Test 2 Material- 2 Flashcards
Antemortem or postmortem discolorations which occur prior to (or during) embalming due to the deposit of matter on the body surface.
Surface Discoloration Agents
- Mechanical
- Chemical
Methods of Removal of Surface Discoloration Agents
Use an abrading device and wash with suitable cleaning agents and soft cloths or brushes; danger dessication marks- red, brown. (Use the soft side of the sponge).
Mechanical Method
Use proper solvent when discoloration cannot be removed by mechanical cleaning. Waterless hand cleaner or trichloroethylene called dry wash (dry cleaners also used to use this, this chemical has been outlawed and replaced by dry wash II). The danger of this is that these chemicals are toxic and dehydrating.
Chemical Method
- May conceal signs of fluid distribution or diffusion.
- Most are more difficult to remove after tissues have firmed.
Importance of Pre-embalming Removal (Surface Discoloring Agents)
Postmortem discoloration that may be present before embalming but has become more intense, changed in hue, or may have evolved due to embalming.
- Razor burns
- Formaldehyde grey
- Desiccation marks
- Green discoloration
- Eye enucleation bruises
- Decomposition changes
Reaction of Embalming Chemicals Upon Body Contents
Caused by the dehydrating effects of the air to damaged epidermis- reddish brown discoloration- becomes progressively worse as time passes also dessication marks increasingly more noticable must be continuiously monitored.
Razor Burns
The chemical combination of formaldehyde with hemoglobin results in the formation of a substance called methemoglobin. With the passage of time, the color changes from pink to dark slate grey.
- Dark complexions are most susceptible
- Opaque cosmetics required
Formaldehyde Grey
Complete flushing of the venous system (removal of all blood). Keep head elevated above the stomach/chest, and active dye to impart a more life-like appearance. Counter act with an active dye eosin commonly used.
Counteracting Formaldehyde Grey
Fluid burns due to excessively strong solutions- reddish-brown discoloration. Usually seen on the face and becomes progressively worse as time passes.
- Opaque cosmetics required
Desiccation Marks
Results from high formaldehyde index solutions converting bilirubin (yellow) to biliverdin (green) in a jaundiced body. Also caused by acidic environment.
Green Discoloration
This is the primary concern with a jaundiced case.
Preservation
Result from damage to tissue and capillaries during the enucleation. Cavity fluid pack with bleaching cavity fluid followed by application of opaque cosmetics will be necessary.
Eye Enucleation Bruises
How to address potential swelling and discoloration during the embalming process of eye enucleation cases.
External Pressure
Postmortem discolorations which are due to the action of bacterial and/or autolytic enzymes on the body tissues. There may be progressive color changes in the tissues if enzymes are not inhibited. Yellow to light green to dark green to blue back to marbling.
Decomposition Changes
- Tan discoloration
- Red to purple
- Maroon
- Green
Examples of Color Changes Associated with Decomposition
Seen in the sclera of the eye due to postmortem dehydration.
Tan Discoloration
Associated with livor mortis eventually followed by postmortem stain.
Red to Purple
Decomposition of the arterial system causing the vasa vasorum to deteriorate changing the artery to _____; looks like muscle tissue making the visual of the artery difficult.
Maroon
A spot about the size of a silver dollar will appear over the cecum indicating the activity of E.coli.
Green
- Color
- Odor
- Purge
- Skin Slip
- Accumulation of gases
Cardinal Signs of Decomposition
In time, the ____ discoloration will spread over the entire body if the body is not embalmed properly and in a timely manner.
Green
- Use sectional hypodermic injections of chemicals designed to bleach and preserve.
- Surface compresses saturated with a proper bleaching agent.
- Chemicals: bleaching cavity fluid, phenol and topical jelly. (searene)
Treatment: Reaction of Embalming Chemicals Upon Body Contents
- Skin Lesions
- Pustular and ulcerative lesions
- Other conditions
Conditions Related to Discolorations
Any traumatic or pathological change in the stucture of the skin.
Skin Lesions
- Disinfect lesion: phenol gel, cavity pack, bleaching agents
- Prepare lesion for post-embalming treatment.
Purpose- Skin Lesions
For the purpose of embalming treatment, skin lesions may be grouped into these categories:
- Skin unbroken but discolored
- Skin scaling as exanthematous disease
- Skin broken but separated from the body
- Pultular or ulcerative lesions
Classification of Skin Lesions
- Allergic reaction antemortem
- Trauma
- Tumors
Skin Unbroken but Discolored: Examples
Increased blood flow into affected area with some swelling.
Inflammation: Skin Unbroken but Discolored
Strong arterial solution to reduce swelling, surface compresses- phenol gel, bleaching cavity fluid packs.
Recommended Treatment: Skin Unbroken but Discolored
Examples:
- Acidosis
- Seborrhea
- Eczema
- Psoriasis
- Healing sunburn
- Certain medications given prior to death
- Measles
- Chicken pox, etc.
Skin Scaling as in Exanthematous Disease
Heavy coat of massage cream or petroleum jelly (petrolatum) over exposed areas, face and hands, during arterial injection. After injection, remove massage cream or petrolatum carefully. After cleansing, use dry wash to further cleanse and remove scaling skin. A safety razor may also aid in removing scaling skin but could result in severe desiccation marks. Lastly, apply topical phenol for several hours. Application of opaque cosmetic may be difficult should scaling persist.
Recommended Treatment: Skin Scaling as in Exanthematous Disease
Examples:
- Abrasions
- Blisters (vesicles)
- Desquamation
Skin Broken and Separated from the Body
Remove this before embalming.
Skin loose on the lips
This can be done before or after embalming (after embalming if they are not in a viewable spot).
Lance Blisters and Treat
- Apply topical disinfectant
- Open and drain- blisters (vesicles) if present
- Remove all loose skin- desquamation
- Use strong arterial solution for injection- sectional injection may be required (6 points)
- Apply surface compresses of cavity fluid (cavity pack); use bleaching cavity fluid or apply phenol jelly to raw tissue.
- Preservation demand may require hypodermic injection into damaged area with bleaching cavity fluid or phenol solutions.
- Clean away all preservative chemicals with solvent (dry wash)
- Dry area with hair dryer to prevent further leakage-cauterize if necessary with electric spatula.
- Restorative Art
Recommended Treatment: Skin Broken and Separated from the Body
After dressing and casketing, basket weave suture wax and cosmetics usually opaue will be required.
Restorative Art- Skin broken separated from the body
The dark brown discoloration on surface tissue due to desiccation from harsh chemicals as well as air.
Major Problem Post Embalming- Skin broken separated from the body
For skin broken and separated from the body, do not apply massage cream at this time or petrolatum over top of surface abrasions. Instead, allow strong arterial solutions to flow through the broken surface tissue.
During Injection
Examples:
- Boils
- Carbuncles
- Furuncles
- Ulcers
- Pustules
- Fever blisters
Pustular or Ulcerative Lesions
Herpes, decubitus ulcers. Initially decubitus ulcers are asepctic. Eventually they become streptococcus or staphlyococcus. Decubitus ulcers are caused by pressure on body parts.
Most Dangerous type of Pustular or Ulcerative Lesions
- Remove all bandages and apply disinfectant chemicals or phenol jelly directly to the area.
- Terporarily pack the area to reduce odors and to promote surface preservation; use phenol jelly (autopsy gel, topical gel, preservative jelly) or fumeless cavity pack.
- Embalm body: arterial, sectional, hypodermic, surface compresses or all four.
- Utilize plastic undergarments containing embalming powder and/or strong hardening compound applied to ulcers. Plastic garments will prevent leakage and odor.
- Restorative art may be required.
Recommended Treatments: Pustular or Ulcerative Lesions
- Unionalls
- Stockings
- Sleeves- an alternative is custom cut stockings
- Coveralls
- Pants
- Capri pants
List of Plastic Undergarments
______ must be the most important goal in embalming all bodies. Problems associated with discoloration are secondary in importance.
Preservation
- First degree
- Second Degree
- Third Degree
- Fourth Degree
Burns
Redness of the skin (erythema/hyperemia)
First Degree Burns
Blistering and redness
Second Degree Burns
Charred tissue
Third Degree Burns
Disintegrated tissue.
Fourth Degree Burns
- Initially intravascular but becomes extravascular quickly.
- Bright cherry red color to the blood
- Low blood viscosity, intense livor mortis
- Rapid postmortem staining
Carbon Monoxide Poisoning (carboxyhemoglobin)
- Low blood viscosity, intense livor mortis
- Head faced downward, livor and stain
- Possible abrasion and bruising
- The body sinks at first, then floats due to accumulated gases.
Drowning
- Death caused by amps, not volts
- Extreme cases cause blood coagulation (heat)
- Point of contact, burn marks may be present
- Point of exit burn marks may be present
Electrocution
- Little livor mortis, paleness to skin surfaces (pallor)
- No blood discoloration
Exsanguination
Eyelids can show ecchymosis, swelling of eye area when injury is to face or head.
Gunshot Wounds
Intensive livor in facial tissues; some capillary rupture showing petechial stain.
Hanging
- Loss of blood- little livor mortis
- Ecchymosis and bruising at affected areas.
Mutilation- Trauma
Variable- From generalized conditions such as jaundice and cyanosis to localized discolorations such as caustic burns or petechial hemororhage.
Poisons
- Low blood viscosity, intense livor mortis
- Postmortem stain speeded
- Dehydration of mucous membranes and skin surface after long exposure to cold air.
- All are in supine position.
Refridgeration
Because of of ____ ____ investigation, postmortem interval is usually longer. Two solutions are recommended for these conditions:
- Restricted cervical injection and drainage method will be utilized (non-autopsied)- good for severe edema, use humectants.
- Special purpose high index arterial fluids will be utilized in high concentrations as much as one bottle to a gallon- 30 to 38 index.
Medical-legal
Most of the bodies that will come under the jurisdiction of the medical examiner will have __ _____. Often, much of the blood discolorations will disappear because of the evisceration process.
Full Autopsies
- Hypostasis to livor mortis to hemolysis will occur rapidly- livor mortis to postmortem stain. As little as 6 hours.
- Fluid distribution and diffusion problems
- Surface dehydration- most severe in fingertips, lips, eyelids, nose (can part eyelids and mouth)- Tissue builder
- Distention of viscera during injection causing purge.
- Capillary rupture throughout vascular system due to ice formation.
Major Problems Caused by Refridgeration
- Increased capillary permeability
- Easy rupture of the capillaries during arterial injection
- Tissue structure breakdown as a result of the slow, continuous processes of autolysis and bacterial enzymes
- Increased coagula in the vascular system
- Gravitation of blood and body liquids into the dependent body tissues, resulting in an increase in mositure in these tissues.
- Intense livor mortis
- Rapid hemolysis resulting in postmortem extravascular stain surface tissues, possible skin-slip
- Decomposition signs (abdominal discoloration, purge and skin slip)
- Rapid distension of abdominal organs during injection, resulting in stomach and/or lung purge.
- Increased algor mortis
When bodies have been refridgerated for long periods of time and wrapped in plastic or placed in a plastic pouch, the embalmer can expect some of these problems.
- Postmortem edema
- Blood thickens and agglutinates over time during refridgeration
- Slow reaction between body proteins and preservative solutions
- Can solidify subcutaneous fatty tissues so they feel firm to the touch
- Light pink color
- Slows but does not stop postmortem chemical and physical change
Major Characteristics of Refridgeration
Formation of high moisture content in some body tissues because the serum portion of the blood leaves the blood vascular system and gradually makes the way to the surface of the body (imbibition).
Postmortem Edema (Refridgeration)
Sludge formation/ blood clots.
Blood thickens and agglutinates over time during refridgeration
Delayed detectable firmness. Cold stiffening is often confused with firming of the tissues.
Slow reaction between body proteins and preservative solutions
False signal to the embalmer that a reaction has occurred between the preservative solution and the body protein.
Refridgeration can solidify subcutaneous fatty tissues so they feel firm to the touch
Color will occur confusing the embalmer into thinking the tissue is receiving arterial fluid solution. Results from hemolysis not arterial fluid solution. Always use more than one method to identify signs of distribution and diffusion.
Light Pink Color
Particularly decomposition and rigor mortis.
Refridgeration slows but does not stop postmortem chemical and physical change.
- Allow time for the body to warm
- Always use cold water to thaw (Never use warm/hot water becuase it causes coagulation and desiccation marks).
- Restricted cervical method
- Solution- high index 30 to 38, 16 ounces to a gallon.
- Add tracer dye and co-injection, do not use preinjection; it will cause “water logging”
- Hypodermic and surface embalming for areas not receiving arterial fluid solution.
- Low pressure- low rate of flow- slow gentle rain.
Recommended Treatment- Refridgeration
- Head freeze
- Hot water only works for short distances
- Always place two wet towels over the embalming tank to contain the fumes
- Waterless solutions for instant tissue fixation
- Not true waterless
Extreme Adverse Conditions
- Hot water
- High index
- Waterless embalming
Ways to achieve Head Freeze (Instant Tissue Fixation)
The femoral artery is most likely to be affected by this. The use of the common carotid artery and right internal jugular vein will be the primary injection site.
Arteriosclerosis
- Type 1
- Type 2
- Type 3
3 Types of Arteriosclerosis
The inner wall of the artery is hardened and thickened but the lumen is well defined and large. These vessels can usually be used for arterial injection. This condition is frequently observed in the autopsied body when the common iliac arteries are exposed.
Type 1 Arteriosclerosis
The lumen is quite reduced in size and pushed to one side of the artery. The lumen can usually be identified and a small arterial tube can be used for injection.
Type 2 Arteriosclerosis
The artery is completely occluded. If ischemia or gangrene is not present in the area supplied, the collateral circulation may have increased to supply blood to the limb, or there may be minute paths in the occluded artery through which the blood can pass. The formation of these paths or canals is called canalization. These arteries cannot be used for injection.
- Worst type
Type 3 Arteriosclerosis
Pre-injection fluid should not be used when it is thought it will be difficult to establish arterial solution distribution. Swelling coud result later when the preservation solution is injected, as the system would be filled with pre-injection fluid. Pre-injection fluid should be used only if circulation is thought to be good; in such cases, it maintains the good distribution and drainage. Many persons who had vascular diseases were given blood thinners and anticoagulants. These bodies generally exhibit good arterial solution distributio and few or not clots in the drainage.
Problem of “Water-Logging” as it Relates to the use of Pre-Injection Fluid
- Arteriosclerosis
- Arterial coagula (Thrombosis, blood clots)
- Atherosclerosis
- Arheroma
4 Intravascular Arterial Conditions that can Limit the Distribution of Arterial Solution to Various Body Areas
The cavity of a vessel. The farther away from the heart the vessel travels, the smaller this becomes.
Lumen
- Tunica Interna (Intima)
- Tunica Media
- Tunica Adventita (Externa)
Layers of Blood Vessels
The inner lining made of endothelial cells, which continue to form walls of the capillaries and then the inner walls of veins and arteries. (This endothelial layer of cells lines the entire blood vascular system).
Tunica Intima (Interna)
The middle layer composed of smooth muscle cells and elastic tissue. The muscle allows the vessels to expand and contract.
Tunica Media
The outer layer composed mostly of connective tissue. The blood within the vascular lumen is unable to supply blood to this most outer layer. Therefore, the vessels that supply nuturients are called vasa vasorum.
Tunica Adventita (Externa)
Can occur due to physiological or pharmeceutical reasons.
Vasodilation and Vasoconstriction
Active dye (Eosin) used to trace the distribution of arterial solution indicates that one side of the body has received a large amount of solution and the other side a small amount. This frequently occurs after death from _________.
- Vasodilation
- Vasoconstriction
Cerebral Vascular Accident (Stroke)
The vessels on one side of the body have undergone __1___ (the side not getting as much solution). In an effort to supply more oxygen to the tissues in life, the vessels on the other side have undergone ____2__.
- Vasoconstriction
- Vasodilation
Multisite injection may be necessary, but in most bodies injection of a sufficient quantity of solution should overcome the problem.
Treatment of Vasodilation and Vasoconstriction
Sometimes, death certificates cite ___ ____ ____ as the primary cause of death (this is caused by high blood presure). Some complications of the end stage of this are of particular interest to the embalmer.
Congestive Heart Failure
- Blood is congested in the right side of the heart
- The neck veins are engorged with blood; the facial tissues are dark because of the congestion of blood in the right side of the heart and the veins of the neck.
- Lips, ears, and fingers of cyanotic.
- Generalized pitting edema is often present. Edema of the legs and feet is pronounced in most bodies. Ascites may be present. Sometimes, the edema in the extremities may be so edamatous that it becomes Anasarca (severe edema).
- Blood may be more viscous because of an increase in red blood cells.
- Salt is retained in the body fluids.
Complications of End Stage Congestive Heart Failure
Increase in red blood cells.
Polycythemia
- Restricted cervical injection and drainage method.
- Continuous method- unrestricted drainage
- Immediate cavity treatment- re-aspirate (always good to reaspirate)
- Edema will require stronger solutions
- Lung purge common
- ascites common
- Build-up of decomposition gases
- Pack trachea and esophagus prior to suturing incision
Recommended Treatment: Congestive Heart Failure
- Air/water collars sometimes filled with sand
- Turkish towel
- Cold water packs
Methods to Reduce Swollen and Distended Neck
Avoid lanolin base and/or humectants fluids for arterial injection. Certain circumstances will require humectants be injected into the face but not the rest of the body.
Edema will Require Stronger Solutions
Encourage (massage cream on the face).
Lung Purge Common
Aspirate prior to injection (only if necessary)
Ascites Common
Aspirate prior to injection (only if necessary).
Build-up of Decomposition Gases
Fluids containing quantities of certain chemicals sufficient to supplement the injection mixture previously diluted (co-injection, etc).
Supplemental Chemicals
- Reduced pressure and rate of flow
- Utilize care in raising vessels
- Use gauze or similar heavy material to tie off vessels to prevent cutting or damage.
- Use various distribution and drainage aids, manipulation of appendages, massage.
- Proper selection of size and type of injection and drainage tubes.
Mechanical and Manual Aids (Intravascular difficulties)
- Use of alternate injection an drainage or intermittent drainage as indicated.
- Low pressure
- Sectional Arterial Injecton- 6 points
Controlled Injection and Drainge (Intravascular difficulties)
- Arteriosclerosis as well as poor peripheral circulation.
- May or may not be obese (22%)
- Gangrene may be present in distal fingers, toes. When gangrene is present it is often dry (aseptic).
- Decubitus ulcers- poor circulation intially aseptic turns septic (staph/strep) contagious/infectious
- Abnormal pH values my result in difficult tissue firming.
- Increased bacterial and mycotic infections.
Diabetes Mellitus Characteristics
- Restricted cervical method
- Torso and appendages
- Strong arterial solutions
- Co-injection - avoid pre-injection
- High pressure and rate of flow
- Intermittent drainage
- Pulsation (better distribution and diffusion)
- Tracer dye
- Higher volumes of solution
- Immediate cavity treatment 3 bottles (each cavity, abdominal, throacic, pubic) re-aspirate
- Topical Jelly
- Direct treatment of ulcers
- Unionalls- coveralls- preservative powder or hardening compound inside.
Recommended Treatment: Diabetes Mellitus
Phenol and/or hypodermic injection of undiluted strong cavity fluid with parietal needle into necrotic tissue.
Topical Jelly
- Milder solution- humectants added in co-injection
- Tissue builder after injection may also be necessary
Head: Dehydration
Head freeze: Immediate tissue fixation (LAST RESORT)
Head: Edema
Pressure on the outside of an artery or vein is referred to as this, and may restrict the flow of arterial solution into a body region or may restrict damage through a vein.
Extravascular Resistance
- A slightly stonger, well-coordinated arterial solution should be used as distribution may be limited.
- Multisite injection may be necessary if extravascular resistance is present.
- Use of higher embalming pressure may promote distribution.
- Stopping injection and allowing time for drainage may help to prevent blood discolorations.
- Use of concurrent drainage throughout the entire operation.
- Massage and manipulate the tissues to promote both fluid distribution and blood drainage.
Treatment of Extravascular Resistance
- Rigor mortis
- Ascites
- Gas in cavities
- Bandages
- Contact pressure
- Tumors
- Swollen lymph nodes
- Hydrothroax
- Visceral weight
Sources of Extravascular Resistance
Relieve as much rigor as possible by manipulation prior to arterial injection. This includes the legs and neck.
Rigor mortis
Relieve the abdominal pressure by draining prior to or during arterial injection. Only in extreme cases.
Ascites
Puncture the abdomen to relieve gases prior to or during arterial injection. Only in extreme cases.
Gas in Cavities
Remove tight bandages prior to injection. (Talk about the removal or casts with the family).
Bandages
Massage these areas. Use positioning blocks to reduce the amount of surface that the body comes into contact with.
Contact Pressure
Excise, with permission, if absolutely necessary. Sectional injection may be necessary. It does not matter if these are malignant or benign.
Tumors
Multipoint injection may be necessary.
Swollen Lymph Nodes
Drainage may be possible prior to injection, but can be difficult.
- Too risky, the embalming will probably puncture a major artery.
Hydrothorax
Above and below heart injection and drainage points can be employed.
Visceral Weight
Always keep the head and neck ____ the chest and abdomen. Otherwise purge and HCHO grey will occur.
Above
- Sectional arterial injection
- Sectional hypodermic injection (used as a supplement to arterial injection)
- Operative aids (written permission should be obtained).
- necrotic tissue excision
- swollen tissue excision
- New growths excised
- Surface compresses in case of skin slip, etc.
Recommended Treatment for Extra-Vascular Difficulties
