Embalming Protocols Part 3 2019 Course Notes PDF

in [Embalming Protocols ] [Part Three] *Specific for --* Vascular Conditions Other Problematic Cases & *Effects of:* Drugs- Chemotherapy- Antibiotics Module: MSE 019 **LEARNING OUTCOMES FOR THIS COMPONENT:** Upon satisfactory completion of this component, from the Mortuary Science curri...

in [Embalming Protocols ] [Part Three] *Specific for --* Vascular Conditions Other Problematic Cases & *Effects of:* Drugs- Chemotherapy- Antibiotics Module: MSE 019 **LEARNING OUTCOMES FOR THIS COMPONENT:** Upon satisfactory completion of this component, from the Mortuary Science curriculum, the student shall be able: - - - - **RESOURCES USED IN THE PREPARATION OF THIS COMPONENT:** - - - - - - - - - - - VASCULAR CONDITIONS =================== EMBALMING PROBLEMS ENCOUNTERED ============================== GENERAL INFORMATION ------------------- It goes without saying that, without the Blood Vascular System, the art and science to professional embalming would simply not exist. As mortuary science practitioners we rely on this vast network of vessels so heavily that any type of pathological or traumatised changes that either disrupt or obstruct this delivery system will certain have an impact on the success or failure of our work. Consequently, we need to be very concerned with Extravascular (outside the vessel) and Intravascular (inside the vessel) conditions, diseases or tissue changes outside and inside the walls of, or within the blood vessels. The major portion of this course component will deal with Intra-vascular conditions, and although you have previously covered Extra-vascular resistances in a previous component, we will go over them again here briefly. From previous study you learned that it is the arteries that carry the injected arterial solution to the capillaries. From the capillaries some of the arterial solution will then leave the vascular system to enter the interstitial spaces where it will come into contact with the cells, cellular network and cellular proteins. A quick review of the artery layers and the lumen is warranted here. Arteries just like veins have three layers (tunics / coats): - - - - - - - - - - **GENERAL INFORMATION CONCERNING THESE TYPES OF CASES:** - - - - - - - - - - - - - **ARTERIOSCLEROSIS:** Arteriosclerosis heads the list of vascular problems because it is so wide spread throughout the world today; having no barriers concerning race or culture. As for age, you can encounter arteriosclerosis in many people from year thirty onward. In fact, many people who die of heart disease in their fifties show signs of more sclerosis than many 90-year olds. Mayer's embalming textbook has a very good drawing of where you will most likely encounter arteriosclerosis in many cases -- on page 411. However, arteriosclerosis can be found in other arteries as well. **POINTS OF FACT:** - - - - - - - **TYPES OF ARTERIOSCLEROSIS:** - - - - - - - - - - - - Type 1 Type 2 Type 3 GENERALISED LOCATIONS OF ARTERIOSCLEROSIS ----------------------------------------- - - - - - - - - - - - - - - - - - - - - - **EMBALMING PROTOCOLS -- ARTERIOSCLEROSIS (ATHEROSCLEROSIS) CASES:** - - - - - - - - - - - - - - - - - - - - - - - - - - **ANEURYSM:** Unless you have a clue from the D/C concerning an aneurysm, then most likely you won't have a clue to their presence until the arterial injection starts to go wrong and no distribution is seen. That is because aneurysms occur on the inside of the case -- an observable area you can't see. **Aneurysm is defined as:** - Now take this definition one step further. Okay a vessel has a dilation of the wall so how does that affect you? Actually it won't *[unless you are using very high machine pressure and a great rate of flow.]* So if you are following good injection protocols, and you are taking it easy with the pressure and flow many times the aneurysm will not be a problem. The problem comes with a non-autopsied case with a RUPTURED ANEURYSM. In this case the aneurism "blew-out" during life causing immediate haemorrhaging out into the cavity. **GENERAL INFORMATION CONCERNING RUPTURED ANEURYSMS:** - - - - - - - - - **EMBALMING PROTOCOLS -- A NON-AUTOPSIED CASE WITH A RUPTURED AORTIC (OR ANY OTHER TYPE OF) ANEURYSM:** - - - - - - - - - - - - - - - VALVULAR HEART DISEASE: ----------------------- The subject of problems with specific heart valves as it would affect successful embalming were discussed in a previous component: MSE-013, *Arterial Solution Distribution and Diffusion, pages 14 to 16.* Specifically we are speaking about two important heart valves; *The Aortic Semilunar Valve & The Bicuspid Valve.* The former valve separates the Left Ventricle from the opening into the Ascending Aorta, and the later valve separates the Left Ventricle from the Left Atrium. And if you want the classic example of a Short Circuit it would be the injected arterial solution going from the RCC to the Brachiocephalic Trunk, to the Arch of the Aorta, to the Ascending Aorta. Now here it should stop due the Aortic Semilunar Valve being closed at death. IF that did not occur then the solution would rush downwards into the Left Ventricle -- and stop -- IF the Bicuspid Valve closed at death. IF the Bicuspid Valve did not close at death then the arterial solution would rush from the Left Ventricle into the Left Atrium -- and from there it would find its way into the Lungs using the L/R Pulmonary Veins. Of course from the lungs the arterial solution would find its way through the Lungs into the Bronchi, into the Trachea, and eventually up and out the mouth and nose. AND if the Pulmonary Semilunar and Tricuspid Valves failed to close in the right side of the heart as well you would have the arterial solution making its way back out of the Lungs, into the right side of the heart and out in drainage. **EMBALMING PROTOCOLS -- VALVULAR HEART DISEASE CASES:** - - - - - - - - **CONGESTIVE HEART FAILURE:** The words Congestive Heart Failure on a D/C can mean many things, and there are several possible problems that occur in the ante-mortem stage that you need to be aware of: - - - - - - - - - **EMBALMING PROTOCOLS -- CONGESTIVE HEART FAILURE:** - - - - - - - - - - - - - - - - - - - - - - - - - - **CEREBRAL VASCULAR ACCIDENT - STROKE** When a person has been stricken with a Cerebral Vascular Accident (often called a Stroke), the blood vessels on the affected side of the body undergo Vasoconstriction (they shut down -- close off). The human body compensates for this by having the blood vessels on the opposite side (the unaffected side) of the body to open wider than normal (called Vasodilation). This is done in an effort to supply more oxygen to all of the tissues through any anastomosis available to the affected area. If you have started the injection process let's say from the RCC towards the heart (using additional arterial solution dye and you notice that an imaginary line has been established right down the centre of the face -- with dye being evident only on one side -- then is very possible that a CVA/Stroke occurred prior to death. **EMBALMING PROTOCOLS -- CEREBRAL VASCULAR ACCIDENT / STROKE:** - - - - - - - ARTERIAL COAGULA: You know from previous components in this course that at the time of death there will still be some blood in the arterial side of the circulatory system. This is especially true of the Arch of the Aorta, and the Descending Thoracic and Abdominal Aortas. The length of time, from the time of death to the time of embalming will also determine how much of this blood will congeal and coagulate, and long term refrigeration will accelerate this coagulation. The biggest problem with arterial coagula is you can't see it unless it is peeking out at you after you make that "nick" into the artery chosen for injection. **EMBALMING PROTOCOLS -- ARTERIAL COAGULA:** - - - - - - - - - - - - - **VENOUS COAGULA:** In almost every case that you embalm, you will encounter some type of venous coagula. You could have a great amount of it or it may be minimal. And as a rule the proper use of a drainage instruments (vein forceps or drain tube) will remove a great deal of the venous coagula present. **EMBALMING PROTOCOLS -- VENOUS COAGULA:** - - - - - - - - - - - - - **DIABETES:** Diabetes is listed here as a vascular condition because it relates so many times to Arteriosclerosis and poor peripheral circulation. Diabetes has also been previously discussed in the component: *Embalming Protocols -- Part One, pages 30 to 31.* Running parallel with Diabetes could be such problems as arteriosclerosis, gangrene and decubitus ulcers -- all of which have already been covered. **RIGOR MORTIS:** As with Diabetes, Rigor Mortis has been covered extensively, specifically in the beginning of this component. As you already know, rigor mortis can be both an Intravascular and Extravascular Resistance to good arterial distribution and diffusion. However good techniques in breaking the rigor down and good massage techniques should overcome the problems associated with rigor mortis. **OTHER PROBLEMATIC CASES** **RENAL FAILURE:** One of the most difficult cases that confront an embalmer is the RENAL FAILURE case: Nephrosis and other problems that affect the kidneys are some of the most common causes of embalming failure. And that is why throughout this course, from almost day one, much emphasis has been given to this most difficult condition. One of the main reasons why Renal Failure is missed in a pre-embalming analysis is the fact that it is so hard to identify -- to isolate as a condition to be aware of. Although most embalming textbooks give "*Identification Signs*" to enable you to identify a Renal Failure case it is not always a cut-and-dry observation. In the section below listed as 'Identification Signs" there will be notations as to whether a specific sign can *really be observed.* And then there are now new revelations concerning embalming science and Renal Failure that may confuse you even more. There are two embalming science textbooks that are the ones most readily used in mortuary science colleges in North America; *Embalming -- History, Theory & Practice (Robert G. Mayer, author)* and *The Principles and Practice of Embalming (Frederick & Strub)*. These two textbooks now take a completely different slant on WHY Renal Failure causes embalmers so much trouble. Due to this new information now available we will be going more further into depth concerning Renal Failure cases giving you information not only found in Mayer's embalming textbook but also from *The Principles and Practices of Embalming.* Remember that although both Frederick and Strub have since died their textbook is still updated and published regularly by Professional Training Schools in Dallas, Texas -- USA. **GENERAL INFORMATION:** - - - - - - - - - - - - - - - - **IDENTIFICATION SIGNS FOR RENAL FAILURE:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **Renal Failure -- In Parallel with Other Problems:** Renal Failure is famous for running parallel with many other problems, and you need to be very concerned about these conditions: - - - - - - - **RENAL FAILURE vs. THE ARTERIAL SOLUTION -- DIFFERENCES IN OPINION:** You can speak to 100 practitioners concerning how they inject Renal Failure cases, and you just might get 100 different formulas for the arterial solution (the index fluid used, the percentage of the first and subsequent tanks, and so on). When it comes to the opinions of the two embalming textbooks, they are far apart. And to add to your confusion there are many methods by which the above suggested arterial solution should be injected. Those will be outlined in the protocols below. However both textbooks do suggest that restricted cervical injection is the best primary injection site(s) to use on a Renal Failure case -- as a minimum -- and multiple point injection would be even better. **EMBALMING PROTOCOLS -- A RENAL FAILURE CASE:** - - - - - - - - - - - - - - - - - - - - - - - - **PURGE:** The subject of Purge has been with us from almost the beginning of the course, going back to MSE-005 (*Basic Mortuary Skills*). We discussed post-embalming purge in a more recent component: MSE-016 -- *Post-Embalming Analysis & Terminal Embalming Analysis*, page 16 to 17. So there will be no need to cover that aspect of Purge here again. However we will be covering Purge from its possible origins up to the end of the embalming process. **GENERAL INFORMATION:** - - **[Causes] of Purge (4):** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **THREE CLASSIFICATIONS OF PURGE -- RELATING TO EMBALMING TIME PERIODS:** **PREEMBALMING PURGE:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **CONCURRENT EMBALMING PURGE (During the injection process):** - - - - - - - **POSTEMBALMING PURGE:** - - **GASES:** Basically, there are five types of gases that could be found in the tissues of a deceased person; (1) Ante-mortem Subcutaneous Emphysema, (2) Air from the Embalming Machine, (3) Gas Gangrene, (4) Tissue Gas, and (5) Decomposition Gas. Not every case will exhibit all of these as many factors play a role as to which ones are present or not and to what extent they are present. Upon death, and as the post-mortem period advances, gases will move to higher areas of the case, even if the source of the gas is still in the dependent areas. If the case is in a supine position, the gas will move into those areas of the neck and face that are not supported by any object (floor or bed). **Gases can be detected in three specific ways:** - - - - - - - - - - - - **THE FIVE TYPES OF GASES FOUND IN TISSUES OF A HUMAN REMAINS:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **THE REMOVAL OF GAS FROM SELECTED TISSUE SITES:** **General Information:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **OBESE CASES:** There are some who still think that adipose (fatty) tissue is difficult to preserve. Obese cases are not really viewed as problematic cases from the standpoint of the injection process as they are from the standpoint of SIZE. Many of the protocols listed here are normal ones that have only been adjusted for the size of the case. Obese cases are classified as being heavier and larger than a normal-sized case of the same height. **EMBALMING PROCOLS -- OBESE CASES:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **ALCOHOLIC CASES:** Cases that have died from chronic alcoholism or who have this problem listed as a contributory cause of death will many times have other problematic conditions running parallel. On many occasions it will be the other problems that will set the pre embalming analysis -- not necessarily the alcoholism. **PARALLEL PROBLEMS AND ALCOHOLISM:** - - - - - - - - **EMBALMING PROTOCOLS -- ALCOHOLIC CASES:** - - - - - - - - - - - - - - **MYCOTIC (FUNGAL) INFECTION CASES:** I spoke briefly about Mycotic Infections in the MSE-002 *Infection Control* component, and now is the time to speak about it again as it relates to specific embalming protocols. As with many pathogenic microorganisms, Mycotic/Fungal organisms are very dangerous, and should be of great concern to anyone who handles, transports or otherwise prepares any human remains. Mycotic/Fungal infections can continue onwards from an Ante-mortem condition directly to a Post-mortem condition. **GENERAL INFORMATION:** - - - - - - - - - - - - - - - - - **FUNGAL INFECTIONS IMPORTANT TO EMBALMING:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **IMPORTANCE OF MYCOTIC (FUNGAL) INJECTION TO M.S. PRACTITIONERS:** - - - - - - - - - **EMBALMING PROTOCOLS -- MYCOTIC/FUNGAL INFECTION CASES:** - - - - - - **HANGING CASES:** Suicide by hanging is still a common way for despondent people to end their lives, and as such there will certainly come a time when you will come across this type of case in your career. Although the embalming protocols are fairly standard it is the *[cosmetic]* problems that will need your attention. In most hanging cases death is caused by either asphyxia or cervical injury. **EMBALMING PROBLEMS ASSOCIATED WITH HANGING CASES:** - - - - - - - **EMBALMING PROTOCOLS -- HANGING CASES:** - - - - - - - - - - - - **BURNED CASES:** Heat, electrical shock, radioactive or chemicals agents could cause the burn itself. Death due to burns could involve a short to long hospitalisation. Therefore, it is not necessarily the local effects of the burns BUT rather the systemic effects brought about by major burns that the practitioner needs to be concerned about. With severe burns affecting all body regions, then the decision must be made on just how far you can go in the hopes of giving back to the family a deceased that represents anything better than what you started with -- a deceased that is restored to a natural appearance. Many things must be examined before a decision can be made (time available to do the work, amount of expertise you have, your ability to see the work through to the end, etc.). Just remember that if at all possible, viewing needs to occur to allow the family to go forward --but not at the expense of shocking them by a case you just couldn't bring back properly. **GENERAL INFORMATION:** - - - - - - - - - - - - - **GENERALISED PROTOCOLS -- BURN CASES:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **ELECTROCUTION CASES:** Death by electrocution caused by lightening is seldom, if ever seen by most practitioners. Here in Australia, a death by any type of electrocution would surely have gone through the Coronial Services system; most likely having a full autopsy as well. However, if you are confronted with such a case, the following information may be of help to you. **GENERAL INFORMATION:** - - - - - - - - - **EMBALMING PROTOCOLS -- ELECTROCUTION CASES:** - - - - - **CARBON MONOXIDE (CO~2~) POISONING:** Most of the cases you face that have died from Carbon Monoxide Poisoning should not cause big problems concerning the Arterial and Cavity Embalming. As with any case, if there are other problems running parallel with this condition, then your protocols will be adjusted accordingly. The only real problem that may affect viewable areas would be discolouration. These dis-colourations are the basis for the "classic cherry-red" colouring of the tissues -- specifically the dependent tissue regions. **GENERAL INFORMATION:** - - - - - - - - - **EMBALMING PROTOCOLS -- CO~2~ POISONING CASES:** - - - - - - - - - - - - - - **DROWNING CASES:** With Drowning cases, everything concerning embalming protocols will revolve around four factors that are out of your control: (1) Whether the case was autopsied or not, (2) How long the case was under the waterline before being found, (3) The temperature of the water, and (4) How long the case floated at or near the surface and the temperature of the ambient air. **GENERAL INFORMATION (Non-autopsied and Autopsied Cases):** - - - - - - - - - - - - - - - - - - - - - - - - **EMBALMING PROTOCOLS -- DROWNING CASES (Non-autopsied and autopsied):** - - - - - - - - - - - - - - - - - - - **GUNSHOT WOUND CASES:** Any case that has sustained one or more gunshot wounds is always a difficult case to embalm. Gunshot wounds present many problems, but the one that causes the most worry for the practitioner is the partial to complete disruption of the blood vascular system to and from that area/region. Gunshot wounds in viewable areas will also require some form of Restorative Art and specialised cosmetics. Of course, there are some gunshot wounds to the head that will require you to make a serious decision on whether or not embalming, restorative and cosmetics will restore the case to a natural appearance. Invariably almost all cases involving gunshot wounds will have been to Coronial Services, and the autopsies will have been thorough. That being said when a forensic autopsy has been performed on a case with gunshot wounds to the head, many injectable arteries will have been excised away -- leaving you with little to no arteries to inject from. The Embalming Protocols listed below are all inclusive; embalming + restorative art + cosmetics on viewable areas. Some of this work will be exhaustive, requiring both time and expertise. YOU must be the judge as to whether it SHOULD or COULD be done. **EMBALMING PROTOCOLS -- GUNSHOT WOULDS TO THE HEAD** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **EMBALMING PROTOCOLS -- GUNSHOT WOULDS TO ANY POSTERIOR AREA (Except the head):** - - - - - - - - - - - - - - **EMBALMING PROTOCOLS -- GUNSHOT WOULDS TO ANY ANTERIOR AREA (Except the head):** - - - - - - - - - - **LAST THOUGHTS -- GUNSHOT WOUND CASES:** Yes gunshot wounds can create havoc to tissues, bone shape/contour -- to the entire region. No -- we have not covered the Restorative Art-side of how to repair gunshot wound(s) to the head, as that is a wide open subject that entails much more than the framework of this certificate course allows. So basically speaking there are several very important things to think about concerning your work with a gunshot wound case. - - - - - - - - **POISONING CASES:** The possibility of you coming across a case that died of accidental/intentional poisoning is in much the same category as coming across an electrocution case -- seldom if ever. And as if so many of the cases we have discussed up to now, most likely Coronial Services will have had the case, for investigation and autopsy. Remember this: Poisons can enter the body by a number of routes; skin, mouth, nose, other mucous membranes. This means that many internal body systems can be affected, and therefore your pre-embalming analysis must take all this into consideration. **PROBLEMS ASSOCIATED WITH POISONING CASES:** - - - - - - - - - - **EMBALMING PROTOCOLS -- POISONING CASE:** - - - - - - - - - - - - - - **MUTILATED CASES:** A discussion of cases that have gone through mutilation could fill an entire component, because "mutilation" could mean a wide range of problems from one practitioner to another. An auto accident involves mutilation; a gunshot wound involves mutilation; a stabbing with a knife involves mutilation; falling off a skateboard could involve mutilation; and of course, many Coronial Service autopsies (which they say are necessary to determine the cause and manner of death) involve mutilation. Mutilated cases could be as minimal as one or two lacerations, gunshot/knife wounds or other types of openings. Mutilation could also mean that one or more body parts have been separated completely from the body. First we will cover the generalised protocols necessary for a variety of mutilated cases. Then we will cover three different types -- where a specific body part has been torn away. **GENERALISED EMBALMING PROTOCOLS -- MUTILATED CASES:** - - - - - - - - - **SPECIFIC EMBALMING PROTOCOLS -- SEVERED HEAD:** This is an example of what you could do if the entire head had been severed from the neck, or the head/neck severed from the trunk. Because of the importance of the head for ID and viewing, this operation is more intricate than the other two listed below. Again, as with so many problems we have been discussing so far, Coronial Service most likely will have had the case, and a full autopsy would have taken place. For the examples below, we will *[presume]* that a full autopsy has been done. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **SPECIFIC EMBALMING PROTOCOLS - SEVERED ARM/LEG:** - - - - - - - - - - - - - - - - - - - - - - - - - - **EXSANGUINATION CASES:** **The Definition of Exsanguination is**: *The process of losing blood to the point where life can no longer be sustained -- OR -- Excessive blood loss to the point of death.* If you look closely at the definition above you might think that this case would be easy -- just think -- no blood = no drainage = no clots = no venous obstructions -- *[RIGHT?]* A case that has died of Exsanguination carries with it its own problems; not all being associated with arterial injection or cavity embalming. **GENERALISED PROBLEMS -- EXSANGUINATION CASES:** - - - - - - - - - - - - **EMBALMING PROTOCOLS -- EXSANGUINATION CASES:** - - - - - - - - - - - - - - - - - - - - - - **EFFECTS OF DRUGS --** **CHEMOTHERAPY --** **ANTIBIOTICS** Before we begin this part of the component, we need to discuss the origin of how medicinal drug therapy, chemotherapy and antibiotics came to be. Of course, indigenous people throughout the world have used specific plants, herbs and the like for "medicinal" purposes since the beginning of humankind. Dr. Paul Ehrilich (1854 to 1915) was searching for what he called "The Magic Bullet"; a chemical that could stop bacterial growth. While researching a series of arsenical substances, he stumbled upon one that he called \#606. Later to be called Salvarsan, it was able to stop Syphilis in its tracks. Dr. Alexander Fleming (1881 to 1955) also wanted to find a "magic bullet" to combat bacterial diseases that were a constant threat to battlefield surgeons. By sheer accident, he came across a petri dish that he had added a mould-like substance to that also contained several types of bacteria. He discovered that the mould-like substance prevented all the bacteria from spreading. His discovery was Penicillin, and Sir Alexander Fleming, Dr. E.B. Chain and Sir Howard W. Florey were awarded the Nobel Prize in medicine and physiology in 1945. As you know, Penicillin and its derivatives have been around ever since. And that, in and of itself, seems to be a problem nowadays for we currently live in the age of *multiple-agent chemotherapy.* The multiple-drug approach to combat many infections is common today with one or more antibiotics being administered for the treatment of many infections (and some viruses). For the treatment of cancer this multiple-drug therapy is also common. In fact it is not uncommon for an Oncologist to prescribe both a cytotoxic drug (one that destroys the cancer cell directly) and an antimetabolite (a drug that slowly starves the cancer cell by depriving it of a needed nutrient). The overall result of this multi-drug therapy for the treatment of diseases and infections has brought on an increase in the number and types of embalming problems. For reason of simplicity, we will address the Introduction, General Information and Embalming Protocols under the banner of *Chemotherapy or Chemotherapeutic Agents*. Both of these banners will include not only Chemotherapeutic Agents, but also any drugs (chemicals) used to combat diseases and/or infections -- specifically Antibiotics. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **THE CHEMOTHERAPY CASE -- WHAT YOU SHOULD EXPECT TO ENCOUNTER:** **General Information:** - - - - - **Changes Associated with Systems or Organs of the Body:** - - - - - - - - - - - - - - - - - - - - - - - - - **HOW CHEMOTHERAPEUTIC AGENTS INACTIVATE THE PRESERVATIVES:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **COMBINATION OF CHEMICAL AGENTS IN CHEMOTHERAPY:** - Professional mortuary science practitioners only have one shot at getting things right when it comes to arterial and cavity embalming. What we do the first time around the preparation table has to be right on the mark -- re-embalming IS NOT an option here. **CORTICOSTERIODS AND ANTI-INFLAMMATORY CHEMICAL AGENTS (DRUGS):** **General Information:** - - - - - - - - - - - - - **CANCER CHEMOTHERAPEUTIC AGENTS AND THEIR EFFECTS:** - - - - - - - - - - - - - **EMBALMING PROTOCOLS FOR CHEMOTHERAPY CASES:** Sometimes, the best-laid plans all come to a halt due to our lack of "real-time" information, and that is a fact with these types of cases. The best method to use to determine IF and WHEN a deceased has undergone chemotherapy is to sit down with the medical history (charts) of the deceased and go through them thoroughly. However, and as it should be, there are privacy rules concerning the privileged relationship between a doctor and his/her patient. Therefore, you and I are not privy to the medical records or history of any case that we come into contact with. And that leads us to be reminded once again that, when it comes to the administration of chemotherapeutic drugs during the ante-mortem time period -- *'We are flying blind in trying to determine the arterial solution content and strength in relationship the chemotherapeutic drugs.* And if that wasn't enough to deal with, most likely there was more than one drug given -- we must take all this into consideration as well. All of the above is all fine and dandy but, how can you tell if one or more chemotherapeutic drugs have been given? Unfortunately, unless you or an associate at the funeral home has come into contact with the surviving family and they have given up this information -- or unless you have good relationships with the hospital/nursing home staff -- you won't know. So, what to do? Approach the case as if it is to go to the moon on a raft -- and return for viewing -- *[period!]* You MUST remember this: *In all of the examples above and below, the cell membrane has been almost completely enclosed by the chemical properties of the drug administered -- and of course, that is what the drug was intended to do. However, when it comes to the embalming process, you will need both a well-coordinated (with all of the recommended co-injection fluids) solution that needs to be stronger than normal to overcome -- break through that cell membrane -- to reach the intracellular material and proteins. If you can't do that, decomposition will occur.* **Embalming Protocols -- Chemotherapy Cases:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **RADIOACTIVE ISOTOPES AND THEIR EFFECTS ON THE EMBALMING PROCESS:** Although the subsequent discussion concerning the preparation of a radioactive case is generally associated with cancer treatment, we live in a world where nuclear science could very well mean something else entirely. For the purpose of this section of the component, we will be discussing radiation as it relates to the treatment of disease. As cancer is so widespread throughout the world today, the use of radioactive materials for cancer chemotherapy is great. **GENERAL INFORMATION:** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **SOURCES OF RADIATION ENCOUNTERED BY MORTUARY SCIENCE PRACTITIONERS:** **General Information:** Two most common examples of radiation exposure that are found in the deceased are due to: - - - - - - - - - - - - - - - - **EMBALMING PROTOCOLS FOR CASES EXPOSED TO HIGH LEVELS OF RADIATION:** **Protection:** - - - - **Limit The Time Of Exposure:** - - - - - **Distance From The Case:** - - **Positioning Of The Case:** - **Running Water At All Times:** - **Special Hazardous Waste Container:** - - - **Cover The Floor:** - - - **The Arterial & Cavity Embalming Processes:** - - - - - - **Final Clean Up:** - - - - - - - - - - - - - **Sharps Or Other Injuries While Preparing These Cases:** - - - - - **TRANQUILLISTERS AND MOOD-ALTERING DRUGS** It is not the intent of this course or its author to delve into the subject of drug abuse, regardless of whether the subject is a recreational drug user, or a hardened daily drug user. Rather, we are looking at this subject in relationship to how these drugs affect the case and the embalming process itself. **General Classification of Drugs Encountered:** - - - - - **Embalming Problems Associated With These Drugs:** - - - - - - - **Embalming Protocols:** - - - - -