CHAPTER 9 Questions
1~Define the following terms-
Multipoint Injection~ Vascular injection from two or more arteries An example would be injecting the carotid and the femoral artery to achieve the desired results and proper distribution of the fluid.
Sectional Embalming~ The embalming of an entire body region. This method of embalming is employed when embalming an unautopsied body and embalming is begun with a one-point injection and clots are freed and move to smaller arteries and block the arterial solution from entering and entire body region, such as the extremities or one side of the head. It then becomes necessary to separately inject this body region in a sectional embalming process.
Restricted Cervical Injection~ Both right and the left common carotid arteries are raised; tubes are placed into them and directed toward the head on both right and left side. One tube is directed toward the trunk into the right artery; the inferior portion of the left artery is ligated. Drainage is generally taken form the right internal jugular vein. During downward injection, the arterial tubes directed toward the head remain open.
One-Point Injection~ An artery and vein at one location are used for injection and drainage. An example would be the incision and injection or the right common carotid artery and the right internal jugular vein. The right common carotid artery is injected and the right internal jugular vein is used for drainage.
Six-Point Injection~ In this injection method six arteries are raised that will separately inject the head and the limbs: the right and left common carotid arteries, the right and left axillary or brachial arteries, the right and left femoral or iliac arteries. Drainage can be taken from one location or from each individual incision location.
Split Injection~ The injection is made in an artery at one location and the drainage occure from a vein at another location. Example would be incision of the right common carotid artery and drainage from the right femoral artery.
2~Differentiate between arteries, veins, and nerves.
Nerves-They are solid structures with a silvery white sheen that show striations along their surface and do not have a lumen when cut. They do not have blood in them and the vasa vasorum are not visible.
Veins- Veins are thinner than arteries and contain valves. When they are cut they have a lumen and collapse to create a funnel effect. They are bluish when filled with blood and the vasa vasorum are not visible.
Arteries- They have thick walls and a creamy white in appearance . The vasa vasorum can be seen. The lumen of the artery is very pronounced when cut and the walls do not collapse. They are elastic and can be easily stretched.
3~List the twelve major factors to consider in choosing an artery for injection and a vein for drainage. Age of the deceased, sex of the individual with respect to the type of clothing that will be used to dress them in, weight, fat distribution, disfigurations present, disease present, edema present local or generalized, location or obstruction or congestion, possibly creating discolorations or a lack of preservative solution flow to a body region, trauma present from mutilation, accident or surgery, medico-legal requirements with regard to autopsies; preparation for international shipping; preparation under military contracts; requirements of a coroner or medical examiner, cause of death and the manner of death.
4~List several advantages to use the common carotid artery as a vessel for injection. It is very large in diameter, it has no branches except the terminal branches, so it is easily raised to the skin surface, it is very elastic, it is rarely found to be sclerotic, is supplies fluid directly to the head, it is situated close to the arch of the aorta, it is accompanied by a very large vein that can be used for drainage, arterial coagula are pushed away from the head when using the common carotid artery.
5~List the steps for raising and inserting instruments into the common carotid artery and the internal jugular vein. Stand at the head of the embalming table, turn the head of the deceased to the left to raise the right common carotid or right to raise the left, place shoulder block under the shoulders, remove the head block to give yourself more work area, make the incision and dissect through the platysma muscle and the superficial fat and facia, find the sternocleidomastiod muscle at the clavicular articulation, raise the internal jugular vein and tie it off and move it laterally, debreed medial and deep to find the carotid artery, bring it to the surface, place two strings around it, open the artery and insert the arterial tubes one superiorly and the other inferiorly, now secure them with the ligatures. Open the vein and insert the drainage device.
6~List the six incisions that can be used to raise the common carotid artery. The anterior lateral, anterior vertical, posterior vertical (parallel), anterior horizontal, flap or semilunar incision, and the strap line incision.
7~List the advantages to use of the restricted cervical method of injection. The arteries are large, carotids are very elastic and have no branches, so they are easily elevated, the arteries are accompanied by large veins for drainage, the arteries are rarely sclerotic, clots or coagula present in the arterial system will be pushed away from the head area, solution is supplied directly to the head, allows the best control over the amount of arterial solution entering the head, two rates of flow can be used: one for the head and the other for the trunk, two pressures can be used: one for the head and the other for the trunk, large volumes can of solution can be injected through the trunk without overinjecting the head, features may be set after the trunk is embalmed and aspiration if purging tool place during injection.
8~Describe the relationship of the common carotid artery to the internal jugular vein. The internal jugular vein lies lateral and superficial to the common carotid artery.
9~Describe the relationship of the femoral artery to the femoral vein. The femoral artery lies lateral and superficial to the femoral vein.
10~Describe the relationship of the axillary artery to the axillary vein. The axillary artery lies lateral and deep to the axillary vein.
11~Give the steps for raising and inserting instruments into the femoral artery and vein. Stand at the right side of the table, make the incision parallel to the vessels on the linear guide through the skin and superficial fascia, dissect superficial fat and fascia bluntly, and be mindful of the great saphenous vein that lies quite superficially, locate the sartorius muscle, which the vessels are located along the medial side of, locate the femoral artery and dissect it free, place ligature around the superior and inferior portions of the vessel, pull the artery laterally, dissect medially and deeper to find the femoral vein, bring the vein to the surface and place ligature around each end of the dissected vein, make an incision in the vein and insert drainage device, tube or forceps toward the heart, tie the tube in the vein, bring the artery to the surface of the incision, incise the artery and insert on arterial tube directed toward the head and a second tube directed down the leg, and secure both with the ligatures that are in place.
12~Describe where the incisions are made for the raising of the radial and ulnar arteries. The incision for the radial artery is made just lateral of the tendon of the flexor carpi radialis muscle on the lateral side of the forearm, or parallel to the artery directly on the linear guide, about one inch above the base of the thumb. The incision for the ulnar artery is made between the tendons of the flexor carpi ulnaris muscle and the flexor digitorum superficialis muscle, or parallel to the artery on the linear directly on the linear guide, about one inch above the pisiform bone.
13~Describe several incisions that can be used to open an artery for insertion of the arterial tube. Longitudinal incision, Transverse incision, Diagonal incision, “T” incision, Double “T” incision, Wedge incision.
14~List the incisions that can be used to raise and inject the popliteal artery. Two incisions can be used they are:
1- The body may be turned and the incision made down the center of the popliteal space, parallel to the artery.
2- If the body is not turned the knee may can be slightly flexed and a longitudinal incision may be made along the posterior-medial aspect of the lower third of the thigh, actually just superior to the popliteal space.