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The right lung is comprised of three lobes and the left lung two lobes. The left lung is further characterized by the presence of a cardiac notch or impression to accommodate the ventricles of the heart. Both of the lungs relate to the mediastinum and contain the hilar structures that are the pulmonary vessels and the min-stem bronchi. The heart is positioned retrosternally in the middle of the mediastinum and extends from the second intercostals space inferiorly to the fifth. The lateral cardiac margins extend beyond the lateral margins of the body of the sternum. The great vessels arise from the base of the heart at the level of the second intercostal space, behind the upper portion of the body and the manubrium of the sternum.
Identify the trocar guide for the heart
Move the trocar along a line 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.
Explain why the heart would be the first trocar guide to follow when beginning aspiration
Gases are usually found in the anterior portions of the abdominal and thoracic cavities. Liquids gravitate to the posterior portions of the cavities. Also after arterial injection, there might not be sufficient drainage of blood. It's a good idea for the embalmer to direct the trocar directly into the right atrium of the heart to take away any blood which would be left over after the arterial injection.
Identify the pros and cons for the immediate and delayed aspiration.
Large number of microbes can easily multiply and accelerate decomposition are removed as soon as possible
Removal of microbes prevent the possibility of translocation of the microbes to the skeletal tissues
Removal of these microbes prevents or minimize the production of gases that could cause purge.
Immediate aspiration removes materials that could purge if sufficient gases were generated during the delay
Removal of the contents of the hollow viscera and cavities eliminates a bacterial medium
Most important, removal of blood from the heart, liver and large veins helps to prevents blood discolorations
If there has been some distension of the neck or facial tissues during arterial injection, immediate aspiration decreases the swelling. This is often seen in bodies dead from pneumonia when hydrothorax is present.
Maximum arterial solution to penetrate into the tissues spaces.
Preserve the walls of the visceral organs
Easier to pierce walls of the visceral organs
Humectants coinjection to fill out emaciated tissues
Only problem is the time delay. You might encounter a situation were the body needs to be ready for disposition or receive another call. And the embalmer might not have time to delay aspiration.
Describe the aspirate contents of the thoracic cavity.
II. Chapter 15 Preparation of the Body After Arterial Injection
Compare and contrast the two suture methods of mouth closure.
Both suture methods are used in terms of closing the mouth. The muscular suture is done by inserting the needle into the mouth; by raising the upper lip insert the threaded needle at a point where the upper lip joins the maxilla under the left nostril. This closure may cause a pucker which might result at the top of the chin and can be easily seen. In the Mandibular suture is identical to the muscular suture except of inserting the needle into the musculature portion of the chin, the needle is passed around the mandible. The Mandibular suture is excellent in shipping the body to another funeral home. It ensures that the mouth will not open during the transportation.
Identify the common instrumentation and supplies needed to close the mouth of the case that has no dentures and the dentures were not available at the time of the embalming.
When there is nothing available in terms of dentures or teeth the embalmer has a number of items they use to model the mouth. Packing the throat and oral cavity by using cotton. A mouth former can be placed over the jaw bones. The embalmer can use a few mouth closure methods which include the needle injector, muscular sutures and mandibular suture. With the needled injector the embalmer needs a needle injector and wires which go with it. For both mouth sutures, the embalmer should use half curved needle sutures and thread. Also the use of super adhesives will help keep the mouth in place.
Explain what steps should be taken if purge is evidenced from the mouth after embalming.
If purge is evident after embalming, it is necessary to reaspirate the body. The cavity should be reinjected with undiluted cavity fluid. If there were gases noted, leave the body in the prep room if possible for a few hours and repeat treatments again before dressing the body. Mouth and nasal cavities should be checked for dryness and tightly repacked with cotton or cotton webbing. The lips can be resealed and recosmetized. Distended eyelids may indicate gases in the tissues. It may be necessary to reaspirate the cranial cavity and inject some cavity fluid into the anterior cranial cavity.
III. Chapter 16 General Body Considerations
Preparation of the Infant Case
Explain why a postmortem examination has been completed on most infant cases.
75% of infant cases are autopsied.
Any activity of the death associated with the death due to domestic violence (ex. shaking the infant)
Death due to suffocation
See if the infant had any disease prior to death (ex. Cardiac arrest)
Describe the issues and remedies associated with eye and mouth closure and reconstruction of the small cranium (when autopsied) of the infant cases
The scalp is usually open by a usual transverse incision from ear to ear. Access to the floor of thr cranial cavity would be necessary to control leakage from the internal carotids and the vertebral or basilar arteries during arterial injection. The scalp should be reflected and the floor of the cavity and be dried. The walls of the cranial cavity should be coated with autopsy gel, and inside surface should be coated as well. A quantity of cotton should be coated may be used to fill the cranial cavity and to reproduce the normal contours as well as act as and absorbent for seepage. The scalp is then drawn back to its normal position and sutured.
Identify the injection protocol of embalming the infant case via the ascending aorta.
Involving the aorta as the primary injection point, the ascending aorta is used. Several incisions are used to reach the ascending aorta as it leaves the heart. One incision for drainage, the right auricle of the heart is clipped open. An incision can be made directly down the midline of the sternum. A second incision can be made straight down from the midclavicle to the bottom of the ribcage, where it makes a right angle across the inferior margin of the sternum to a point identical to the midclavicle incision. The cut is directed upward to the midclavicle position. The skin is dissected upward, thus disclosing the sternum, which is then opened by serving the sternal cartilage at this junction with the ribs.
What are the legal ramifications involved with embalming via the ascending and abdominal aorta?
In the US all hospital deaths require hospital personnel to solicit autopsies. The family may suspect that an autopsy was performed without their consent and thus want to examine the body of the embalmed infant at their first opportunity. The incisions for raising the abdominal aorta or the arch of the aorta closely resemble an autopsy incision. Laypersons can arrive at a false conclusion in these circumstances and blame both the funeral home and the hospital using the mistakenly identified incisions as evidence of a surreptitious autopsy
IV. Chapter 17-18 Preparation of Autopsied Bodies/Organ and Tissue Donors
Eye Enucleation/Tissue donor cases
Indentify the nine steps involved in restoration of the eye enucleation donor case
Remove packing from the eye
Saturate pieces of cotton with autopsy gel and loosely fill the orbital cavity. Autopsy gel on the outside of the eyelids will not create additional problems
Fill the eye with sufficient cotton to recreate the normal appearance of the closed eye.
Embalm the body; use the procedures previously suggested to avoid swelling. If swelling does begin, strengthen the arterial solution so only a minimum amount can be injected. Stop injection if swelling becomes excessive and, if necessary, use surface embalming.
After arterial injection, remove the autopsy gel saturated in cotton and dry out the orbit.
Carefully place a small amount of incision seal powder or mortuary putty into the base of the orbit.
Pace the orbital cavity with cotton, kapok, or mortuary putty
Exercise the eyelids and insert an eyecap over the filler.
Glue the eyelids closed
Why is heparin given to most tissue donor cases?
Before the removal if donated organs, heparin is used to help keep blood from clotting
What are the issues associated with heparin.
At first it would lead to a more effective drainage, but the time lapse between embalming and death would predispose livor mortis and PM Stain because thinned blood would more readily gravitate to dependent parts of the body.
Identify and describe the two methods for long bone tissue restoration (Femur, tibia, fibula, and hemipelvis)
Support, using head blocks can be placed along the medial and lateral side of the legs. This will help channel to drain blood and embalming chemicals flow to the foot of the table
The embalmer locates and identifies any ligatures that have been put in place by the tissue procurement team.
Embalmer will then dissect and ligate the left and right femoral arteries to isolate each extremity for injection separately from the rest of the body
The trunk, hips, head, neck, and upper extremities of the body can be injected by using cervical and or femoral vessels as injection and drainage sites.
The thigh and leg areas are injected by using the left and right femoral arteries.
The leg and foot are injected by using the right and left poplieteal arteries
Hypodermic injection may be used supplemental to arterial injection
Embalmer then dry's the bed
A light coating of preservative drying compound is applied to the tissue beds
The incisions are then closed
Plastic stockings are then placed on the legs as a further barrier to leakage
Method 2: Free Flow Method
Leave sutures in place
Raise the right and left iliac arteries and insert the tubes directly down into the legs in each vessel
Prepare a strong concentration: a high index arterial fluid with equal parts and inject each leg using at least a half gallon of solution
Stop injection after the arterial solution saturate the the tissues while the head arms and trunk are being embalmed
Puncture an area of the lower leg
Insert drain tube or trocar and force as much solution of the leg as possible
Pad with gauze pads
The procurement team sutures can be coated with surface glue and the leg placed in a plastic stocking containing preservative powder or autopsy gel.
V. Chapter 21 Moisture Considerations
Identify and describe edema in terms of it complications on the embalming process
Tissues are swollen/distension
Leakage from intravenous punctures and small openings
Dilution of arterial solution (secondary dilution)
Speeded decomposition because the autolytic and hydrolytic enzymes will have an ample source of water for their role of decomposition.
What techniques are available for the embalmer for treating pitting edema of the lower extremities
In pitting edema the fluid is in the interstitial spaces. Pitting edema can be gravitated, by elevating the head helps to drain some of the fluid from the tissue spaces. Elevation of the head and shoulders during arterial injection can drain a considerable amount of edematous fluids from the facial tissues. Passing the trocar through tissues of the neck while aspirating, will provide channels through which these fluids can pass from the face into the thorax. A sufficient amount must be given for drainage to occur.
Using the Factors determined in the Embalming Analysis prescribe an embalming protocol for the case with anasarca and ascites.
Pre Embalming Analysis
Based of the general body conditions, the embalmer will notice areas affected be the edematous area on the body. It's a good idea for the embalmer to take notice of distortion, leakage and possible signs of decomposition. One major concern the embalmer will have to be with face distension and swelling in the fingers due to the edema. Channeling areas of the face and fingers will help relief portions of edema. It will also help the embalmer before arterial injection. Prior to arterial injection, it's a good idea to make a solution and inject a sufficient strength and volume to counter act the secondary dilution. ALL pressure should be removed prior to arterial injection.
Injection of the body
All of the embalming should begin with a slow rate of flow. Once distribution has been established the embalmer can increase the rate of flow to ensure good distribution to the distal body areas. The embalmer should take notice of the areas receiving distribution, and be concern with distending portions of the body. The use of special high index solutions will cause dehydration in the body. Colloidal solutions can be made during the embalming process this will help the body retain moisture for the look of a more natural appearance
Evaluation of the body after arterial injection
The embalmer needs to take notice of the areas of the body which have not received arterial solution. Distension caused by the edema can be relieved by inserting the trocar into the edematous area and channel. Ascities can exsist and can be unnoticeable because the edematous fluid is located within the cavity and around the visceral organs. Its unaffected by arterial fluid treatment or blood drainage. Ascites will not dilute arterial solution, because the arterial solution and edema in the abdominal cavity don't come into contact. Ascites will be a diluting factor for cavity fluid.
Explain why Epsom Salt is sued in preparing an embalming solution for the edematous case.
Swollen condition brought by edema can be reduced by using Epsom Salt. The Epsom Salt creates a hypertonic solution and sets up an osmotic gradient that draws the edema from the tissue spaces toward this concentrated salt solution in the capillaries