test 4

Question 1

pre embalming long bone donation cases

Answer 1

• clean/bathe the body as normal
• disinfect mouth, nose, and eyes as normal
• set features as normal

Question 2

embalming long bone donation option 1

Answer 2

• remove and open all procurement incisions
• remove prosthetic devices
• raise left and right carotid for head and trunk
• do not use pre injection and make arterial stronger for trunk and limbs

Question 3

embalming long bone donation - legs

Answer 3

• use femoral
• start as high on leg as possible
• clamp off vessels
• if femoral has been cut inject below the cut
• might use anterior/posterior tibial or even dorsalis pedis
• inject hypodermically if have to

Question 4

embalming long bone donation - arms and hands

Answer 4

• inject using axillary or brachial
• possibly use radial
• hypo if need be

Question 5

embalming long bone donation - trunk

Answer 5

• inject through femoral, subclavian, or carotid

Question 6

embalming long bone donation - head

Answer 6

• inject through carotids
• solution does not need to be as strong as solution for trunk and limbs

Question 7

embalming long bone donation - after injection

Answer 7

• allow body to sit and drain as long as possible
• dry all tissues
• replace prosthetics
• coat tissues with preservative and absorbent
• use tight suture (baseball)
• wash entire body
• cavity work as normal
• mortuary glue on incisions and cotton

Question 8

embalming long bone donation option 2 - before injection

Answer 8

• after features set, cleaned, disinfected, raise right common carotid
• make solution for trunk, arms, and legs stronger than normal

Question 9

embalming long bone donation option 2 - during injection

Answer 9

• do not use pre injection
• inject carotid down with strong than normal solution
• if not getting enough move to another artery lower down limb or hypo
• inject head through carotid using weaker arterial

Question 10

embalming long bone donation option 2 - after injection

Answer 10

• wash entire body
• cavity work as normal
• use trocar at bottom of incision to aspirate accumulation of fluids
• allow to sit/drain for long as possible
• suture and seal as usual

Question 11

eye enucleation procedure

Answer 11

• raise lid gently with aneurysm hook
• remove packing in socket
• dry socket with cotton
• swab socket with cotton soaked in drying agent then leave inside
• place eye cap over the cotton and close lid
• coat eye area in massage cream
• do not use pre injection
• use normal strength arterial
• use minimum pressure and rate of flow
• observe carefully during injection

Question 12

eye enucleation after injection

Answer 12

• remove cotton packing from socket
• dry socket and duplicate eye with cotton and place in socket
• place eye cap on top of cotton
• close eye (glue if necessary)

Question 13

if removal of just the cornea

Answer 13

• treat like enucleation except
• aspirate the fluid from eyeball before embalming
• drying and packing is done inside the empty eyeball instead of the socket

Question 14

embalming severed limbs

Answer 14

• each part of limb embalmed separately
• if blood vessels intact through arterial
• if not vessels hypo
• when done vessels should be ligated

Question 15

suturing severed limbs

Answer 15

• suture the muscles of both parts tightly
• suture skin entirely around limb
• suture line can be covered with sealer
• after sealer dries cover with cotton and second coat of sealer

Question 16

restoring length to severed limbs

Answer 16

• use four metal/plastic/wood rods
• straight section of metal hanger
• rods placed in each section of limb reproducing correct length
• rods covered with rolled cotton and sealer
• entire area taped
• tape should extend 4-5 inches past the cotton onto the skin to keep sections connected

Question 17

missing limb - arm and hand

Answer 17

• long sleeves recommended
• sleeve stuffed with soft material
• white glove can be stuffed
• glove then pinned to inside of sleeve
• can try and remake a hand out of mortuary mastic
• if remade hand, place it under the natural one in casket

Question 18

twisted limb

Answer 18

• may be necessary to sever the ligaments behind elbow or knee
• place in proper position and dry incision, seal it, and saturated
• metal splints can be used under knee for support
• may have to tweak casket interior to fit arthritic limbs

Question 19

decapitation embalming

Answer 19

• head and body embalmed separate
• embalm head using waterless solution (max preservation with minimum solution)
• tie off vessels and openings (esophagus)
• use a sealer to cover are on body and neck
• use dowel rod to reconnect head to body
• add extra rods around opening for stabilization
• liquid sealer on both had and opening
• suture (baseball stitch after attached)

Question 20

what is decomposition

Answer 20

separation of compounds into simpler substances by the action of microbial and/or autolytic enzymes

Question 21

proteolysis

Answer 21

breakdown of proteins

Question 22

autolysis

Answer 22

breakdown of self by self

Question 23

lipolysis

Answer 23

breakdown of lipids (fat)

Question 24

fermentation

Answer 24

breakdown of carbohydrates

Question 25

saccharolysis

Answer 25

breakdown of sugars

Question 26

signs of decomp - color

Answer 26

• along trunk there can be green discoloration in lower right quadrant of abdomen; large intestine will be identifiable
• vascular marbling in small superficial vessels
• livor mortis and stains in dependent areas

Question 27

signs of decomp - purge

Answer 27

putrefactive body fluids become forced out of body orifices

Question 28

signs of decomp - gas

Answer 28

• produced by chemical/microbial activity during decomp of solid wastes
• clostridium perfringens cause gas and leads to stomach and rectal purge
• heat/humidity increase likelihood of gas
• bloating, eyes and tongue can protrude
• distension of abdominal cavity can cause purge

Question 29

signs of decomp - odor

Answer 29

• autolysis and putrefaction products emit foul odor
• C. perfringens produce pungent odor

Question 30

signs of decomp - skin slip

Answer 30

• aka desquamation
• on hands, face, etc

Question 31

extrinsic factors that affect decomp

Answer 31

• temperature (higher = faster)
• moisture (more = faster)
• access of air
• animal activity
• pressure due to clothing or earth
• bacteria

Question 32

intrinsic factors that affect decomp

Answer 32

• internal moisture
• febrile diseases (infections)
• gas gangrene, moist gangrene
• bacteria in body

Question 33

mode of death that affects decomp

Answer 33

• drowning
• suicide like hanging, gun shot
• deaths that leave a lot of trauma to the body

Question 34

order of decomp of body

Answer 34

• liquid tissues (blood/lymph)
• soft tissues (parenchyma or organs/functioning material)
• firm tissues (muscle/stroma or organs)
• hard tissues (cartilage/bone)

Question 35

5 stages of decomp

Answer 35

1. fresh (1-2 days)
2. bloated (2-6 days)
3. decay (5-11 days)
4. post decay (10-25 days)
5. dry (25+ days)

Question 36

possible problems with decomp

Answer 36

• discolorations: livor mortis, post mortem stain
• gas: distension from moisture and tissue gas
• skin slip: weakens superficial layer of skin, gas moves easily causing blisters
• maggots: if body found in 50 degree or more

Question 37

embalming complications with decomp

Answer 37

• fluid distribution will be poor
• coagula in arterial system
• drainage poor from decomposed vessels
• swelling of tissues
• ammonia and nitrogenous products which neutralize formaldehyde
• require higher preservative demand

Question 38

embalming a decomp case

Answer 38

• multi point injection and RCI
• strong solution
• hypo areas if needed
• perfuming agents or kitty litter for smell
• cauterize agent/drying agent on areas needing wax and cosmetize work