Emb II Exam 5

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Emb II Exam 5
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2013-01-16 17:04:54
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General Preparation Body
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Emb II Exam 5 General Preparation of the Body
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  1. Begins when the deceased is moved from the removal cot to the prep table.
    Preliminary preparation…
  2. (Disinfect oral cavity and nostrils before moving the body)
    Preliminary preparation…
  3. Pull don’t push
    Preliminary preparation…
  4. Use of an “easy-mover” is recommended.
    Preliminary preparation…
  5. Use proper lifting methods and moving techniques that will not cause back injury.
    Preliminary preparation…
  6. Should be removed without cutting whenever possible
    Clothing…
  7. Clothing, bedding, and/or body bag may be soiled and should be immediately disinfected.
    Clothing
  8. Valuables should be documented and secured.
    Check for valuables…
  9. Rings, jewelry, money, wallet, purse, ID, glasses, watches, etc.
    Check for valuables…
  10. After bedding and clothing has been removed, disinfect the entire surface of the body and all orifices with a commercial spray. Be sure to allow sufficient contact time.
    Primary disinfection…
  11. After allowing sufficient time for the spray disinfectant to work a through washing
    of the body is necessary.  Be aware of
    vermin that may infest the body, i.e. lice, mites, scabies, maggots.  (maggots will eat embalmed tissue)
    Primary disinfection…
  12. Any commercial product (shampoo for example) that kills lice and mites.
    Pediculicide…
  13. Warm water and germicidal soap
    Washing the body…
  14. Pay special attention to the hair, hands and
    face.
    Washing the body…
  15. Dry hair wash is useful for removing scaling
    skin, and encrustations on the scalp.
    Washing the body…
  16. Use of disposable items is recommended for primary disinfection.
    Washing the body…
  17. It is recommended that we clean the finger
    nails during primary disinfection rather than waiting until the end.
    Washing the body…
  18. A good shampoo and cream rinse will make
    washing the hair much easier.
    Washing the body…
  19. When combing tangles out of long hair, start
    at the distal end and work toward the scalp.
    Washing the body…
  20. Always check with the family
    In regard to shaving facial hair…

  21. Follow the family’s instructions
    In regard to shaving facial hair…
  22. Shaving after embalming is problematic
    In regard to shaving facial hair…
  23. Use a good sharp blade (new blades or new
    razors may be required)
    Shaving tips…
  24. Use warm water and a good saving cream.
    Shaving tips…
  25. Begin on the left side of the face (non
    viewing side)
    Shaving tips…
  26. Shave in the direction of hair growth.
    Shaving tips…
  27. Use small, short, repeated strokes.
    Shaving tips…
  28. Try to shave without lifting the razor off
    the face. (Apply sight pressure and slide the razor on the face)
    Shaving tips…
  29. Rinse the razor frequently under warm water.
    Shaving tips…
  30. Trim a beard (closely) with scissors before shaving.  (Mr. Mayer does not agree.)
    Shaving tips…
  31. Prevents dehydration.
    After shaving, apply mineral oil, baby oil, or massage cream…
  32. Prevents discoloration from razor burn.
    After shaving, apply mineral oil, baby oil, or massage cream…
  33. Acts as a lubricant for massage.
    After shaving, apply mineral oil, baby oil, or massage cream…
  34. Excellent skin cleanser.
    After shaving, apply mineral oil, baby oil, or massage cream…
  35. Protection from stomach purge.
    After shaving, apply mineral oil, baby oil, or massage cream…
  36. Provides a base for cream cosmetics.
    After shaving, apply mineral oil, baby oil, or massage cream…
  37. Over application is common, but unnecessary –
    a light application is adequate
    After shaving, apply mineral oil, baby oil, or massage cream…
  38. Reliving rigor…

    • Flex
    • Bend
    • Rotate
    • Extend
  39. Move the neck from side to side
    Reliving rigor…
  40. Flex the head up and down
    Reliving rigor…
  41. Flex the lower jaw several times
    Reliving rigor…
  42. Massage the temporalis and masseter muscles in the side of the face.
    Reliving rigor…
  43. Flex and bend and rotate each arm.
    Reliving rigor…
  44. Flex and extend all fingers
    Reliving rigor…
  45. Flex and rotate the foot.
    Reliving rigor…
  46. Bend the legs at the knee.
    Reliving rigor…
  47. Raise and lower each leg
    Reliving rigor…
  48. Repetition of movement is key to reliving
    rigor
    Reliving rigor…
  49. Pre embalming positioning of the body and setting of features is extremely important.
    Positioning the body…
  50. Head, chest, and abdomen should be observed to create a natural form.
    Positioning the body…
  51. Tilt the head 15% to the right
    Positioning the body…
  52. The body must appear comfortable and restful.
    Positioning the body…
  53. Support the head and support the shoulders
    Positioning the body…
  54. Elbows should be elevated
    Positioning the body…
  55. Hands placed in a customary position
    Positioning the body…
  56. Position legs and feet (feet close together
    and elevated?)
    Positioning the body…
  57. Use blocks and bridges that are non-porous and impervious to water and embalming chemicals.
    Positioning the body…
  58. Splinting and wrapping as used in a way to help position the body.
    Manual aid…
  59. Cutting tendons and muscles to help position the body

    (only when necessary, and at the request of the family)
    Operative aid…
  60. Relieve rigor if present.
    Closing the mouth…
  61. Disinfect oral and nasal cavities, swab them
    clean.
    Closing the mouth…
  62. Remove & disinfect dentures and bridgework, clean thoroughly.
    Closing the mouth…
  63. Pack the throat.
    Closing the mouth…
  64. Replace dentures or bridge work.
    Closing the mouth…
  65. Close the mouth observing the natural bite.
    Closing the mouth…
  66. Secure the mandible using one of several methods of mouth closure.
    Closing the mouth…
  67. Pose the lips (Generally the line of lip closure is at the inferior margin of the upper teeth). Remember the classic hunting bow.
    Closing the mouth…
  68. Embalm the body.
    Closing the mouth…
  69. After embalming always check the mouth for moisture or purge
    Closing the mouth…
  70. Seal the mouth.
    Closing the mouth…
  71. Dentures were not retrieved during removal. 
    (Edentous.) 

    Use of a mouth former is recommended
    Problems encountered with the mouth…
  72. Projection of the jaws that may cause problems with mouth closure and alignment of the teeth. (Buck teeth.)
    Prognathism…
  73. Prognathism
    • Maxillary prognathism
    • Mandibular prognathism
    • Alveolar prognathism
    • Dental prognathism
  74. For extreme prognathism (and with the family’s permission) one might consider
    • Extraction of the teeth
    • Realignment of the teeth
    • Simply allowing the teeth to show
  75. For extreme prognathism (and with the family’s permission) one might consider
    Make an incision inside the lower lip which will allow you to stretch the lower lip to the desired length.  (Placement of wax inside the incision may help retain the proper shape and form of the mouth.)
  76. A mechanical device used to impel specially designed metal pins (or tacks) into the bone.
    Needle Injector…
  77. Pins should be inserted at the midline of each jaw (the nasal spine is quite strong).
    Needle Injector…
  78. It is best to insert dentures before the pins are set.
    Needle Injector…
  79. If the jaw is fractured or broken four pins may be used and the wires secured in an “X” formation
    Needle Injector…
  80. Reflect the lower lip exposing the frenulum.
    Muscular Suture…
  81. Insert a needle on the right side, at the point where the lower lip meets the gum.
    Muscular Suture…
  82. Keep the need next to the bone.
    Muscular Suture…
  83. Take a very wide bite with the needle, and exit with the needle on the left side
    Muscular Suture…
  84. Reflect the upper lip exposing the frenulum.
    Muscular Suture…
  85. Insert the needle on the left side, sliding along the bone, and enter the left nostril.
    Muscular Suture…
  86. Draw the needle and thread out of the left nostril.
    Muscular Suture…
  87. Pass the needle thorough the septum of the nose, keeping the needle close to the bone, and enter the right nostril.
    Muscular Suture…
  88. Draw the needle and thread out of the right nostril.
    Muscular Suture…
  89. Insert the needle into the base of the right nostril, keeping the needle against the maxilla, and exit where the upper lip joins the gum.
    Muscular Suture…
  90. Insert dentures at this point if necessary.  Lower dentures first. (Or fill the mouth with cotton and use a mouth former)
    Muscular Suture…
  91. Tie the two ends of the ligature together and pull the jaw into position.
    Muscular Suture…
  92. Open the mouth and insert a needle at the center of the mouth, at the base of the tongue; behind the teeth.
    Mandibular suture…
  93. Pushing downward, exit with the needle at the submandibular area.
    Mandibular suture…
  94. Reinsert the needle in to the same hole at the base of the chin, pushing upward, exit with the needle in front of the teeth.
    Mandibular suture…
  95. Now the suture has passed completely around the mandible.
    Mandibular suture…
  96. Insert dentures at this point if necessary.
    Mandibular suture…
  97. Pass the needle through the nose as previously described, and secure by tying both ends together.
    Mandibular suture…
  98. This method is useful for bodies that will be “shipping-out”.  It insures that the mouth will not open during transit.
    Mandibular suture…
  99. The deceased must have natural teeth to use this method.
    Dental Tie…
  100. It is achieved by tying dental floss or ligature around the base of one tooth in the upper jaw, and the base of one tooth in the lower jaw. The two ends are tied together to hold the jaw in position
    Dental Tie…
  101. Drilling small holes in the maxilla and mandible.
    Drilling and Wiring…
  102. A wire is passed through the holes; the ends are secured to hold the jaw in place. This method is useful for aligning and securing a fractured jaw.
    Drilling and Wiring…
  103. Has little value for closing the mouth; but may be useful for infants and small children. (Use rubber cement or super glue.) This method is not recommended for adults.
    Gluing the lips…
  104. Actually more of a chin clamp than chin rest. This method depends upon the embalming fluid rapidly and firmly setting
    the tissues.  Two prongs are inserted into the nostrils and a support is placed under the chin; the device is then tightened to cause closure.
    Chin Rest (historical)…
  105. An inferior view of the mandible suggests the shape of a horseshoe
    The horseshoe shape…
  106. When the natural teeth are present, but there a several teeth missing; use putty to fill the gap, or cotton sheeting to bridge the gap. This will ensure the natural form and contour of the mouth.
    Missing teeth…
  107. Most mouth-formers need to be trimmed to insure a custom fit for each individual…
    Mouth formers…
  108. Positioning and closing the lips…
    To hold the lips in position during embalming…
    • petroleum jelly
    • rubber cement
    • lip and lid cement
    • cotton slings
  109. Positioning and closing the lips…
    Pay particular attention to…
    • cheeks
    • line of closure
    • natural shape and form of the lips.
    • the upper mucous membrane is usually thinner and longer.
    • remove scabs, blisters, loose skin

    Consider the use cotton padding or mortuary putty inside the mouth (under the lips) to help create and maintain the natural form and shape.
  110. The superior palpebra forms the upper 2/3 of the closed eye.
    Line of eye closure…
  111. The inferior palpebra forms the lower 1/3 of the closed eye.
    Line of eye closure…
  112. The line of eye closure is located in the inferior one third of the orbit
    Line of eye closure…
  113. The line of eye closure is a gently dipping curve (not a straight line).
    Line of eye closure…
  114. Usually done prior to arterial injection.
    Closing the eyes…
  115. Clean the eyes well prior to closure.
    Closing the eyes…
  116. Conjunctivitis and herpes often infect the eye and can be communicable to the embalmer.
    Closing the eyes…
  117. The eyelids can be stretched if necessary (but excessive manipulation may cause swelling).
    Closing the eyes…
  118. To facilitate proper closure and establish proper projection, consider the use of eye-caps even if the eye is not sunken.
    Closing the eyes…
  119. Cotton may be placed under the closed eyelid, to keep the lids closed and establish the convexity of the closed eye. The cotton may be saturated with cavity fluid if needed.
    Closing the eyes…
  120. If the eyes are sunken, before inserting eye caps, be sure to fill the orbit with cotton, putty, or wax to maintain the proper projection of the eye.
    Closing the eyes…
  121. Some embalmers use a dab of petroleum jelly or massage cream on each eye to facilitate closure.
    Closing the eyes…
  122. Use lip and lid cement, rubber cement, or super glue to keep the eyes closed.
    Closing the eyes…
  123. Remember, the eyelids should abut, but not overlap.
    Closing the eyes…
  124. Use tissue builder only after embalming.
    Closing the eyes…
  125. Always pack the throat, mouth, nasal cavity.
    Packing the body orifices…
  126. Ears should be cleaned and packed.
    Packing the body orifices…
  127. Spray disinfectant on the anal and pubic areas before packing (pre-embalming or post-embalming?).
    Packing the body orifices…
  128. Cotton used for packing should be saturated with cavity fluid.
    Packing the body orifices…
  129. Any tubing entering the mouth, nose, or throat will need to be removed before embalming
    General treatment of invasive devices…
  130. Most embalmers prefer to leave all other devices in place until after embalming.
    General treatment of invasive devices…
  131. Use a hazardous waste container to dispose of devices.
    General treatment of invasive devices…
  132. Disinfect, pack the opening, and suture.
    General treatment of invasive devices…
  133. Inspect all incisions to see if healing has begun.
    Surgical Incisions…
  134. Check to see if the suture and incision is tight and leak proof.
    Surgical Incisions…
  135. Is there swelling or infection?
    Surgical Incisions…
  136. Does the incision need to be packed?
    Surgical Incisions…
  137. Does the incision need to be re-sutured?
    Surgical Incisions…
  138. Has the incision dehisced?
    Surgical Incisions…
  139. The post embalming use of internal incision sealers (powder) and external incisions sealers (liquid) is highly recommended.
    Surgical Incisions…
  140. Any device that is inserted into the circulatory system should be left in place until embalming is complete.
    Intravenous lines and arterial catheters…
  141. These can be removed prior to embalming.
    Urinary catheters…
  142. Be sure to cut the catheter before removal and allow the dilated balloon to deflate.
    Urinary catheters…
  143. Must be removed and left open during embalming, as an exit for purge.
    Tracheotomy tubes…
  144. Older tracheotomy techniques leave scar tissue around the opening and cannot be closed with a simple purse string suture.
    Tracheotomy tubes…
  145. Newer tracheotomy techniques have little scar tissue, and may be closed with a purse string.
    Tracheotomy tubes…
  146. It is best to remove colostomy bags after embalming.
    Colostomy openings…
  147. Disinfect, pack the opening, and suture with a purse string.
    Colostomy openings…
  148. If the body is to be cremated, this device will need to be removed.
    Pacemakers
  149. Disinfect, and suture
    Pacemakers
  150. If casts are left in place the embalmer has no idea if the area is receiving proper fluid distribution
    Casts
  151. The best practice is to remove them (or have them removed).
    Casts
  152. A reciprocating saw (like the devise used for cranial autopsies) is required.
    Casts
  153. If casts are not removed at the hospital, the embalmer will have to borrow a saw (or take the body back to the hospital).
    Casts
  154. Involve metal rods that are attached to the bone but may protrude through the skin.
    Orthopedic devices
  155. The rods can be unscrewed before or after embalming.
    Orthopedic devices
  156. Ecchymosis may be treated hypodermically before, during, or after arterial embalming with a bleaching chemical containing phenol.
    General Pre-embalming Treatments
  157. Many times all three treatments are necessary.
    General Pre-embalming Treatments
  158. Decubitus ulcers may be treated topically with a cavity pack, before, during, or after embalming.  (Provided adequate ventilation is provided)
    Skin lesions and ulcerations
  159. Cover the area with plastic sheeting to protect air quality.
    Skin lesions and ulcerations
  160. Treat these areas hypodermically after embalming.
    Skin lesions and ulcerations
  161. Four reasons for immediate treatment of DCU’s…
    • 1. To disinfect the area.
    • 2. To preserve the tissues.
    • 3. To dry the tissues.
    • 4. To deodorize the tissue.
  162. Five problems associated with DCU’s…
    • 1. They are a source of contamination.
    • 2. They are necrotic and decomposition is in
    • progress.
    • 3. Distribution and diffusion will be poor or
    • nonexistent.
    • 4. Odor may continue after dressing and
    • casketing.
    • 5. They may produce gas gangrene (caused by clostridium perfringens).
  163. Clean any jagged wounds prior to embalming.
    Lacerations
  164. If on a visible area, small bridge sutures (using dental floss) may be used to hold the margins together during embalming.
    Lacerations
  165. Allow the laceration to drain during embalming.
    Lacerations
  166. Carefully glue or stitch the wound after embalming
    Lacerations
  167. If the laceration is in an area that will not be visible, a baseball stitch may be used.
    Lacerations
  168. If the area is visible finish with an intradermal stitch and glue the margins together, after embalming.
    Lacerations
  169. Tissue must be firm and dry.
    Lacerations
  170. Compound fractures (with bone showing through the skin) will need to be “set” or put in place by pulling on the distal end of the arm or leg.
    Fractures
  171. Support (in the form of a splint) may be necessary to facilitate proper dressing and casketing.
    Fractures
  172. Simple fractures may be aligned in a similar fashion.
    Fractures
  173. During embalming abraded areas may ooze fluid.  This is alright and is an indication of good distribution.
    Abrasions
  174. An abrasion already dehydrated and scabbed over.
    Dry Abrasions
  175. A cosmetic problem if found on the hands and face.
    Dry Abrasions
  176. Scabs may need to be removed with a solvent.
    Dry Abrasions
  177. Apply a cavity pack to dry the tissues. Cosmetics can only be applied to firm dry tissue.
    Moist Abrasions
  178. Severe distention of the abdomen will cause resistance to distribution and distribution in the area.
    Ascites
  179. Decide if distention of the abdomen is caused by gas or edema.
    Ascites
  180. The insertion (not aspiration) of a trocar may help determine the difference.
    Ascites
  181. Consider insertion of the trocar on the side (right or left) of the body to allow fluid to drain if ascites is present.
    Ascites
  182. During the pre embalming period the operator should determine if any one of three types of gasses are present.
    Gases
  183. Gases
    Subcutaneous emphysema – most common
    Allow air to escape from incisions

    Establish good arterial preservation

    Channel tissues with trocar
  184. Gases
    Gas from decomposition – easiest to treat
    Gas in the abdominal cavities can be relieved with a trocar

    Establish good arterial preservation
  185. Gases
    True tissue gas – of most concern, may spread throughout the body
    Most difficult to treat

    Strong arterial solutions

    Special Tissue gas chemicals are available

    Hypodermic injection of localized areas.
  186. Skin slip, Torn Skin, Blisters…
    Pustules and Scabs…
    Disinfect with a topical spray

    Remove loose skin.

    Open and drain all blisters.

    Apply a cavity pack or gel.

    These areas will eventually turn brown and can be covered with opaque cosmetics.

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