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Embalming Special Cases

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    Embalming is the art and science of temporarily preserving a lifeless human body to delay decomposition. With this process, one hopes to preserve, sanitize and restore the previous physical attributes of a dead body. There are many reasons for the need to embalm. The reasons of different cultures to embalm are varied and have developed through the years. Egyptians are known for their efforts to perfect the embalming process because in their ancient days, they believed that it was necessary for the spirit to have a body when it enters the afterlife.

    A lot of other cultures also embalmed their dead because of religious beliefs. During the Renaissance Period, anatomists used embalming to preserve their animal specimen. However, during the American Civil War, embalming was used to preserve the bodies of troops so that these can be shipped back to their grieving families for proper burial. Today, we embalm our dead also for preservation and restoration to a more pleasing appearance so that we can view them in their funerals. Embalming is one of the first surgical procedures done by mankind.

    It also involves injecting chemicals that depend on the physical state of the body being processed. Normal Embalming Procedures Preparing The Body The body is placed on a stainless steel or porcelain table and washed with a germicide-insecticide-olfactant. The insides of the nose and mouth should also be swabbed with the solution. A condition called Rigor mortis (stiffening of the muscles after death) may set in but can be relieved by moving the limbs and head or by a little massage.

    When limbs are distorted because of a disease such as arthritis, the tendons and muscles might need to be cut in order to place the body in a more natural pose. Work on the face first. Massage cream must be applied unto the face and hands to keep the skin soft and pliable. Cotton must be put in the nose, eye caps placed below the eyelids, a mouth former inserted into the mouth and cotton or gauze placed in the throat to absorb purging fluids. The mouth is then tied shut with wires or what are called sutures. If needed, facial hair is removed.

    The traditional method for treating the eyes involves placing a bit of cotton between the eye and eyelid. Usually the eyes sink back into their sockets, so small plastic “eye caps” (objects that are shaped like large contact lenses with textured surfaces hold the eyelid in place. A small amount of stay creme is placed on the eyecap to avoid dehydration of the eyelids. It is not true that eyelids are sewn but instead, embalmers choose to use glue to keep them closed. Arterial Embalming When the body is ready, blood is drained from a vein or the heart while injecting embalming fluid into an artery.

    Normally, it takes two gallons of a mixture of formaldehyde or other chemical and water. In situations wherein the person used certain drugs prior to death or had certain cancers and diabetic conditions that have pre-empted body deterioration, it is better to use a stronger or “waterless” mixture. Chemicals are also injected by syringe into other areas of the body. The other areas of the body are also injected with the chemical solution. Cavity Embalming Cavity embalming is the next step after arterial embalming.

    A trocar is a long, pointed, metal tube attached to a suction hose that is inserted close to the navel. This is what the embalmer uses to puncture the stomach, bladder, large intestines and lungs. This needs to be done in order for gas and fluids to be sucked out of the body and prepare it for the injection of what is called “cavity fluid”, a more acidic mixture of formaldehyde. The cavity fluid is then injected into the torso. Seepage may occur in the other cavities of the body such as the anus and vagina. These areas need to be packed with cotton or gauze or plastic fitting garment.

    Sealing The Body To seal the body, the holes and cuts made must be sewn or filled with what look like large plastic screws called “trocar buttons. ” The body is then washed and dried. If needed, the nails are then manicured. If there are missing facial features (due to an accident or sickness), these can be reconstructed using molded wax. Hair is then styled before putting on the necessary makeup on the face and hands. There are also situations wherein the fingers need to be glued together before putting on the clothes. Special Cases

    The above describes the normal procedures in embalming. However, there are certain conditions that require different techniques for preservation. These are jaundice, edema and Creutzfeldt- Jakob Disease or CJD. Jaundice Jaundice is a yellow color in the skin, the mucous membranes, or the eyes. The yellow pigment is from bilirubin, a byproduct of old red blood cells. (“Jaundice-Yellow Skin,” 2007) There are many causes of jaundice and most are because of viral hepatitis, alcoholic hepatitis, drugs, chronic liver disease, gallstones and malignant diseases like pancreatic cancer.

    These diseases are usually treated with drugs that can aggravate the intensity of the discoloration. The embalming of jaundiced bodies has and always will be a serious problem in the embalming industry. (“Jaundice Embalming: The Superiority of Glutaraldehyde Versus formaldehyde,” 2005) Slight jaundice can be minor in nature and can respond to cosmetic treatment when embalmed. There are excellent opaque mortuary cosmetics available that can cover any discoloration – including severe jaundice. However, there are no cosmetics that will stop the decomposition process.

    With acute jaundice, or when the drugs saturate the body tissues with uremic poisons, the preservative action of the usual embalming chemicals becomes seriously impaired. (Adams, 1994). The use of a weakened preservative solution on a jaundice case or any case could have severe consequences due to early decomposition. There are good chemicals like Metasyn or Jaundofiant that address the problem of jaundice but in severe cases, these are not enough to make the color of the skin look natural enough. In the early days before cancer was treated with chemo-therapy, embalmers opted to weaken preservatives to lessen the effects of jaundice.

    Weakening the preservatives means adding more water to the solution and this aggravates the edema (too much water in the body that causes bloating) that usually accompanies jaundice. The body also decomposes faster. Some embalmers opt to use cavity fluid for the arterial injection thinking that the cavity chemicals will bleach the jaundice discoloration. However, these chemicals are made to firm, dry and cauterize the viscera so their acidity is unsuitable for arterial injection and will burn off tiny vessels before proper penetration and preservation happens.

    Jack Adams, an embalming lecturer and educator with over forty years of experience, has experimented with jaundice cases among his more than 18,000 bodies embalmed. He believes that there are better ways to treat the problem. He recommends pre-injections with co-injections, counter-stains, and care in using a pulsator. Pre-injections and Co-injections Using a Pulsator. If the body does not have too much water yet, pre-injecting and co-injecting would be the best solution to treat severe jaundice. Pre-injection can enhance the process of flushing out blood discolorations.

    Co-injections are important tools because it allows even distribution and penetration of the arterial solution and dye. Pre-injection using a mixture of two bottles each of Metaflow and Rectifiant with a quart of warm water or three bottles of both chemicals without water not only produce a flushing action but are also great for clearing pathways to deliver jaundice arterial chemical and dye. Metaflow is a chemical formulated to intensify embalming formulation receptiveness within the vascular system and the tissues beyond.

    Rectifiant, on the other hand, stabilizes the pH values to prevent chemical precipitation and counter attacks the jaundice effect of chemotherapeutics. It is best to use a pulsator when pre-injecting. This instrument controls the rate of flow and pressure which can be beneficial in achieving good distribution of the chemicals all over the body. After pre-injection, a mixture of around10 ounces each of Metasyn (a counter-jaundice chemical), Metaflow and Rectifiant must be added with warm water to make a gallon of injectible fluid. It is to this solution that one must add the dye.

    Once injected, the embalmer must pay attention to the effect of the dye on the body. It will be the embalmer’s discretion if more dye would be needed to overcome the discoloration. Counter-stain. There are times when the natural skin-tone is achieved by counter-stain or a series of dye colors that cover each other up. This is done by distributing a dominant dye evenly to cover the undesirable color pigment. The result is usually a red-brown color which resembles the natural skin color. In some cases when the jaundice still shows, cosmetics can resolve the problem. Edema

    Edema is an observable swelling from fluid accumulation in certain body tissues. Edema most commonly occurs in the feet and legs, where it also is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in spaces within the tissues that are outside of the blood vessels. (“Edema,” 2006) Because medical techniques and medications have progressed so well in the past several years (and that is good, because lives are being saved, the condition of bodies presents a much greater embalming challenge than we used to face. Daulton, 1997) There are many cases of edema nowadays due to medicine needed for diabetics and other illnesses. Due to good research in the field of embalming, there is finally a solution called Edemaco that is successful in dehydrating the excess liquid from the body without causing wrinkles. Success in embalming a body with an extreme condition of edema can be achieved by diluting the mixture of a bottle of Rectifiant and two gallons each of Introfiant (a co-injectable embalming chemical), Edemaco and Metaflow in warm water.

    By raising the right carotid artery and jugular vein and intermittent drainage using a drain tube, the chemical mixture will be forced into the tissues. Because chemicals take the path of least resistance, use of a drain tube and closing of that tube at regular intervals will evenly distribute it. Embalmers, however, are advised to depend on their own opinion as to the concentration of the mixture depending on the severity of edema on the body. Creutzfeldt-Jakob Disease Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. Typically, onset of symptoms occurs at about age 60.

    About 90 percent of patients die within 1 year. In the early stages of disease, patients may have failing memory, behavioral changes, lack of coordination and visual disturbances. As the illness progresses, mental deterioration becomes pronounced and involuntary movements, blindness, weakness of extremities, and coma may occur. (“What is Creutzfeldt-Jakob Disease? ” 2007) What makes this disease and embalming challenge is its property of being infectious. The causative agent is extremely hardy and resistant to all measures of decontamination and sterilization routinely used in funeral homes.

    It can live for long period of time in a dried state and challenges the routine decontamination measures practiced today. (Steelman, 1996) It is therefore advisable, that the embalmer himself is protected from the disease by the certain measures. Protective Gear. A list of protective attire must include a disposable fluid resistant coverall or gown and pants, a cover apron, heavy latex gloves or double latex surgical gloves, a disposable surgical mask, hair and shoe covers and suitable eye protection such as goggles or full face splash shield. Positioning.

    As with regular procedures, the body must be placed on a steel table with all post mortem wrappings removed as well as clothes and other valuables. Anything soiled with bodily fluids should be disposed of properly and not reused. Topical Disinfection. The whole body, including orifices, must be topographically disinfected with the correct chemicals or with diluted arterial fluid or concentrated embalming fluid mixed with water. Washing. Any facial hair must be removed by shaving. The whole body, including the hair must be washed using a solution of germicidal soap. Manipulation.

    As with normal procedures, Rigor Mortis may be solved by massage and manipulation. The body must be straightened and placed in a relaxed position. The head must be higher than the chest and the arms placed either on the stomach or at the side. Mouth and eyes must be closed. Injections. It is still under research as to whether CJD can be transmitted by blood remains. All other secretions such as urine, feces, milk, saliva and semen are proven non-infectious. The embalmer should not worry in a non-autopsied case because the infection can only be spread from the brain, the spine and cerebral spinal fluid.

    Normal mixtures of embalming chemicals may be injected. It is advisable to use preservative fluids diluted with water. A mixture of one to four gallons total dilute mixture is recommendable. None of these chemicals are for disinfection or eradication. These are simply for preservation and cosmetic purposes only. The normal injection procedures may be followed to the completion of this arterial stage of embalming. Areas of the injections must be dried and tightly sealed with absorption chemicals or glue and suture. Cavity Aspiration.

    Given the probability that tissue may flow with the aspirate, it is not advisable to undergo cavity injection or aspiration on the thoracic and abdominal cavities. However, the embalmer may opt to introduce eight ounces of cavity fluid orally while massaging the throat area externally to let the fluid enter the esophagus and bronchi. Additional Guidelines. The embalmer must ascertain that the nose, mouth, and all other orifices are packed with treated cotton to reduce bloating, purge (release of abdominal contents) and visceral decomposition.

    If purge is a probability, the embalmer must use minimal pressure for injection and use a nasal aspirator for the nose, throat and mouth. As previously advised, the orifices must be packed with treated cotton. The embalmer must not use a trocar especially on the thoracic and abdominal cavities. Neither should one directly inject undiluted preservative cavity fluid. Any wounds or surgical device or openings bust be cauterized with a phenol-based chemical before applying suture and sealed. Washing.

    To ensure protection, follow the normal procedure of washing the body again but with dilute bleach, rinsing with water. The hair must be shampooed or washed with germicidal soap. Autopsied Cases. Should there be viscera, preservative powder or fluid or gel must be added into the viscera bag taking care not to make contact with the viscera. The bag must be enclosed in a second protective bag. All liquid must be aspirated from the thoracic and abdominal cavities and internal surfaces must be treated with a preservative gel or powder.

    For even more protection, the viscera bag must be placed and sutured within the thoracic and abdominal cavities. The cranial cavity must be dried and the walls also applied with preservatives in gel or powder form. Only after following these instructions can the calvarium be re-attached and incision sutured. Embalming is a serious and very important step in the closure of a life. Done properly, it may save even more lives.

    References

    Adams, Jack CSFP. (1994). Embalming the Jaundice Case. The Dodge Magazine, 6/94. 4. Bedino, James J. (2005). Jaundice Embalming: The Superiority Of Flutaraldehyde Versus Formaldehyde. Champion Expanding Encyclopedia of Mortuary Practices, 654. 2681. Edema. Retrieved April 17, 2007, from http://www. medicinenet. com/edema/article. htm Jaundice – Yellow Skin. Retrieved April 17, 2007, from http://www. nlm. nih. gov /medlineplus /ency/article/003243. htm Steelman, Victoria M. , MA, PhD(c), RN, CNOR. (1996). Creutzfeldt-Jakob Disease: Decontamination issues. Infection Control & Sterilization Technology. What is Creutzfeldt-Jakob Disease?. Retrieved April 17, 2007, from http://www. ninds. nih. gov/disorders/cjd/cjd. htm

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