Week 3 Legs, Technique, & Cavity Flashcards
terminal branches of the descending abdominal aorta
common iliac arteries
common iliac artery bifurcates into ____ & ____
internal and external iliac arteries
____ takes blood to the gluteal, pelvic, and genital regions
internal iliac artery
termination of the external iliac artery
femoral artery
external iliac artery is ____ to the external iliac vein
lateral
external iliac artery passes beneath the ____
inguinal ligament
anatomical guide for external iliac artery
artery extends to a point under the center of the inguinal ligament
boundaries of the femoral triangle (Scarpa’s triangle)
medial border of the sartorius
lateral border of the adductor longus
base – inguinal ligament
roof – dense sheet of fascia (fascia lata)
floor – iliopsoas and pectineus muscles
apex – adductor canal
femoral artery is ____ & ____ to the femoral vein
lateral & superficial
(lat. to med. & sup. to deep both NAV)
femoral sheath contains the ____ and ____.
____ sits outside the sheath
femoral artery & femoral vein
femoral nerve
____ sits on the surface of the fascia lata and sits on the medial aspect of the leg
greater saphenous vein
linear guide for the femoral artery
a line from the center of the inguinal ligament to the center of the medial prominence of the knee (medial condyle of the femur)
anatomical guide for the femoral artery
artery passes through the center of the femoral triangle and is bounded laterally by the sartorius muscle and medially by the adductor longus muscle
anatomical limits of the femoral artery
artery extends from behind the center of the inguinal ligament to the opening in the adductor magnus muscle
origin and termination of the femoral artery
continuation of the external iliac artery; terminates as it becomes the popliteal artery
incision for femoral artery
draw a line centered between the anterior superior iliac spine and the pubic symphysis; incision is made along the medial portion of the linear guide
borders of the popliteal space
bordered superiorly by the biceps femoris (laterally) and semimembranosus & semitendinosus (medially), bordered inferiorly by gastrocnemius (both medially and laterally)
linear guide for the popliteal artery
a line on the surface of the skin from the center of the superior border of the popliteal space parallel to the long axis of the lower extremity to the center of the inferior border of the popliteal space
anatomical guide for the popliteal artery
vessels are located between the popliteal surface of the femur and the oblique popliteal ligament
anatomical limits for the popliteal artery
artery extends from a point beginning at the opening of the adductor magnus muscle to the lower border of the popliteus muscle
origin and termination of the popliteal artery
originates as a continuation of the femoral artery; terminates as a bifurcation into anterior tibial and posterior tibial arteries
popliteal artery is ____ & ____ to the popliteal vein
lateral & deep
incision for the popliteal artery
longitudinal incision along the posterior—medial aspect of the lower third of the thigh just superior to the popliteal space
linear guide for the anterior tibial artery
a line from the lateral border of the patella to the anterior surface of the ankle joint
anatomical guide for the anterior tibial artery
artery is located in a groove between the tibialis anterior muscle and the tendon of the extensor hallicus longus muscle
anatomical limits for the anterior tibial artery
artery extends from a point beginning at the inferior border of the popliteus muscle to a point in front of the middle of the ankle joint on the respective sides
incision for the anterior tibial artery
incision is made along the lateral margin of the inferior third of the crest of the tibia; artery is at the superficial margin of the tibia
linear guide for the posterior tibial artery
a line on the surface of the skin from the center of the popliteal space to a point midway between the medial malleolus and the calcaneus bone
anatomical guide for the posterior tibial artery
artery is located between the posterior border of the tibia and calcaneus tendon
anatomical limits for the posterior tibial artery
artery extends from a point beginning at the inferior border of the popliteus muscle to a point over and between the medial malleolus and the calcaneus of the respective foot
incision for posterior tibial artery
incision is made midway between the medial malleolus and the large calcaneus tendon
linear guide for dorsalis pedis artery
a line from the center of the anterior surface of the ankle joint to a point between the first and second toes
incision for the dorsalis pedis artery
incision is made from a point midway between the medial and lateral malleoli to a space above the toes
steps in raising an artery (5)
shave area if necessary
grab instruments, ligature, etc.
make incision
blunt dissection of fascia, fat, etc.
locate, clean off, and loosely ligate vessels
ways to incise vessels (5)
transverse
diagonal
longitudinal
T incision
triangular (wedge)
considerations when choosing a vessel (7)
superficial vs deep
surrounding structures
proximity to aorta
size
effect on posing the body
location regarding exposed / viewable areas
practicality of drainage from corresponding vein
sharply-pointed aspirating instrument used in cavity embalming to remove gases, liquids, and semi-solids from the body cavities and hollow organs and inject cavity fluid
trocar
internal organs enclosed within a cavity
viscera
decomposition of proteins by the action of enzymes from anaerobic bacteria
putrefaction
separation of compounds into simpler substances by the action of microbial and/or autolytic enzymes
decomposition
postmortem evacuation of any substance from an external orifice of the body as a result of pressure
purge
two main steps of cavity treatment
aspiration
injection of preservative/disinfectant
historical tools for cavity treatment (2)
hand pump & air pressure machine
instruments for ____ may include a trocar, hydroaspirator, electric aspirator, autopsy aspirator, infant trocar, and/or nasal aspirator
cavity treatment
three reasons for treating the viscera
1) to insure that the contents of the hollow viscera and body cavities are perfused
2) to prevent the formation of any products of decomposition in the body cavities or hollow organs
3) to prevent putrefactive changes in tissues within the body cavities
during embalming a trocar may be used to drain ascites or remove gases (T/F)
true
cavity treatment must immediately follow arterial injection (T/F)
false (may be delayed)
situations where aspiration and cavity treatment do not occur
-humanity gifts registry (or similar program)
-embalming occurring prior to autopsy
order of operations for treatment of viscera
1) aspiration (immediate or delayed)
2) suture incisions
3) injection of cavity chemicals
4) closure of point of entry
5) wash body, dry, etc.
6) possible re-aspiration, possible re-injection
clean trocar during & after use
suggested order for cavity treatment
1) thoracic cavity
2) abdominal cavity
3) male genitalia (where necessary)
4) cranial cavity (where necessary)
purge from the nose/mouth which is dark brown liquid and has “coffee grounds” appearance, acidic pH, and odor is from ____
the stomach
frothy purge from the nose/mouth which may be tinged red with blood and has little odor is from ____
the lungs
creamy white or bloody purge from the nose/eyes/ears is from ____
the brain
the ____ region would contain part of the liver, part of the right kidney, greater omentum, coils of small intestine, and the gallbladder
right hypochondriac
the ____ region would contain the stomach (including cardiac and pyloric openings), part of the liver, duodenum, pancreas, suprarenal gland and parts of the kidneys, and greater omentum
epigastric
the ____ region would contain part of the liver, stomach (fundus and cardiac regions), spleen, tail of pancreas, left colic splenic flexure, part of left kidney, and greater omentum
left hypochondriac
the ____ region would contain the lower part of the liver, ascending colon, part of right kidney, coils of small intestine, right colic (hepatic) flexure, and greater omentum
right lumbar
the ____ region would contain the transverse colon, part of both kidneys, part of duodenum, coils of small intestine, greater omentum, and bifurcation of the abdominal aorta and inferior vena cava
umbilical
the ____ region would contain part of the left kidney, descending colon, coils of small intestine, and greater omentum
left lumbar
the ____ region would contain the cecum, appendix, part of the ascending colon, coils of small intestine, and greater omentum
right inguinal (iliac)
the ____ region would contain the bladder in adults (if distended), uterus during pregnancy, coils of small intestine, and greater omentum
hypogastric
the ____ region would contain part of the descending colon, sigmoid colon,
coils of small intestine, and greater omentum
left inguinal (iliac)
Insertion point of trocar is ____
2” to the left and 2” above the umbilicus
trocar guide for right side of heart
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 stomach
direct the trocar point toward the intersection of the fifth intercostal space and the left midaxillary line (a line from the center of the medial base of the axillary space drawn inferiorly along the rib cage); continue until the trocar enters the stomach
trocar guide for the cecum
direct the trocar 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” of the R ASIS; dip trocar 2” and insert into colon
trocar guide for the urinary bladder
keep trocar point up near abdominal wall directing the trocar to the median line of the pubic bone until the point touches the bone; retract trocar slightly, depress point slightly, and insert into bladder
cavity injection methods/devices (2)
1) gravity injector
2) injector with trigger (evolution injector)
aspiration follows embalming except in the case of ____ in order to reduce ____
abdominal distension
extravascular resistance
reasons for immediate cavity treatment (5)
1) removing microbes (which multiply very quickly) stops decomp attributed to microbial populations and microbial translocation
2) microbes = gas = purge
3) removing material in the body cavities removes medium for the microbes
4) removing blood prevents discolorations
5) immediate aspiration / cavity injection prevents and reduces swelling
reasons for delayed treatment (3)
1) allows for a buildup of pressure which assists with diffusion
2) arterial solution has a longer time to penetrate tissues and organs
3) allows for any supplemental fluids to infuse tissues as well
close cavity treatment incision as quickly as possible using ____ or ____
purse string suture
trocar button
close surgical or organ donation incisions tightly ____ aspirating and injecting cavity fluid in most cases
before
order of operations in cases of partial autopsies or organ donation
1) treat the walls of the autopsied cavity via hypodermic treatment and cavity gel or viscerock
2) fill cavity with absorbent material and saturate absorbent material with cavity fluid
3) suture cavity closed tightly
4) then treat the unautopsied cavity via aspiration and injection of cavity fluid
treatment of male genitalia (if indicated)
-trocar should be directed toward the most anterior portion of the symphysis pubis and into the penis or scrotum as necessary
-try to force excess fluid into the pelvic cavity by using a towel
cranial treatment (if indicated)
-point of entry is the R / L nares
-use a small trocar to push through the cribriform plate
-any gases or materials removed must be done from the anterior aspect
-only a few ounces of cavity are needed (can use a hypodermic syringe with a long needle)
-pack nostrils tightly to prevent leakage
____ may cause facial tissues to be distended, tongue may protrude, other tissues may be distended
subcutaneous emphysema
if suspecting subcutaneous emphysema AND there is no odor AND no signs of decomp, ____ or ____ can alleviate some of the pressure
*CAREFULLY inserting the trocar through the diaphragm or making a carotid incision
indications for re-aspiration and injection (12)
-death by drowning
-true tissue gas
-advanced decomposition
-gas and/or ascites in the abdomen after embalming
-ship–outs
-ship–ins
-recent abdominal surgery
-obese bodies
-purge after embalming
-blood infections
-abdominal cavity infections
-facial tissue distension
a substance capable of causing illness or death to an organism
poison
a poisonous substance that is organic in nature
toxin
the smallest dose of a poison that produces death
minimum lethal dose (MLD)
