Dilution, Distribution and Diffusion

Question 1

The dilution of the concentrated fluid with water to form the arterial fluid solution. Case analysis or pre-embalming analysis will determine the strength of the dilution. It will also determine the need for pre-injection, co-injection and water conditions, etc. Occurs in the maching.

Answer 1

Primary Dilution

Question 2

Normally, it is the further dilution of the already diluted fluid by the fluids in the body. It is the union of the tissue juices and liquids with the arterial fluid solution to further reduce the concentration of the preservative ingredients. It occurs in the body.

Answer 2

Secondary Dilution

Question 3

Body conditions will vary from extreme dehydration to extreme edema. Variation in the moisture content of the body will determine the variation in primary dilution.

• Dehydrated
• Normal
• Edemous

Answer 3

In Secondary Dilution

Question 4

100 pounds of body weight will yeild 65 pounds of water.

Answer 4

Dehydrated Bodies in Secondary Dilution

Question 5

100 pounds of body weight will yeild 75 pounds of water.

Answer 5

Normal bodies in Secondary Dilution

Question 6

100 pounds of body weight will yeild 85 pounds of water.

Answer 6

Edamous Bodies in Secondary Dilution

Question 7

The movement of arterial fluid solution from the point of injection throughout the arterial, capillary, and venous portions of the blood vascular system.

Answer 7

Fluid Distribution

Question 8

• Capillaries - 85%
• Veins- 10%
• Arteries- 5%

Answer 8

Capacity of Blood Vessels - Forced by Articulo-Mortis

Question 9

1. The movement of the fluid solution from a high pressure potential to a point of minimum resistance.
2. The use of a fluid solution having a high diffusive power and a low viscosity. The lower the viscosity, the better the penetration.

Answer 9

Maximum Fluid Distribution Witout Undesirable Surface Changes is Based Upon Two Factors:

Question 10

The passage of some elements of the injected arterial fluid solution from an intravascular to an extravascular position.

• Pressure Filtration
• Osmosis
• Dialysis
• Gravity Filtration

Answer 10

Fluid Diffusion

Question 11

1. The mechanical force or pressure provided by the injector.
2. The internal molecular force generated by osmotic pressure.

Answer 11

Fluid Diffusion Results From a Combination of two Forces:

Question 12

The passage through the capillary walls of arterial fluid solution because of positive intravascular pressure exerted by a pump (embalming machine), compressor or gravity against the fluid, forcing the liquid out through the tiny intracellular spaces in the capillary bed; in other words, putting fluid into the body via an embalming machine.

Answer 12

Pressure Filtration

Question 13

The passage of solvent through a semi-permeable membrane from a dilute to a concentrated solution (fluid). When two solutions of unequal concentration are separated by a semi-permeable membrane, such as a capillary wall, the solvent molecules will move in the greatest number from the area of lower solute concentration to the area of higher solute concentration. (hypo to hyper)

• Isotonic
• Hypertonic
• Hypotonic

Answer 13

Osmosis (Hindered Diffusion)

Question 14

Solution having equal tension on both sides of the capillary wall (same osmotic pressure).

• Example: Salt solution and blood (.9 saline solution).

Answer 14

Isotonic Solution

Question 15

A solution having abnormally high tension or viscosity and an osmotic pressure higher than that in an isotonic solution (too thick for arterial solution).

• Example: Topical Jelly

Answer 15

Hypertonic Solution

Question 16

A solution having abnormally low tension or viscosity and an osmotic pressure lower than an isotonic solution (better for arterial fluids).

Answer 16

Hypotonic Solution

Question 17

Arterial fluids injected at high pressures and rates of flow cause tissue cells to fill rapidly with a hypotonic solution, eventually causing the cells to swell and burst.

• Examples: Puffed necks, lips and eyelds.

Answer 17

Danger of Hypotonic Solutions

Question 18

The separation of differing substances in solution because of their differing diffusability through semi-permeable membranes. It is the process of separating crystalloids and colloids in solution by the difference in their rates of diffusion through a semi-permeable membrane. Many of the essential agents in an arterial fluid solution are dissolved crystalloids, which must depend upon the pulling power of the water molecules to carry them through the semi-permeable membranes into the tissue cells.

Answer 18

Dialysis (Selective Diffusion)

Question 19

The intravascular (which eventually becomes extravascular) settling of fluid by gravitational force. It is the eventual downward passage of fluid solution into adjacent tissues under the influence of gravity.

Answer 19

Gravity Filtration

Question 20

• Fluid dye
• Distension of superficial blood vessels
• Blood drainage
• Clearing of intravascular blood discolorations

Answer 20

Signs of Fluid Distribution

Question 21

• Dye in the tissues
• Firming of the tissues
• Loss of skin elacticity (beginning firming)
• Drying of the tissues
• Rounding of fingertips, lips, and toes
• Mottling of the tissues (bleaching)
• Fluorescent dye observed using “black light”

Answer 21

Signs of fluid Diffusion

Question 22

1. Amount of fluid to use
2. Strength of solution
3. Temperature of solution
4. Pressure of Injection
5. Rate of flow
6. Relation to each of the above to disinfection, preservation, removal of discolorations, swelling.

Answer 22

Summary of all factors relative to fluid and its injection.

Question 23

1. Puncture Test
2. Tracer Dye
3. Fluorescent dye test

Answer 23

Tests for fluid distribution and diffusion

Question 24

Slightly puncture tissue with a needle, then squeeze to detect fluid at the legs/toes, arms/fingers, and head (behind ear).

Answer 24

Puncture Test

Question 25

Adding any of the commercial active dyes to the arterial fluid solution. This will be detected in the surface tissues. This is the most common method. Always inject from the femoral artery so it enters the head evenly; for highly concentrated dye, two capfuls to a tankful. * Active dyes are a type of this

Answer 25

Tracer Dyes

Question 26

Detected only under ultraviolet black light; viso-balm co-injection.

Answer 26

Fluorescent Dye Test

Question 27

* Diminish secondary dilution * Remove intravascular discolorations * Prevent distention * Permit disinfection and preservation * Retard postmortem decomposition.

Answer 27

Purpose and Importance of Drainage (List question)

Question 28

* Closed drainage technique to limit blood exposure- heart tap with a trocar * Use of procedure with allows control of drainage by vein tubes inserted into veins or into the right atrium by means of flexible tubes.

Answer 28

Drainage Procedure

Question 29

1. Short barrell trocar directly into the right atrium of the heart. 2. Long barrell torcar directed into the right atrium of the heart from another point of entry (starting at the anterior, superior iliac spine).

Answer 29

Methods of Heart Tap

Question 30

It is not so much the volume of solution injected into the body that counts, but the amount that actually remains there. Fluid which merely passes through the vascular system to end up in the drainage can't possibly accomplish anything in the way of preservation.

Answer 30

Arterial Fluid Retention

Question 31

* Back Pressure * Closing the drain tube pump

Answer 31

Methods of Fluid Retention

Question 32

Clamp the corresponding vein after all blood has exited (straight or autopsy case).

Answer 32

Backpressure

Question 33

Creates backpressure (straight case)

Answer 33

Close the drain tube pump rod to create backpressure

Question 34

Disinfection and preservation of human remains. The action of embalming chemicals can be summarized as having three over-all effects.

Answer 34

The purposes of Embalming Process

Question 35

1. Inactivate the action of chemical groups on proteins and amino acids. 2. Inactivate both autolytic and bacterial enzymes. 3. Kill microorganisms

Answer 35

3 Over-all Effects of Embalming Chemicals

Question 36

Is second only to good distribution of arterial fluid solution in the embalming process.

Answer 36

Good Drainage

Question 37

This is the basic foundation establishing drainage. All methods of establishing drainage involve some variation of this concept.

Answer 37

Displacement

Question 38

Consists of injecting fluid solution into the aterial system and allowing it to push the blood ahead of itself into the venous system and out through the drain tube.

Answer 38

Displacement (definition)

Question 39

Center of embalming circulation.

Answer 39

Arch of the Aorta

Question 40

Center of venous drainage is the juncture of the superior and inferior vena cava at the:

Answer 40

Right Atrium

Question 41

* Both liquid and clotted * Arterial fluid solutions * Interstitial fluid- fluid between the organs and tissues. * Lymphatic fluid

Answer 41

Drainage consists of any one but usually a combination of these 4 substances (fluids).

Question 42

At the right atrium of the heart.

Answer 42

Direct Aspiration

Question 43

Accomplished by inserting a narrow barreled trocar directly into the right atrium of the heart during injection. (Most embalmers today feel this is foolhardy).

Answer 43

Heart Tapping

Question 44

* Most of the time the embalmer will puncture the arch of the aorta by accident (6 point injection). * Clotted drainage will clow the small holes at the end of the trocar; thus the whole purpose is defeated. * Even if the embalmer is accurate at hits the right atrium and the drainage is clot free, the emblamer still has no way to create backpressure to overcome short circuits. If anything, a successful heart tap encourages short circuits.

Answer 44

Problems with Heart Tap

Question 45

Utilize either right internal jugular, right femoral or right iliac vein and insert with great care a slick hose or tube until it drops into the right atrium of the heart. The hose or tube must be pushed back and forth to allow it to enter the superior and inferior vena cava.

Answer 45

Flexible rubber or plastic tube or hose

Question 46

* Increase pressure and pulsating pressure. Increase rate of flow. * Creating a backpressure by opening and closing drain tubes. * Massage the body, especially arms and legs; always toward heart; elevation of appendages. * Instruments- Drain hoses, trocar, drain tube, forceps, vibrating embalming table (outdated). * Chemicals- Co-injection, pre-injection (usually idential chemically) does not dissolve blood clots but dilates and lubricates the lumen of the vessels and prevents further clotting.

Answer 46

Methods of Stimulating Drainage (List Question)

Question 47

1. Multiple points of injectio and drainage. 2. Slow rate of pressure and flow; first to allow arterial fluid to ride over and around clots. 3. Cold packs to encourage drainage 4. In severe, almost hopeless situations, surface embalming and hypodermic embalming are the only solutions. (surface embalming/jellies and cavity packs, danger of burning tissue). Can use arterial fluid if it does not contain active dye.

Answer 47

Solving Difficult Drainage Problems

Question 48

Beware of sludge; can accumulate at bifurcations if you start off too fast (high pressure and rate of flow).

Answer 48

Slow rate of Pressure and Flow

Question 49

* Alternate method * Intermittent method * Concurrent or Continuous method * Discontinuous injection method

Answer 49

Methods of Drainage in Relation to Injection

Question 50

The arterial fluid is injected into the arterial system wtih the drain tube pump rod kept tightly closed until the superficial veins being to discend. The injection is then halted and the drain tube pump is opened and pumped until drainage stops. The process is repeated over and over until the body is embalmed.

Answer 50

Alternate Method

Question 51

* Will build up a uniform backpressure * Wil get more uniform fluid distribution * Will overcome short circuits in vascular system * Will get maximum amount of drainage * Will equalize the arterial pressure and venous resistance and allows for the removal of obstructions from the smaller vessels that are not removed in other techniques. * Will ensure the removal of gravitated blood from the dorsal portions of the body; this is blood which is not removed by the concurrent or continuous technique.

Answer 51

Advantages of the Alternate Method

Question 52

* Most likely to lead to distension and swelling. * Very time-consuming method * More theoretical than practical

Answer 52

Disadvantages of the Alternate Method

Question 53

Continuous drainage and injection; the embalmer usually uses drainage forceps instead if a drain tube.

Answer 53

Concurrent (Continuous) Drainage Method

Question 54

* Fastest way to embalm * Least likely to lead to distension * Simplest method to learn

Answer 54

Advantages of the Continuous Method

Question 55

* Renders the least uniform backpressure * Method having poorest fluid distribution and saturation. * Method does not overcome short circuits in the vascular system- body only partially preserved. * Indicates the embalmer lacks skill with the drain tube. * Unnecessary waste of arterial solution * Serious dehydration may occur during rapid injection with open drainage.

Answer 55

Disadvantages of the Concurrent (Continuous) Method

Question 56

Continuous injection and intermittent drainage. Consists of stopping drainage at intervals by closing the drain tube pump rod while maintaining continuous injection; most logical method of embalming and will give the best results utilizing two points of drainage.

Answer 56

Intermittent Drainage

Question 57

* Assists in blood removal by creating backpressure at key intervals during injection. * Requires less time than the alternate method while still maintaining better arterial fluid distribution, good backpressure and consistent drainage. * Considered by most embalmers to be the best method when utilizing modern high rate of flow motorized embalming apparatus.

Answer 57

Advantages of the Intermittent Method

Question 58

* Still the possibility that short-circuit paths may be established during the interval when the drain tube is open. * The interval during which the drain tube is closed by also be insufficient to equalize the pressure and resistance.

Answer 58

Disadvantages of the Intermittent Method

Question 59

A repeated arterial injection. The injection of smaller amounts of arterial fluid solution at intervals rather than the injection of a larger volume of arterial solution at one time. This method will get the most beneficial results, it is good for burial at sea and edema.

Answer 59

Discontinuous Injection Method

Question 60

Pulsating pressure is preferred instead of continuous pressure. The brief intervals between pulsations ensure a better absorption with less danger of distension than is characteristic of continuous pressure. The rest period is usually from one to four hours involving one quart to one gallon volumes; third and fourth injections may also be utilized.

Answer 60

Rest Period- During Discontinuous Injection

Question 61

* Uremia * Septicemia * Nephritis * Signs of decomposition * Infectious contagious cases * Holding bodies for long period of time * Anatomical embalming to make cadavers * Refridgerated bodies * Trauma cases- Accident, murder, etc.

Answer 61

Conditions When the Discontinuous Injection Method Should be Utilized

Question 62

The prevention of highly objectionable degrees of feature distension. Prevent swelling and distortion of features.

Answer 62

Advantage of Discontinuous Injection Method

Question 63

It is too time consuming for commercial funeral home embalming.

Answer 63

Disadvantage of Discontinuous Injection Method

Question 64

1. One point injection and drainage 2. The split injection and drainage method 3. One point of injection with two points of drainage 4. The restricted cervical method 5. The multi-point or sectional injection

Answer 64

The 5 Operative Prodedures- whether the embalmer uses the alternate, continuous or discontinuous techniquesm one of these will be used

Question 65

Injection and drainage at and from a single point; very few cases fall into this category. These are ideal cases beacause there are: * No lingering diseases * No clotting * No major pathological changes * A perfect vascular system with no obstructions * Embalmed shortly after death * No presence of antemortem drugs

Answer 65

One Point Injection and Drainage

Question 66

* The right common carotid artery and right internal jugular vein * The right femoral artery and the right femoral vein * The right axillary artery and right axillary vein * The right brachial artery and right basilic vein

Answer 66

Points most often used in single point injection and drainage

Question 67

Primary one point injection and drainage site.

Answer 67

Right carotid artery and right internal jugular vein

Question 68

Best for contagious infectious diseases for one point injection and drainage sites because it minimizes exposure for the embalmer.

Answer 68

Right femoral artery and right femoral vein

Question 69

Because fo the many recent problems faced by modern embalmers, this procedure is rapidly becoming the most popular. All cases involving complications short of decomposition, including most hospital and nursing home cases, fall into this category. **It is injection and drainage from separate points.**

Answer 69

The Split Injection and Drainage Method

Question 70

* The left common carotid artery and the right internal jugular vein * The left axillary artery and the right axillary vein * The left brachial artery and right basilic vein * The right femoral artery and the right internal jugular vein * **Any artery above the heart and any vein below the heart** * **Any artery below the heart and any vein above the heart**

Answer 70

Points most often used for split injection and drainage

Question 71

May cause a puffed up neck

Answer 71

Any artery above the heart and any vein below the heart

Question 72

Better choice

Answer 72

Any artery below the heart and any vein above the heart.

Question 73

The vast majority of embalmers consider this method to be the most logical and most successful in solving contemporary embalming problems.

Answer 73

One Point Injection and Two Points of Drainage

Question 74

* Establish a single point of injection that will lead to the arch of the aorta. Any major artery will do. * Establish two points of drainage, one above the heart at the right internal jugular vein (which leads to the superior vena cava) and one below the heart at the femoral vein or common iliac vein (which leads to the inferior vena cava) * **Utilizing the right femoral artery and right femoral vein and right internal jugular vein is the best method for treatment of a lenghty postmortem interval.**

Answer 74

Procedure- One point of Injection and two Points of Drainage

Question 75

Utilizing two separate supraclavicular incisions, raise both common carotid arteries and both injernal jugular veins.

Answer 75

Restricted Cervical Method

Question 76

* Inject the left common carotid artery downward and drain from both internal jugular veins. Clamp off the right common carotid artery with a hemostat and nick it above the clamp to allow clots to drain. * Inject the torso first, utilizing the left common carotid artery downward into the center of embalming circulation at the arch of the aorta. * After the torso and the appendages are injected and thoroughly embalmed, inject the head (left common carotid upward first, and the right common carotid artery upward next).

Answer 76

Procedure- Restricted Cervical Method

Question 77

* **Severe edema in the body** * All obese bodies (300lbs of excess body fat) * All cases where maximum preservation is desired, such as ship-outs and storage cases * All cases where the embalmer anticipates swelling of the neck and facial features. * **Cancer and radiation therapy with rapid weight loss (especially renal cancer- excess urea)**

Answer 77

Cases that Warrant the Restricted Cervical Method

Question 78

The torso and appendages can be injected with a rather strong solution for maximum embalming effect while the head, particuarly the face, can be injected with a mild, less dehydrating solution. * Also can utilize instant tissue fixation of the cardinal signs of decomposition are present (particularly in the head).

Answer 78

The greatest advantage of the restricted cervical method.

Question 79

If the cardinal signs of decomposition are present, particularly in the head, then this can be used followed by aspiration and injection of cavity fluid into the brain will be necessary through the cribiform plate of the ethmoid bone.

Answer 79

Instant Tissue Fixation (Head Freeze)

Question 80

* The head can be adequately embalmed through the vertebral arteries with no swelling or distortion of the facial features, thus eliminating the need to inject both common carotids upward. * Most embalmers will still inject both right and left common carotids upward for safety.

Answer 80

Notes: Restricted Cervical Method

Question 81

The six point injection. Any case involving the necessity to utilize two or more complete injection sites. Every artery raised will require that its corresponding vein also be raised for drainage.

Answer 81

The Multi-point or Sectional Injection

Question 82

On any multi-point or sectional injection, it is recommended that the embalmer inject both directions on every artery raised. In this way, the ____ \_\_\_ ____ areas will recieve the fluid solution.

Answer 82

Thoracic and Abdominal

Question 83

* All cases where decomposition is obvious, including skin slip and greenish abdomens. * All cases where there is a rupture of major proportion in a trunk vessel, such as in a ruptured aortic aneurysm. * All cases where the embalmer experiences severe blockages in the vascular system, such as ASCVD and other degenerative arterial conditions.

Answer 83

Casues that Constitute the Necessity for Multi-point Sectional Injection

Question 84

* Legs: Right and left external iliacs * Arms: Right and left subclavian (to inject vertebrals in back of head) * Head: Right and left common carotids * Always create backpressure by clamping off corresponding veins when drainage becomes clear fluid.

Answer 84

Sequence for Injecting an Autopsy: Multi-point (sectional) Injection

Question 85

For a multipoint injection of an autopsied case, if there are no subclavians, inject into ______ in opposite direction and clamp off subclavians; the fluid will be forced to go into the vertebrals.

Answer 85

Axillary Arteries