Shipping/mold/obese/infectious- Chapter 2-5

Question 1

• How much time is there from embalming to final disposition?
• Will the remains be shipped out of town, state, or country?
• How shipped: air, train, boat, private carrier
• Will foreign embassy or consulate be involved?
• Contagion and infectious disease
• Autopsied or non-autopsied body
• Sealed or non-sealed casket
• Death certificate
• Embalming report
• Customs inspection

Answer 1

Embalming Analysis

Question 2

All treatment should begin with topical disinfection followed by a good soap and water washing of the body, cleaning of the nasal, oral, and orbital area, and gentle extension and manipulation of the head and extremities to relieve any rigor mortis.

Answer 2

Primary Disinfection

Question 3

Intravenous tubes or any other invasive connections to the arterial or venous systems should be left in place and removed _____ arterial injection.

Answer 3

After

Question 4

Trachotomy tubes or any tubing placed into the mouth should be removed _____ arterial injection.

Answer 4

Prior to

Question 5

____ parts sodium hypochlorite household bleach.

Answer 5

1-10

Question 6

Always pre-embalming.

1. Glue eyelids to eyecaps top lid 2/3 bottom lid 1/3- orbit of the eye almond shaped.
2. Mouth closure- Mandibular tie or musculature suture- tie ends in a bow so receiving funeral director can clean, change cotton, and repose features. Simply untie and retie suture end. Di not use needle injector gun; wires will break during transportation.
3. Pack trachea and esophagus prior to suturing common carotid incisions to prevent purge.

Answer 6

Feature Setting

Question 7

High index solution with humectant based co-injection to prevent dehydration- 30-38 index 8-16 ounces to a gallon. Exception would be febrile disease with severe dehydration, AIDS and jaundice cases.

Answer 7

Embalming Solution Strength and Volume

Question 8

Immediate method with re-aspiration and injection of fresh cavity fluid. To prevent cavity fluid purge, use thick topical phenol jelly with cavity injector after last aspiration. Be sure button is secure; if not, use purse string suture or reverse N stitch.

Answer 8

Cavity Treatment

Question 9

• Incision closing and sealing
• Pack all orifices
• Terminal disinfection of the body- bleach and water 1 to 10.
• Leaking precautions- unionalls, coveralls, stockings and sleeves.

Answer 9

Post Embalming Preparation

Question 10

Remains not in ___ ____ can be shipped in inexpensive white zipper bag placed in shipping container.

• Other Option: Underwear/underclothing and/or a hospital gown.

Answer 10

Burial Garments

Question 11

• Any area of trauma to the face or hands where the skin was broken or torn.
• Cranial autopsy incisions
• Autopsy sutures
• Surgical sutures
• Sutures at sites where vessels were raised for arterial injection
• Areas where edema is present
• Intravenous punctures
• Punctures used drawing postmortem blood samples.
• Any point where the skin has been broken

Answer 11

Possible Areas of Leakage

Question 12

Coat hands and face with phenol topical jelly and cover with plastic saran wrap; formaldehyde is a useless preventative against these things.

Answer 12

Mold/Fungi

Question 13

1. Secure head and hands with prep towel wrap
2. Place body in disposable inexpensive zipper bag to pretect casket interior
3. Secure- tie body in pouch to spring mattress. Then lower mattress with crank kep; use wide strips of webbing to secure body. Place cardboard around sides.
4. Special particle board shipping boxes will have webbing and positioning devices inside.
5. Zeigler box may be required when shipping embalmed bodies uncasketed to foreign countries or embalmed body may be placed in a Zeigler box, sealed, and then placed inside a sealer casket. In extreme situation, casket may be welded shut.

Answer 13

Stabilizing Techniques in the Casket for Shipping

Question 14

Autopsy- non-autopsy. Complete and written in the language of receiving funeral director, chemicals used, injection and drainage sites, cosmetics, any problems.

Answer 14

Embalming Documentation

Question 15

All rules and regulations must be followed in accordance with the embassy or consulate of receiving country. U.S. customs may also be involved when shipping human remains or receiving human remains to or from foreign countries.

• Emblaming report
• Burial transit permit
• Copies of death certificate

Answer 15

International Considerations

Question 16

1. Increased solution strength- 30 to 40 index
2. Increased solution volume- 2 gallons/100lbs
   
   1. Avoid humectants co-injection
   2. Avoid lanolin based fluid
   3. Avoid pre-injection
   4. Utilize tracer dye
3. Restricted Cervical Method- followed by, only if necessary, multipoints of injection and drainage.
4. Hypodermic injection may be required to supplement vascular embalming. Remember to increase fluid strength.

Answer 16

Preparation of Obese Bodies

Question 17

Paramount in the embalmer’s mind should be the fact that in dealing with _____ ___ _______ material, he/she assumes the responsibility for the health and safety of several groups of people.

• The family he/she serves
• His/her own family
• Coworkers
• Various people who handle the body
• General public
• Yourself

Answer 17

Contagious and Infectious

Question 18

In most ___ ___ ____, the local health authority directly assumes responsibility, however, they do depend considerably upon the discretion of the embalming in dealing with main source of infection, the body. The embalmer must ensure the prevention of the spread of the disease when treating the body, all articles of clothing, instruments and equipment.

Answer 18

Highly Contagious Diseases

Question 19

Whenever possible, the emblamer should seek and heed the aid of the ___ ______, and when not possible, he/she should use his/her best judgement in dealing with contagion and infection.

Answer 19

Health Authorities

Question 20

Do not hesitate to contact colleagues.

Answer 20

State Board and CDCP

Question 21

Be sure the health authorities are aware of the death. Usually they will call you. Most contagious diseases are now isolated in the C.D. wards in hospitals or ______ in homes.

Answer 21

Quarantined

Question 22

Go to the home equipped with caps, gowns, masks and nitril gloves. Wear clothes that could be subsequently ______ if necessiary.

• The removal vehicle must always contain PPEs for any scenario.

Answer 22

Destroyed

Question 23

Have a sutiable carying case for the body that can be disinfected later. Sheets saturated in any suitable disinfectant should be available to wrap around the body. There are two choices of disinfectant.

Answer 23

Multiple Plastic Zipper Pouches

Question 24

1. 5% fumeless cavity and water
2. Straight bleach (sodium hypochlorite) 1-10 parts

Answer 24

Two Choices of Disinfectant

Question 25

Wrap the body in saturated sheet, place in pouch and place in the removal vehicle. Contact other articles as little as possible. (5% fumeless cavity and water). Always cover _____ in any situation.

Answer 25

Mouth

Question 26

Make sure the health authorities have arranged for proper _____ of home and protection of the family.

Answer 26

Disinfection

Question 27

Remove protective covering from shelf before entering driver's seat and proceed to \_\_\_\_\_.

Answer 27

Mortuary

Question 28

1. Put on protective covering and move body to preparation room, contacting as few articles as possible. (ALWAYS) 2. Remove body from carrying case and place on table. Remove all clothing, jewelry, etc. Properly disinfect all personal effects removed from the deceased before returning them to the family or before discarding or destroying them when directed to do so. (ALWAYS) 3. Wash the body thoroughly with a disinfectant approved by the health department (ALWAYS) 4. Thoroughly disinfect and pack all orifices with absorbent cotton. **Aspirate nose and mouth** (ALWAYS) 5. AFterial embalm and inject cavities with fluids approved by the state department of health. **Immediate cavity treatment**. 6. Disinfect all drainage and waste matter taken from the body. Double bag everything and pour bleach in the bag before tying. 7. Properly clothe and place body in casket. Place body in Unionalls. Dust with embalming powder and tie neck strings; place tape over strings.

Answer 28

Precautional Measure Against Contagion Prior to, During and After Embalming Procedure

Question 29

* An airtight, metal-lined casket,hermetically sealed should be used. If it is shipped, it must be included in a strong wooden transportation case. Refer to embassy/consulate rules. * A wooden casket may be used in transportation case is metal-lined and hermetically sealed. * A Zeigler case may be used to ship uncasketed remains.

Answer 29

Infectious-Contagious Shipping

Question 30

Should be throughtly disinfected. Use a suitable disinfectant solution if interior can be washed. (Use a bucket of bleach and water) ALWAYS

Answer 30

The car used to Transport the Body

Question 31

All wearing apparel of the embalmer should be:

Answer 31

Disinfected or Destroyed

Question 32

Embalmer and apprentice should thoroughly disinfect themselves with antiseptic or germicidial soap and antiseptic spraying of the nose and mouth. Discuss with health authorities the necessity of ________ or antitoxins for the embalmer and his/her family.

Answer 32

Vaccines

Question 33

Thorough disinfection of _____ room with sutiable chemicals. (ALWAYS)

Answer 33

Preparation

Question 34

Health authorites should be ______ as to permission for public funeral or committal service.

Answer 34

Consulted

Question 35

* Low moisture content due to unusually high fever. * Clotted condition of blood due to toxins in blood and presence of fever (Agonal clotting and Agonal fever).

Answer 35

Possible Postmortem Findings (Contagious-infectious cases)

Question 36

Use a ______ fluid to induce drainage. No more than one gallon per injection.

Answer 36

Pre-Injection (Contagious-infectious cases)

Question 37

Continue with a ____ strength dilute arterial fluid, gradually increasing the dilute index until it is about 2% formaldehyde. * 1 gallon- 8 ounces arterial * 2 gallons- 12 ounces arterial * 3 gallons- 16 ounces arterial

Answer 37

Mild

Question 38

A _____ volume of dilute solution will be required to replenish lost moisture; it is advisible to incorporate humectants into the final injections. Stay with a 20-25 index lanolin based arterial fluid or humectants. * Only co-injection (last gallon)

Answer 38

Greater

Question 39

Use ____ artery and vein as injection and drainage site. Use long drainage tube with extra long drain hose that will reach from the _____ vein to drain hole at bottom of the table. * Theory- Even distribution and diffusion

Answer 39

Femoral

Question 40

Cover injection site with ____ \_\_\_ to prevent splattering. Use drain tube and run the tube all the way to the sink.

Answer 40

Disposable Towel

Question 41

Care with mouth and eyes; use mild disinfectant musculature suture or mandibular tie for mouth closure.

Answer 41

Disinfect all Orifices and Lesions

Question 42

Promptly following arterial embalming. (Immediate method)

Answer 42

Apply Cavity Embalming

Question 43

Inject tissue builder into the puncture hole, super glue afterwards, then place plastics if the deceased is to be shipped.

Answer 43

To Treat Intravenous Punctures

Question 44

Required for all removal companies in the state of maryland to use this when making a removal.

Answer 44

Rubber Zipper Pouch