Embalming Analysis - Textbook PDF

EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen PRESENT-DAY METHODOLOGY...

EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen PRESENT-DAY METHODOLOGY Embalmers consider the aggregate, or sum total of factors that are specific to each decedent. Every dead body is treated with respect to individual embalming requirements. Embalming analysis is applied during each phase of embalming, divided into three time periods: before, during, and after embalming. Embalming analysis is outlined by four steps: CHAPTER lQ 1. Observation and evaluation of postmortem conditions. 2. Proposed methods of treatment. 3. Implementation of treatments. 4. Observation and evaluation of treatment results. Embalming Analysis Communication of Postmortem and Post-embalming Conditions Decedent confidentiality must be strictly observed beyond the workplace. Shared information within the workplace CHAPTER OVERVIEW is conducted on a need-to-know basis. Communications between various funeral service professionals, primarily the Pre-embalming Considerations embalmer and the arranging funeral director, and between the professional and the deceased's family are encouraged. Considerations During Embalming For example, the arranging funeral director should be apprised of any concerns relating to the condition of the body Post-embalming Considerations or if additional time is needed for treatments. The height and weight of the deceased are important for selection of a casket and clothing. The expectations by the family related to the viewing of the deceased are important to communicate to the embalmer. For example, the family may assume that a tumor on the forehead will be removed. The embalming analysis includes all analytical observations of the deceased human body before, during, and after embalming. Analysis incorporates the disciplines of anatomy, pathology, microbiology, chemistry, and restorative art. Observation, analysis, and corrective treatments continue until the time of final disposition. Periodic monitoring of Factors Considered During Embalming Analysis the body for adverse conditions is the professional duty of the embalmer. Postmortem body conditions, embalming The following factors are considered during embalming analysis. Observation and evaluation of these factors help the treatments, and any post-embalming corrective treatments are documented on the Embalming and Decedent Care embalmer to formulate embalming treatments. Report. Body conditions, including age, weight, musculature, body build Immediate cause and manner of death Effects of disease and/or trauma HISTORICAL METHODS OF ANALYSIS Effects of drugs and medical treatments Vintage embalming textbooks described hundreds of diseases, poisons, and traumatic modes of death. Treatments were Postmortem physical and chemical changes concerned only with the specific pathology, specific poison, or specific trauma. No consideration was given to the various Postmortem procedures: refrigeration, autopsy, organ and tissue recovery intrinsic and extrinsic factors, such as the time interval between death and preparation and evaluation of all other observable postmortem changes. A specific embalming treatment was outlined for each condition. Postmortem interval between death and embalming In the mid-195 Os, the method of body typing was introduced. Dead bodies were classified by the conditions exhibited Post-embalming interval between preparation and disposition rather than by the specific cause of death. Professor Ray E. Slocum of The Dodge Company published a detailed system of The embalmer also considers the following body types based primarily on the time between death and preparation, and the degree of postmortem advancement. For positioning of the body, instance, separate categories were established for bodies with jaundice and for infants. Six categories described specific method of mouth and eye closure, chemical formulations necessary for the preparation of the body. Body typing was based on a recipe method. The embalmer treatments for visible antemortem swellings that need to be reduced, followed a different recipe for treatment of each different classification. Variations of the Slocum Method of Body Typing, treatments for removing or altering visible antemortem discolorations, now called pre-embalming analysis, continue today. Most importantly, without the specific recipes. techniques to use to raise sunken or emaciated facial tissues, The practice of medicine underwent radical change in the 1960s with the extensive development and use of new vessels for injection and drainage, medications. The embalmer had to consider the influence of therapeutic medications upon postmortem conditions, in strength of the embalming solution, addition to consideration of all other postmortem factors. volume of the embalming solution, injection pressure and rate of flow,  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen necessary supplemental embalming treatments, and delayed or immediate cavity treatment following arterial injection. The correct embalming treatment is dictated by the conditions present in the body, not solely by the cause of death. (c) Microbial influences (d)Vermin (e) Other Very few causes of death determine the embalming technique. Three examples could include: death from a contagious or (2) Time intervals infectious disease, death from a ruptured aortic aneurysm, and death from renal failure. (a) Time between death and preparation In making an embalming analysis, three important guidelines should always be considered: (b) Time between preparation and disposition 1. The body must be continually observed and evaluated during all phases of embalming. (3) Embalmer preferences 2. Prepare each body as if an infectious or contagious disease is present. Observe Universal Precautions and Terminal Disinfection Protocols. EMBALMING ANALYSIS, PART I: PRE-EMBALMING ANALYSIS 3. Prepare each body as if viewing andfinal disposition will be delayed. Embalmers consider four major factors in making a pre-embalming analysis: ( 1) general conditions of the body, (2) effects Extrinsic and Intrinsic Factors produced by disease processes, (3) effects produced by drugs or surgical procedures, and (4) effects of the postmortem period between death and embalming. The American Board of Funeral Service Education outlines the following variable factors for consideration during Sensory mechanisms such as sight, touch, and smell allow the embalmer to observe and evaluate postmortem embalming analysis: conditions. Most often, the embalmer does not know, at the time of the embalming, the cause of death or the medications I. Preparation of the body which have been administered. It is also in this phase that treatments must be considered for antemortem conditions A. Embalming analysis produced by trauma or surgery; postmortem events such as refrigeration, autopsy, organ and tissue recovery; and the 1. Purpose postmortem changes that have occurred in the body. a. Pre-embalming considerations b. Embalming considerations c. Post-embalming considerations MOST COMMON EMBALMING VARIABLES 2. Variable factors encountered Selection of arterial injection sites a. Intrinsic factors Selection of venous drainage sites ( 1) Cause and manner of death Selection of arterial and supplemental fluids (2) Body conditions Selection of embalming solution strength and volume (a) Pathological conditions Selection of injection and drainage techniques (b) Microbial influence Selection of injection pressure and rate of flow (c) Moisture Selection of mouth closure methods (d) Thermal influences Selection of suturing methods (e) Nitrogenous waste products (f) Weight (g) Gas in tissues or cavity ADDITIONAL PRE-EMBALMING INFORMATION (3) Presence or absence of discolorations Additional information may be obtained from the following sources. This information along with the conditions (4) Postmortem physical and chemical changes presented by the body will contribute to the pre-embalming analysis and the treatments necessary for the care of the (5) Effects of pharmaceutical agents deceased. (6) Illegal drugs 1. Certificate of death. b. Extrinsic factors 2. Infectious or contagious conditions of the deceased provided by the medical facility. (1) Environmental 3. Information concerning the timing of the memorial event and final disposition. (a) Atmospheric conditions 4. Shipping information to another funeral establishment in the same or foreign country. Locations outside of the native (b) Thermal influences country may require specific embalming treatments and the preparation of specific documents.  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 5. Specific requests from the next-of-kin or authorizing party: such as grooming of facial hair and cosmetic treatments. attack and be con.fined to the stomach. In such an event, the patient would not be able to retain foods, either liquid or Listen solid, for weeks just prior to death. He actually might die of starvation although the primary cau se of death would be General Intrinsic Body Conditions cancer of the stomach. The general intrinsic conditions of the body include age, body weight and build, musculature, protein level, and general skin condition. Primary Condition Unimportant Consider that the embalmer is presented with a thin, emaciated, dehydrated subject. The primary cancer of the stomach is less Age Considerations significant. Consider a different patient with cancer. In this subject, the malignancy is of the liver or right suprarenal gland. The Child or Infant. Arteries and veins will be much smaller than in the adult; specially sized instruments are needed for attendant enlargement of these structures bears down upon and obstructs the cisterna chyli, the lymph collecting station of the injection and drainage. Solution volumes will also be lessened. Embalming solutions cannot be assumed to be milder; abdomen and lower extremities. This prevents the lymphfrom returning to the venous systemfrom these areas. All of the parts infants and children often require stronger solution strengths. Higher body moisture and additional complications related drained by this system will become edematous and ascites will develop. The primary cause of death in both examples is cancer. to disease processes, medications, and the accumulation of toxic wastes as a result of organ failure require stronger In one case, we have a subject with edema, ascites, and anasarca; in the other, an emaciated, dehydrated subject. We should also solution strengths. Preservative demands are determined during pre-embalming analysis. A needle injector may not be note here that many other diseases can cause the above-described conditions. When we learn to treat the postmortem conditions, suitable for mouth closure. Positioning will vary from that for an adult. we will treat them successfully, regardless of the cause of death. Advanced Age. Conditions such as arteriosclerosis and arthritic legs may eliminate the use of the femoral artery as an Let me illustrate this further. In incompetence of the right atrioventricular valve of the heart, the valve fails to close injection point. Absence of teeth and dentures may create feature setting challenges. Suturing may be needed for mouth efficiently. During the diastole, blood will regurgitate from the right ventricle to the right atrium. This, of course, reduces the closure when the bones of the jaw are porous and prevent use of the needle injector. amount of blood the right atrium can receivefrom the inferior vena cava. In turn, the amount of blood the vena cava receives from its tributaries is minimized. The resulting venous congestion in the lower venous system increases transudation of plasma Weight Considerations and results again in edema and ascites. Whether the excessfluid is a result of cancer of the viscera or damage to the heart valves, Emaciated. Solution strengths may need to be reduced and humectant co-injection fluids added to create natural moisture the embalming treatment is the same. 0 in the tissues. Dehydration may create challenges with eye closure and mouth closure. Same Basic Treatment Obese. Femoral vessels may be too deep to use for injection. Very large quantities of arterial solution will be needed. By the same token, emaciation, whether caused by cancer of the stomach, actual starvation, or pulmonary tuberculosis, requires The internal jugular vein will afford the best drainage site. Restricted cervical injection will best control arterial solution the same basic embalming treatment. Further inquiry into cancer shows that obstruction to the passage of bile into the intestinal entering facial tissues. There will be positioning challenges. tract can lead to the very common embalming challenge-jaundice. This condition also can be caused by obstruction of the Musculature Considerations common bile duct a -disease not usually related to cancer. Here again, it is the symptoms and not the disease that pose an embalming challenge. A disease that is as common as cancer and can produce as varied a group of postmortem conditions is Well-developed musculature usually assimilates preservative well. Protein in muscle tissues readily absorbs preservative, arteriosclerosis. Depending on the vessel or vessels involved, we can get a wide range of different embalming challenges. except during the stage of active rigor. The embalmer can anticipate good firming o f the body tissues. Intense rigor For example, let us consider renal arteriosclerosis. Here, the blood vessels carrying blood to the kidneys are impaired. As mortis will prevent good distribution and diffusion of the solution. When wasting diseases, poor musculature, senile (or a result, the kidneys diminish in size and efficiency. Nitrogenous wastes and urea instead of passing out of the body via kidney atrophied) tissues are present, the embalmer can expect incomplete firming of the limbs. Swelling may also be expected if and other excretory organs will remain in the bloodstream and tissue spaces. The result will be uremia, cachexia, and possibly large volumes of mild solutions are injected. Senile, loose tissue does not assimilate the arterial solution as well as healthy, edema and ascites, as in some cancers. Arteriosclerosis can affect the vessels of the brain, causing a stroke which, in tum, can firm tissues. lead to other abnormalities. One of these is long-term paralysis of the extremities with the attendant atrophied vasoconstriction. Disease Processes and the Cause ofDeath Another is long periods of confinement to bed, with the attendant decubitus ulcers. A third is immediate death with no special embalming challenges. The cause of death may not be known at the time of embalming; however, the embalmer can observe the effects that diseases have had on the body. For example, jaundice may be caused by the effect of drugs on the liver or red blood cells, Again, the decubitus ulcers and the atrophied parts can stemfrom any other disease that con.fines the patient to bed for obstruction of the bile duct, hepatitis, cancer of the liver, and hemolysis of red blood cells. It is the condition of jaundice that extended periods of time. In all these situations, the resulting conditions cause much greater embalming challenges than the concerns the embalmer, not the disease that caused this condition. disease that led to them. The embalmer must not overlook the fact that any two or three of the diseases discussed here can and do The following excerpts, from an article written by Murray Shor (1972) of the American Academy of Funeral Service, coexist. So can each disease exist in two or more forms. Therefore, a patient can die with stomach and liver cancer. A patient can illustrate how the same disease can produce different conditions in different persons. have liver cancer and renal or cerebral arteriosclerosis. In reality, then, an embalmer should ask, "What conditions exist?" rather than "Ofwhat did the subject die?" Let us begin by examining a very common disease and cause of death today-cancer. This pathological condition may  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 The reader should not construe this article to mean that the author discourages the study of pathology. It is intended, Complication Result Immediate allergic Listen rather, to encourage the student to correlate studies of pathology with embalming. It is incumbent upon the embalmer reaction to the drug Tissues appear swollen Discolored skin surface to learn the embalming treatments for the basic postmortem conditions that create challenges. If the conditions are Possible skin eruptions identified and properly treated, the embalming procedure will succeed regardless of the disease that caused the condition. Liver failure Edema (ascites); edema of lower extremities Drug Treatments and Surgical Procedures Increase in ammonia in the tissues (neutralizes formaldehyde) Since the 1960s, there has been an increase in the therapeutic use of drugs. Like the hundreds of diseases and their effects Purges caused by rupture of esopha- on the body, it would be impossible for the embalmer to embalm a body using chemical formulations designed to combat geal veins Gastrointestinal bleeding; fluid loss; the effects of a specific drug. Most often, a patient is given combinations of drugs, often over a long period. A drug does not possible purge always produce the same effects in each person. Here again, it is important that the embalmer have an understanding of the Hair loss possible effects of drugs and of the fact that embalming challenges often stem from long-term drug therapy. Jaundice Some effects of the long-term use of medications, which can affect the embalming of the body, include (1) jaundice, Renal failure Increase in ammonia in the tissues Edema of tissues (2) discolorations such as purpura and ecchymosis, (3) edema, (4) difficulty in establishing tissue firmness, (5) loss of hair Gastrointestinal bleeding (alopecia), (6) internal bleeding, (7) renal failure causing an increase in nitrogenous wastes in the tissues, (8) changes in the Pulmonary edema walls of cells making it more difficult for preservatives to act on body proteins, and (9) swelling of facial tissues (steroids). Congestive heart failure Discoloration of the skin (sallow color) Chemotherapeutic Agents Are Toxic Uremic pruritus of the skin Damage to blood Skin hemorrhage (ecchymosis, The one axiom that can be universally applied to all chemotherapeutic agents is that they are toxic. Cellular changes occur vessels purpura hemorrhages) when they are used and no matter which drug is administered. Even the relatively innocuous aspirin pill has its effects. Damage to the walls Breakdown of the skin; skin-slip often Drugs have an effect on the skin, circulatory system, liver, and kidneys. Such changes may be comparatively minor in present nature, limited to slight discolorations that respond readily to cosmetic treatment. However, when changes are major, such Clot formation Breakage during arterial injection (poor circulation of (causes discolorations) as acute jaundice or saturation of the body tissues with uremic toxins, the fixative action of the preservatives in the arterial embalming fluids) solution is seriously impaired. Table 10-1 lists some common embalming complications created by the extensive use of Loss of cranial hair Hair restoration may be necessary drug therapies. Growth of facial hair and Hair removal may be necessary hair on the forehead on women and children TABLE 10-1. Embalming Complications Created by Extensive Drug Therapies Creation of resistant Disinfection treatment more difficult strains of microbes Exposure of embalmer to drug-resistant microbes Cell membranes Creates "solid" edema that cannot be become less permeable removed Makes passage of arterial solution into cell very difficult Killing one type of Antibiotics used to kill bacteria give microbe can stimulate fungal organisms a chance to multiply growth of other types Breakdown of the red blood cell Liver failure Jaundice Edema Drainage difficulties Congestive heart failure Facial discolorations Death of the superficial cells Protein degeneration Scaling of skin (seen Ammonia buildup in the tissues which on facial tissues and neutralizes formaldehyde between fingers) Difficult tissue firming Presence of edema  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Condition Treatment Blood Thinners Normal body; some livor; dead less than Any vessel for injection and drainage, pre-injection; mild to moderate solutions (3-5 gallons, Listen 6 h; no edema; no chemotherapy will vary with body size); set tissues to the desired firmness Drugs that thin the blood in life will often reduce postmortem blood clotting in the vascular system. Reduced postmortem Extensive livor of facial areas; dead less Clear discolorations with a mild to moderate solution; jugular and common carotid recom- clotting will improve distribution and subsequent diffusion of the arterial solution. than 6 h; no extreme pathology mended; step-up strength to set to desired firmness Bodies that exhibit a midline scar over the sternum may have underwent open heart surgery, valve repair, or vascular Postmortem stain present; body in or Begin with strong coordinated arterial solutions; continue to increase after circulation is estab- out of rigor; dead more than 6 h lished; restricted cervical injection; slow injection; dye for tracer; sectional injection where bypass. In the medical setting, anticoagulant or blood thinning medications are administered during surgical procedures. needed; hypodermic and surface treatments where needed Keeping the blood thin will increase postmortem hypostasis of the blood and intense livor mortis in the dependent tissues. Decomposition evident Restricted cervical injection; strong coordinated solutions; dye for tracer; sectional/hypoder- Expansion of the veins in the distal arm will be noted when the arms are lowered to the sides of the body. Vessel expansion mic and surface treatments where needed and distension is an indicator that good distribution of the embalming solution can be expected. Bodies refrigerated more than 12 h; Solution stronger than average; avoid pre-injection; dye tracer; circulation problems expected; some rigor; livor restricted cervical injection Jaundice; no edema; yellow Jaundice fluid; mild solutions (however, must meet preservative demands); femoral vessels if Surgery possible, may respond to pre-injection; dye for counterstain In making a pre-embalming analysis, choice of embalming technique may be greatly influenced by whether death occurred Jaundice green Cannot be cleared; solution strength based on preservative demands; plenty of dye to counterstain during or immediately after surgery. Surgery could be the primary factor in an analysis, as illustrated in the following Generalized edema of body Start with solution a little above normal strength; continue to increase; if circulation is poor examples. increase to very strong solutions Heart Surgery or Aortic Repair. During these procedures, the heart may be stopped for a period during which an artificial Localized edema Treat general embalming based on condition of the tissues; separate sectional embalming of area with edema; hypodermic and surface treatments means of life support is used. Frequently, if death occurs during or shortly after this type of surgery, the face and neck are Extravascular discolorations from Use solutions based on size of body, length of time dead, etc.; treat the discoloration when on grossly distended with edema. Repair of an abdominal aneurysm may not always be successful, and the interruption in chemotherapy or pathology hands and face with hypodermic and surface treatments circulation will necessitate sectional arterial injection. Autopsied; dead less than 12 h Moderate solutions; increase if needed to achieve desired firmness Autopsied; dead more than 12 h; Solutions stronger than normal; dyes for tracing; restricted drainage to help achieve circula- Abdominal Surgery. Abdominal surgery on the bowel can result in peritonitis, intense distension of the abdomen, and refrigerated tion; higher pressure may be needed bloodstream infections (septicemia). These conditions require the use of a strong, well-coordinated arterial solution. Death from second-degree burns Begin with strong solutions; use dye for tracer; death will be related to uremia; may need 100% fluid (waterless solution); do the same if autopsied Whenever death follows surgery, there exists the potential for leakage from arteries and veins involved in the surgical Localized gangrene/ischemia/possible Strong solutions when circulation problems are anticipated; bacterial complications can exist in procedure. The embalmer should use dyes to indicate the distribution of arterial solution. It may be necessary to inject a diabetic these bodies;hypodermic/sectional and surface treatments to areas affected; dye for arterial tracing greater volume of arterial solution to compensate for solution that may be lost to the abdominal or thoracic cavities. Frozen bodies Strong solutions; dye for tracer; restricted cervical injection All surgical bodies should undergo thorough cavity treatment. The formation of tissue gas is always a possibility. Be Emaciated with edema Sectional embalming to separately treat affected areas; reduce edema with strong solutions; enhance emaciated tissues with moderate solutions and added humectant certain a liberal amount of undiluted cavity fluid is injected into the area where the surgery was performed. Best practice Emaciated Mild solutions in large volume; add humectants to last injection; restricted drainage is to inject additional cavity fluid into the tissues surrounding the surgical incision. Re-aspiration and re-injection of the Generalized edema with jaundice Always treat for preservation first; moderate to strong solutions; dye for tracer; inject until cavities are anticipated. edema is treated Trauma of face/black eyes/lacerations/ Restricted cervical injection if not autopsied; strong solutions; dye for tracer vessels (iliac/ restorative work needed infants/chii- carotid/aorta) if not autopsied; standard arterial fluid; inject strength and volume as needed; Postmortem Interval Between Death and Embalming dren with no pathological complications based on weight and body conditions; dye for tracing Pre-embalming analysis includes observation and evaluation of changes that occur during the postmortem interval Dehydrated bodies not dead very long Mild solutions; restricted drainage; humectants in last injection between death and embalming. The types of body conditions will determine the embalming treatment (Table 10-2). Bodies with chemotherapy, some Use restricted cervical injection; strong solutions into trunk areas; dye for tracing; may help edema; skin hemorrhage; expect force fluid into tissue spaces Accelerated changes can take precedence over less advanced postmortem factors. Consider that a person who dies of cancer fixation problems is emaciated and jaundiced, and the body is not discovered in for several days. If the environmental temperature is very Eye enucleation/no other remarks To control solution entering head, use restricted cervical injection when body not autopsied; high, postmortem changes will be accelerated. Advanced decomposition conditions will determine the strength of the use a stronger than normal solution; avoid pre-injection embalming solution despite consideration of other postmortem conditions. Contagious disease Use solutions a little stronger than normal (2-3%); run plenty of volume; avoid personal contact with "first" drainage; run volume and increased strengths depending on other body conditions (i.e., weight/edema) TABLE 10-2. Body Conditions and Embalming Treatments Obese Begin with a slightly stronger than normal solution; after blood discolorations clear, strength may continue to be increased; first, vessel choice common carotid/jugular; second, choice external iliac Arteriosclerosis in common carotid Stronger solution; higher and/or pulsating pressure; dye for tracer; sectional injection; hypodermic (subcuticular) injection and surface (topical) treatment Severe arteriosclerosis in femoral when Select common carotid and jugular for primary site as above; hypodermic (subcuticular) used as first point of injection injection and surface (topical) treatment of distal legs  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen As a general rule, best results are obtained when embalming is done as soon as possible following the death. Three postmortem conditions that interfere most with good distribution of the arterial solution are blood coagulation, rigor mortis, and decomposition. Embalming the body before these changes are established helps to produce better results. Postmortem sta in Extravascular; cannot be removed; may be bleached or concealed If there is to be a delay between death and preparation, mortuary refrigeration will help to slow the onset of some postmortem changes. Cooling of the body helps to slow postmortem blood coagulation, the onset of rigor mortis, Generally noticeab, l e six hours postmortem and decomposition. Overextended periods of time, refrigeration can create disadvantages such as dehydration, increased blood viscosity, postmortem edema, intense livor mortis, and postmortem stain. Refrigeration can also create false signs Increased preservative demand due to delay of preserved tissue. Tissue firming is caused by the solidification of fats in the subcutaneous tissues; hemolysis produces discolorations that resemble dyes used in the embalming fluids. Table 10-3 summarizes the embalming significance of interva l postmortem physical and chemical changes. Reddish tissues falsely ind icate the presence of embalming flu id dyes TABLE 10-3. Postmortem Physical and Chemical Changes Change Embalming Significance Physical Algor mortis Slows onset of rigor and decomposition Keeps bl ood in a liquid state; aids drainage Tissues turn g ray after embalming; cosmetics correct Emba lmers Grey Dehydration Increases the viscosi ty of the blood; sludge forms Partly responsible for postmortem edema; increasi ng preservative demands Postmortem Triggers the rigor and decomposition cycles Darkens surface areas; cannot be bleached Eyelids and lips separate; lips and fingers wrinkle When severe. may retard further decomposi- tion, i. e., desiccation caloricity Hypostasis Responsible for livor mortis and eventual postmortem stain Increases tissue moisture in dependent tissue areas Shift in the body Interferes with embalming fluid-protein pH reactions Livor mortis Varies in intensity from slight redness to black depending on volume and vi scosity of the blood lntravascular discoloration; can be cleared Can be set as a stain iftoo strong a n uncoordi· nated arteri al soluti on is used Keeps capillaries expanded; can work as an Dyes ca n appear blotchy EMBALMING ANALYSIS, PART II: DURING ARTERIAL INJECTION OF THE BODY aid to distribution Increase in blood Clearing serves as a sign of arterial solution viscosity distribution Sludge is created; intravascular resi stance The second part of the analysis is an evaluation of the treatments during embalming. When a challenge is encountered, Postmortem edema can accompany problem the embalmer must decide what new approach to take to solve the challenge. During this phase of analysis, after the Blood removal becomes diffi cult; distribut i on can be poor injection of each gallon of arterial solution, the embalmer reevaluates distribution, diffusion, and the results produced. Translocation of Speeds decomposition in various body microbes regions The following are some concerns: Chemical 1. What areas of the body are receiving arterial solution? This can be noted by the presence offluid dyes in the tissues and Rigor mortis Extravascula r resistance Positi oning diffi cult; features may be hard the clearing of intravascular discolorations such as livor mortis. to pose pH not conduci ve for good fl uid reactions 2. What areas are not receiving arterial solution? Dyes will not be present and livor mortis, if present, will not be cleared; nssues swell easily False sign of preservation (fixation) no firmness will be present. After passage, firming is difficult 3. What can be done to stimulate the flow of arterial solution into areas not receiving solution? Decomposition is usually minimal when present a. Massage along the arterial route that supplies fluid to the area. Increases preservative demand Decompositi on Col or changes; odor present; purges; skin- b. Increase the pressure of the solution being injected. slip; gases Poor distribution of solutions c. Increase the rate of flow of the solution being injected. Increased preservative demand d. Lower, raise, or manipulate the body area. Rapi d swelling in affected tissue areas e. Close off the drainage to increase the intravascular pressure.  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen 4. What areas must receive sectional arterial injection? Areas that did not receive solution even after massage and changes in injection protocol must be injected separately. 5. Has the body as a whole received sufficient arterial solution and has the solution been of sufficient strength? Embalming analysis is an ongoing process from the time of receiving the decedent into the embalmer's care until the final disposition of the body. During the process of post-embalming monitoring, the embalmer continues to check for adverse changes on a periodic basis. Adverse changes could include the presence of gas in the tissues or cavities, odor, purge, color a. A high-index arterial fluid can be injected or added to the remaining arterial solution to boost the preservative changes in visible areas, and skin slip. qualities of the solution. When an embalmed body has been received from another funeral establishment, an evaluation must be made of all b. If there is doubt as to the amount of solution, inject additional amounts as long as there is no distension of the neck body areas. Some of the following treatments may be necessary: (1) r e i-njection of a particular body area, (2) supplemental or facial tissues; inject until preservation is well established. preservative treatments, (3) cavity re-aspiration and re-injection, and (4) features reset. Embalming analysis is an ongoing 6. Has sufficient arterial solution been retained by the body? Retention of embalming solution is necessary to continue process from the beginning of the embalming until disposition of the body. the preservation process. After blood and surface discolorations clear; intermittent drainage can be used to help In this third phase of analysis, an evaluation of the preservation of the body is necessary. Areas that are still the tissues retain more embalming solution. It has been estimated that more than 50% of the drainage is arterial lacking solution must now be treated using the supplemental preservative treatments of hypodermic injection or surface solution. (See Selected Readings: The Measurement of Formaldehyde Retention in the Tissues of Embalmed Bodies.) embalming. Some of the following considerations are evaluated during this third phase of the analysis: 7. Is the arterial solution having too much of a dehydrating effect on the tissues? A humectant co-injection fluid can be 1. What body areas have not received arterial solution after primary and multipoint injections are completed? added. a. Look for the absence of fluid dyes, little or no firming of the tissues, and the presence of intravascular 8. Should additional flu id dye be added for internal coloring of the tissues? Additional dyes may be added throughout the discolorations. embalming procedure. b. Treatment now must be hypodermic injection of the area or surface embalming or a combination of both. 9. If purge begins from the mouth or nose, what are its origin and cause? Let the purge continue during the arterial 2. Should cavity embalming be done immediately after arterial injection or delayed several hours? injection unless the purge is arterial solution. If the purge is arterial solution and drainage continues, inject an a. This may depend on the time at which the body must be ready for viewing. additional arterial solution to make up for the preservative lost in the purge. If the purge is arterial solution and there b. In thin, emaciated bodies, an attempt may have been made to fill out the tissues with a humectant- restorative co­ is no drainage, it can be assumed there is a major rupture in the vascular system. Consider multisite or sectional injection; this chemical should be given time to ensure the tissues are firmed before aspiration is done. injections. c. If a body is dead from an infectious disease, the embalmer may wish to delay aspiration to help ensure that 10. Are the tissues firming? This will depend on several factors. In conditions such as renal failure, emaciation, edema, and any blood removed in the aspirated material will have time to mix with the arterial solution injected. Consider wasting degenerative diseases, firming may be very difficult to establish. Poor firming can also be a result of the type injecting a bottle of cavity fluid and waiting several hours before aspirating; this helps to ensure disinfection of of arterial fluid being used. (Some fluids have a slow firming action, and others produce less firming of body tissues.) the aspirated materials. If there is doubt as to the preservative needs of the tissues, the arterial solution can be increased in strength either by 3. Are the features set properly? preparing a new solution using a higher-index fluid or by using more concentrated fluid per gallon. A high-index fluid a. Be certain that the mouth is dry. Remove moist cotton and replace it with dry cotton if purge developed during can be added to boost the strength of the solution being injected. arterial injection. b. Lips and eyelids should be set at the proper line of closure to produce natural appearance. c. If the eyelids are soft, cotton can be used for eye closure, and a drop of cavity fluid can be placed on the cotton to TO INCREASE ARTERIAL SOLUTION STRENGTH make an internal compress before adhesive is applied to the eyelids. A coating of surface embalming gel can also 1. Prepare a solution using a higher-index arterial fluid. be applied externally. 2. Add a higher-index arterial fluid to the present solution. d. If residual air is present in the mouth after gluing, the lips can be parted slightly to release the air; limited 3. Add more concentrated arterial fluid to the present solution. aspiration of the thorax will remove the air. 4. Did purge develop during embalming? 1 1. Does another site need to be selected for drainage? For example, when injecting and draining from the right femoral a. Remove packing material from the nasal and oral cavities. artery and vein, there is little drainage, and the face and neck begin to discolor and veins of the neck become b. Purge may be aspirated from the throat and nasal passages using a nasal tube aspirator. prominent. These changes indicate that drainage should be taken from a location above the heart, such as the internal c. Anal purge can be corrected after cavity embalming; manually apply pressure to the pelvic region to force as jugular vein. much of the fecal material from the orifice; pack the anal orifice with cotton saturated with cavity fluid, phenol cautery fluid, or a chemical solution used for treatment of skin lesions. Install a closure device such as an AV plug EMBALMING ANALYSIS, PART III: EVALUATION OF THE BODY AFTER ARTERIAL EMBALMING if necessary. Pants and coveralls or an adult incontinence brief can be used to protect clothing from soiling and control odors. Post-embalming Monitoring and Treatments  EMBALMING: HISTORY, THEORY, AND PRACTICE, SIXTH EDITION 0 Listen 5. Is the body well-groomed? Trim fingernails and hair per instruction. Photos are helpful. 6. Are the body and hair clean and dried? The body must be turned on its side to check for clots or debris that were not cleaned away. Turning the body allows it to be dried on all sides. POST-EMBALMING MONITORING Periodic monitoring allows the embalmer to make adjustments and perform treatments necessary to ensure ongoing stability of the body after embalming. The following conditions must be addressed and treated appropriately to serve this 7. Have decubitus ulcerations been treated? Compresses should be removed from decubitus ulcerations or skin lesions purpose. and replaced with clean compresses and fresh chemical or embalming powders. Plastic stockings, pants, or coveralls Dehydration. Evaluate the scope and severity of the affected area. Dehydration can be caused by ( 1) excessive embalming can be placed on the body to hold the compresses in position. solution strength, (2) gravitation of tissue fluids from the face and neck into dependent tissues, (3) moisture loss to the 8. Is there any leakage? Intravenous line punctures can continue to leak after arterial injection. They should be properly surrounding environment exacerbated by direct currents from air conditioning or heating systems, and (4) inadequate sealed with a trocar button or superglue. distribution of embalming solution to an area. Surface tissues may be corrected with cosmetics and waxes. Feature 9. Are tracheostomy and colostomy openings closed? A purse-string suture can be used to close these openings. They dehydration may require hypodermic injection of tissue builder, cosmetics, and waxes. Resetting of the features may be should be packed with a cautery chemical and cotton. The tracheostomy can also be filled with incision seal powder. necessary. Apply glue and cotton after the suturing is completed. Purge. Requires immediate correction. Evaluate to determine the origin of the purge. Re-aspiration of the cavities and 10. Are incisions sutured? Sutures should be tight and not allow seepage. If leakage is present, remove sutures, apply repacking of the orifice are necessary. Evaluate the need to re-inject cavity fluid. Clothing may be soiled; remove and incision seal powder or a mastic compound, and replace with tighter sutures. launder or dry clean. Table 10-4 illustrates variations in embalming techniques, fluids, instruments, and other considerations. Odor. Evaluate to determine the origin of the odor. Untreated tissues continue to decompose. Re-embalming may be absolutely necessary. The same or additional arteries can be injected. A waterless solution is recommended. Re­ TABLE 10-4. Embalming Technique Variables aspiration of the cavities and repacking of orifices is likely to further reduce odors. Description Setting of features Variation Before embalming, during embalming, after embalming Leakage. Evaluate; the source of leakage may be edema or possibly an embalming incision that was not tightly sutured. Method of mouth closure Need l e injector, musculature suture, mandibular suture, dental tie Identify the source and treat the affected area. Soiled garments may need to be laundered or dry cleaned. Plastic Method of denture replacement Cotton, mouth former, kapoc, mastic compound garments are recommended to contain minor leakage. Add preservative and absorbent powders inside the garment. 0 Softening of visible tissues. Evaluate; tissue softening occurs with continued decomposition. Discolorations, blebs, and Method of eye closure Cotton, eye caps nme for raising vessels Before setting features, after setting features Artery for primary injection Right common carotid, right femoral, right axillary desquamation are common. Re-embalming may be necessary: arterial, hypodermic, and/or surface corrections. Tissue gas. Requires immediate correction. Foul odor, intense tissue swelling, and crepitation are classic signs of tissue Vein for drainage Right internal jugular, right femoral , right axillary, right atrium of heart Method of injection/drainage One-point, multisite, split injection, restri cted cervical , six-point Method of drainage Continuous, intermittent, alternate gas. Crepitation is the crackling sensation produced by gases trapped in the tissues. Re-embalming is necessary. Tissue Drainage instrument Drain tube, angular spring forceps, trocar for direct heart drainage Body treated with pre-injection Used, not used gas accelerates quickly. Arterial fluid strength Lowindex, medium index, high index Arterial solution injected Mild solution, moderate solution, strong solution Co-injection fluid Used, not used BIBLIOGRAPH Y Fluid dye Used, not used Fluid dye col or Various shades of pink or tan American Board of Funeral Service, Course Content Syllabus, 2016. Use of fluid dye Added to all solutions, added only to final solution Chemotherapy and embalming results. In: Champion Expanding Encyclopedia. Springfield, OH: Champion Chemical Co., Humectant co-injecti on Used, not used Ti me usage of humectant Added to all solutions, added only to final solution 1986: No. 570. Arterial solutio n strength Same strength for all solutions, mild initial strength increased to stronger Frederick JF. Effects of Chemotherapeutic Agents. Boston, MA: Dodge Chemical Co., 1968. Pressure for injection (pounds per square inch) Low (2-1 0 psi), medium ( 1 0 - 20 psi), high (20 or more psi) Rate of flow (ounces per minute) Slow (5-10 opm), medium (1 0-15 opm), fast (more than 1 5 opm) Shor M. Knowledge of effect of disease simplifies embalming. Casket and Sunnyside, September 1960. Change of pressure Not changed during injection; begin low then increase Shor M. Conditions of the body dictate the proper embalming treatment. Casket and Sunnyside, November 1972. Change of rate of flow Not changed during injection; begin slow then increase Volume of solution injected Based on various factors, i. e., weight, postmortem interval, edema, and dehydration Slocum RE. Pre-embalming Considerations. Boston, MA: Dodge Chemical Co., 1958. Method of aspiration Hydroaspirator, electric aspirator Ti me of aspiration Immediately after arterial injection, delayed Re-aspiration Performed, not performed Method of trocar closure Trocar button, sutured Method of cavity fluid injection Gravity injector, embalming machine Cavity fluid re-injected Done, not done, done only if gases are present Define the following terminology: Signs of fluid distributio n Cl earing of livor, tissue firming, presence of dye Features g lued after embalming Performed, not performed Embalming analysis Types of glue to set features Rubber-based, super adhesive Extrinsic factors Treatment for lack of fluid Local arterial injection, surface compress, hypodermic injection 0 Listen Intrinsic factors Post-embalming monitoring 1. Discuss historical methods of embalming analysis and relate these to current practices. 2. List the four steps outlined in embalming analysis. 3. Give several examples of topics that may be discussed during professional communication between the embalmer and arranging funeral director. 4. Give several examples of intrinsic factors and extrinsic factors. 5. Explain the purpose of embalming analysis. 6. Describe the four categories of information used in embalming analysis. 7. Discuss why the conditions present are more important than the actual cause of death. 8. List several effects oflong-term drug therapy. 9. Recall the treatment for post-embalming purge. 10. Recall the treatment for post-embalming tissue gas.