Exam 4 Lecture Notes - Postmortem Change- Physical change Flashcards Preview

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Flashcards in Exam 4 Lecture Notes - Postmortem Change- Physical change Deck (70):
1

Have the greatest influence on the embalming technique in case analysis. In making a pre-embalming analysis of the deceased individual, the embalmer examines the effect of four factors of concerns.

Postmortem Changes

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  1. General body condition.
  2. Effects of disease on the body.
  3. Effects of drug therapy on the body.
  4. All postmortem chemical and physical changes.

Four Factors of Concerns for Postmortem Changes

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  1. Autolysis
  2. Postmortem caloricity 
  3. Algor Mortis
  4. Postmortem Blood changes
  5. Change in tissue pH
  6. Rigor Mortis
  7. Imbibition
  8. Dehydration
  9. General Decomposition 

Postmortem changes listed in the general order of their appearance.

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  • Hypostasis
  • Increase in the viscosity of blood
  • Hemolysis
  • Coagulation (clotting)

Potmortem Blood Changes (In order of appearance)

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Brought about by the:

  1. Stoppage of blood circulation
  2. Gravitation of blood to the dependent parts of the body.
  3. Environmental surface evaporation 

Postmortem Physical Changes

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  • Algor Mortis
  • Hypostasis 
  • Livor Mortis
  • Dehydration
  • Increase in blood viscosity

List of postmortem physical changes

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The postmortem cooling of the body to the surrounding temperature.

Algor Mortis

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Can be antemortem or postmortem- The settling of blood and/or other fluids to dependent portions of the body.

  • Generally, after death, majority of blood is found in the veins.
  • The thinner the blood, the faster this occurs.
  • Medications containing blood thinners maximizes this.
  • Persons who die from conditions in which blood is thickened makes this a longer, more extended process. (example: febrile disease)

Hypostasis

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The postmortem, Intravascular, red-blue discoloration resulting from the hypostasis of blood.

  • First stage is blue pink
  • Last stage is purple
  • Classified as intravascular blood discoloration 
  • Can be removed with arterial injection and venous drainage.

Livor Mortis (Cadaveric lividity, postmortem lividity)

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Loss of moisture from body tissue which may occur antemortem and/or postmortem.

Dehydration (desiccation)

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Has three causes:

  1. Imbibition 
  2. Gravitation 
  3. Agglutination of formed elements

Increase in the viscosity of blood

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The internal organs cool much slower than the surface tissue of the body.

  • For this reason, putrefactive and autolytic decomposition may begin early in the visceral organs.
  • This is due to insulation 

Algor Mortis: Note

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  • Corpulence
  • Age

Intrinsic Factors: Algor Mortis

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It takes longer for an obese person to cool to surrounding temperature.

Corpulence (As an intrinsic factor of algor mortis)

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The very old and very young will cool faster and go into this much faster than healthy young adults.

Age (As an intrinsic factor of algor mortis)

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  • Amount of clothing covering the body.
  • Temperature and humidity of the environment.
  • Temperature of the patient at death.
  • Cause and manner of death.

Extrinsic Factors of Algor Mortis

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Especially bed covering will act as insulation after death. The greater the amount of covering/clothing, the slower the loss of heat causing a slower onset of algor mortis. Covering/clothing will act as insulation after death.

Amount of Clothing Covering the Body (Extrinsic factor: Algor Mortis)

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Surrounding the body at death. Air currents and low humidity increase the rate of surface evaporation and speed of heat loss (increase the onset of algor mortis). High humidity and static air decrease surface evaporation and retard heat loss (decrease onset of algor mortis).

Temperature and humidity of the environment. (Extrinsic factor: algor mortis)

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Air currents and low humidity ______ the onset of algor mortis.

Increase

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High humidity and static air ______ the onset of algor mortis.

Decrease

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  • Normal body temperature = 98.6oF
  • Usually a slight temperature raise after death (postmortem caloricity).
  • First few hours after death, body cools faster
  • Cooling slows as the body reaches that of the environment.
  • This cooling will only occur after postmortem caloricity.

Temperature of the patient at death (extrinsic factor: algor mortis)

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Most causes of death have some influence on the rate of algor mortis. The rate of cooling will be slower in cases of sudden death, largely because of the more normal nutrition and metabolic rate at the time of death.

Cause and manner of death (extrinsic factor: algor mortis).

23

Diseases which increase the antemortem metabolic rate tend to ___1____ the rate of algor mortis. Conversely, exhausting or emaciating diseases will ____2____ the rate of algor mortis.

  1. Decrease
  2. Accelerate

24

The settling of blood into the dependent tissues will cause the smaller vessels and capillaries to expand, thus allowing arterial fluid solution to enter these vessels with greater ease.

Positive aspect for Hypostasis for embalming

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  • Febrile disease
  • Diarrhea
  • Emesis (vomiting)

Antemortem dehydration, agonal dehydration

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Postmortem physical change occuring:

  • Postmortem interval- death to embalming
  • Post embalming- dehydration after embalming

Postmortem Dehydration

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The drying of the body or tissue as a result of the removal of moisture through the skin and membranes to the surrounding air as a natural process.

  • Will retard decomposition because it migrates bacterial cell metabolism.

Postmortem Dehydration

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  1. Surface Evaporation
  2. Imbibition
  3. Gravitation of Serum

3 Causes of Postmortem Dehydration Occuring Prior to Embalming

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Two factors: humid air and dry air will have a direct influence on or the lack of this as it affects the surface of the skin and tissue. In the dead body, the moisture loss will continue through the unprotected skin and surface membranes until the moisture content of the tissues is no greater than the surrounding air. When the air is naturally dry, as in desert areas, or artificially dried, as in a masuoleum crypt, a rapid and complete mummification will occur.

Surface Evaporation

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The most rapid ___________ occurs through tiny pores and very thin mucous membranes of the mouth, eyelids, nostrils, respiratory tract, surface tissue, and fingertips.

Postmortem Moisture Loss

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Become hard, crusty, leatherized, dark, reddish-brownish in color.

Lips (Surface evaporation)

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Hard, brownish in color (leathery)

Eyelids (Surface evaporation)

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Cupping, sclera turns tan in color.

Eyeball (surface evaporation)

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Hard, brownish-red and shrivled

Fingertips (Surface Evaporation)

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Loss of luster and elasticity.

Skin (surface evaporation)

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The complete collaspe of the eyeball as a result of postmortem dehydration.

Cupping

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Absorption of the fluid portion of blood by the tissues after death resulting in postmortem edema. As surface tissues dehydrate, deeper organs go into edema and swell.

Imbibition

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Dehydration of the surface of the body and imbibition will co-exist most often in refridgerated cases where currents of dry air rapidly dehydrate the surface and low temperatures retard blood coagulation and permit gravitation of blood serum and plasma into dependent areas of the body.

Gravitation of Serum

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Will bring about surface discoloration ranging from a yellow into brown and finally black. This cannot be bleached.

Dehydration

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  • Chemical dehydration 
  • Drainage dehydration
  • Environmental surface dehydration

3 Causes of postmortem dehydration that occur after embalming.

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  • Arterial solution is too strong (most common)
  • Use of concentrated arterial/cavity fluid in direct contact with membranes to induce dehydration. (i.e. cavity pack application).
  • Regurgitation of cavity fluid (post embalming purge) up through the respiratory tract or cervical vessels.

Chemical Dehydration

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The removal of tissue moisture may occur as a result of too rapid injection and drainage.

Drainage Dehydration

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Most common cause; concerns with temperature, flow of air and humidity around casketed remains in the reposing room.

Environmental Surface Evaporation

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  1. Tissue will take on a gray cast; in severe cases, dark gray.
  2. Eyes will open
  3. Lips will part
  4. Back of hands will shrivel
  5. Desiccation marks (i.e. razor burns) red-brown is the most noticable.

5 Results of post embalming dehydation.

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  1. Imbibition 
  2. Gravitation
  3. Agglutination of formed elements

Three Causes of an Increase of The Viscosity of Blood

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A steady, progressive separation of the plasma from the blood cells and the absorption of that plasma by deeper and adjacent organs.

Imbibition

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Plasma passes through the capillary walls into the tissues but blood cells remain in the vascular system forming small, rough dry clots which cause scanty drainage in bodies dead for many hours.

Gravitation

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Clumping together of microorganisms and blood cells in the vascular system.

Agglutination of Formed Elements

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  • Any condition causing bodily dehydration
  • Pathological agglutination

Causes of agglutination

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Febrile diseases prior to death causes sludge (sticky grape jelly) substance in blood which coat red blood cells (making them stick together in clumps).

Exceptions:

  • Septicemia
  • Liver Disorders

Pathological Agglutination

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Blood remains fluid because hemolytic substances, which inhibit coagulation are liberated (blood stinks).

  • General definition: the multiplication of bacteria in the blood.

Septecemia

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Bacteria in tissue and/or in blood.

Sepsis

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Presence of bacteria in the blood.

Bacteremia

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Destructive lesions of liver decrease the amount of fibrinogen produced and diminish the coagulating power of blood. Most jaundice cases drain well.

Liver Disorders

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  • Left and right common carotid arteries bifurcate into the left and right internal and external carotid arteries.
  • The descending abdominal aorta bifurcates into the left and right common iliac arteries.
  • The left and right popliteal arteries bifurcate into the left and right anterior and posterior tibial arteries.
  • The left and right brachial arteries bifurcate into the left and right ulnar and radial arteries.
  • The right brachiocephalic artery bifurcates into the right subclavian and right common carotid arteries.

Major bifurcations in the vascular system where sludge will accumulate during arterial injection.

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The left and right common carotid arteries bifurcates into:

The Left and right internal and external carotid arteries.

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The descending abdominal aorta bifurcates into the:

Left and right common iliac arteries.

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The left and right popliteal arteries bifurcate into:

The left and right anterior and posterior tibial arteries.

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The left and right brachial arteries bifurcate into the:

The left and right ulnar and radial arteries.

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The right brachiocephalic artery bifurcates into the:

Right subclavian and right common carotid arteries.

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Density of a fluid.

  • Low = Thin
  • High = Thick

Viscosity

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The diminished coagulability of blood.

Hypinosis

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What will the temperature of the environment (hot) /clothing acting as insulation cause?

Coagulation

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The movement of blood from the arteries to capillaries at death.

  • 85% of blood is in the capillaries.
  • 10% is in the veins.
  • 5% is in the arteries

Articulo-Mortis

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  • Rapidly Forming
  • Slow Forming
  • All white fibrin heart clot

Classifications of Postmortem Clots

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Contains all of the blood elements in a homogenous mass. These clots are bright red in color; they are similar to one taken from a living person. They are called:

  • Currant
  • Sludge
  • Jelly Clot
  • Cruor

Rapidly Forming Clot

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Contains all of the blood elements but has the red and white cells separated into distinct layers. It is classified according to location.

  • Vascular chicken fat clot
  • Cardiac chicken fat clot

Slow Forming Clot

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Has few, if any, red blood cells. They look like flesh colored rubber bands.

White Fibrin Heart Clot

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Emboli are typically found in the veins, where thrombi are typically found in the arteries.

The difference between emboli and thrombosis.

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  • Soft consistency, especially the cruor
  • Elastic and do not completely fill the blood vessel
  • Never attached to the vessel wall
  • They are homogenous as described.
  • When removed unbroken, they appear as a case of the vessel in which they were formed.

Characteristics of Postmortem Blood Clots

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