchymosis
b) Purpura
c) Petechia
d) Hematoma
Postmortem Blood Discolourations - Intravascular
a) Livor mortis
Postmortem Blood Discolourations - Extravascular
a) Postmortem stain
b) Tardieu Spots
Antemortem Discolouration Classifications
a) Blood discolourations
b) Drug and therapeutic discolourations
c) Pathological discolourations
d) Surface discolouring agent discolourations
Postmortem Discolouration Classifications
a) Blood discolourations
b) Surface discolouring agent discolourations
c) Reactions to embalming chemicals on the body
d) Decomposition discolourations
Jaundice complications and strategies to care for remains
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:
- 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.
- 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.
- Buffering - Using co-injection chemicals to slow down the reactions that cause the conversion of bilirubin to biliverdin
Embalming management of Intravascular discolourations
Flushed out using pre-injection or co-injection solutions
Embalming management for extravascular discolourations
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.
3 potential outcomes with ecchymosis
- Arterial solution will penetrate the area, little distention and bleach it out some
- Severe distention will occur
- Nothing will happen - hypodermic and/or surface treatments must be used
Pustular and Ulcerative lesions treatment
- Disinfect surface of lesion
- Open and drain - coat with autopsy gel or cotton compress saturated with cavity fluid or phenol cautery solution
- Embalm body
- Check for preservation. Hypodermic treatment at this time or surface treatment may be needed
- Dry with solvent and force dry with hair dryer
Embalming treatments for Burn wounds
- 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
Challenges created by edema
- 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
Physical methods to reduce edema
- Massage
- Steep incline on prep table
- Making drainage punctures, channelling and wicking
- Higher pressures and lower rate of flow
Chemical methods to reduce edema
- 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
Challenges created by dehydration
Unable to achieve proper preservation due to lack of water required for osmosis and pressure filtration in the body
Methods to reduce dehydration
Pre-injection with humectant
Topical humectant packs
Moderate arterial solution with intermittent or alternate drainage to help enhance distribution and diffusion
Challenges with refrigerated remains
- Stops blood clotting process creating a greater stain and promoting hypostasis
- Surface and vascular dehydration
Challenges with frozen remains
- 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
Methods for embalming frozen remains
- 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
Challenges created by a senile purpura & corresponding embalming tx
- 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.
Embalming infant too small for arterial injection
- 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.
What are pustular lesions and provide examples
Local, clearly defined skin elevations containing pus ie: Boils, furuncles or carbuncles
What are ulcerative lesions?
Localized necrotizing of the epithelium layer or mucous membrane
