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PREPARATION OF AUTOPSIED BODIES AND WHAT IS

THE PROPER TREATMENT AND DISPOSITION OF THE


VISCERA

OBJECTIVES

Knowing and understanding the
purposes of an Autopsy
Recognizing the types of
Autopsies
Complying with work practice
controls


OBJECTIVES
Preparation
partial autopsy
complete autopsy
OBJECTIVES
Embalming
raising vessels,
hypodermic treatment,
drying tissue,
suturing
OBJECTIVES

Viscera
Proper treatment
Disposition of the viscera

Autopsy purposes
An autopsy necropsy or postmortem is an
examination of the dead human body.
There are four main types of autopsies
Medico-Legal autopsy or forensic or coroner's
Clinical or Pathological
Anatomical or academic
Virtual or medical imaging

Autopsy purposes
Among the four main types of autopsies, each
one is performed for certain purposes.
Autopsy purposes
The types of autopsies we are most
likely to see in the mortuary
profession are the medico-legal
autopsy or forensic or coroner's
autopsies, clinical or pathological
autopsies.

Autopsy purposes
With the virtual or medical imaging
autopsies, we as morticians would never
know it was performed.
This imaging autopsy is performed to
see where and if something is placed
within the decedent.
Autopsy types
Medico-Legal or Forensic,
,
and
Autopsy purposes
Autopsies are divided into two categories
Partial autopsy
Complete

Partial Autopsy

Generally only one body cavity
is opened to examine one
specific item when a partial
autopsy is done.

Complete Autopsy
The medico-Legal or hospital autopsy
can be either partial or complete

The forensic, coroner's or medical
examiner autopsies are generally
complete autopsies.
Autopsy purposes
Medico-Legal autopsy or forensic or coroner's
autopsies
Seek to find the cause and manner of death
and to identify the decedent. They are
generally performed, as prescribed by
applicable law, in cases of violent, suspicious or
sudden deaths, deaths without medical
assistance or during surgical procedures [1].

Autopsy purposes
Clinical or Pathological
Performed to diagnose a particular disease or
for research purposes. They aim to determine,
clarify, or confirm medical diagnoses that
remained unknown or unclear prior to the
patient's death.
Autopsy purposes
Anatomical or Academic
Performed by students of anatomy for
study purpose only.

Autopsy purposes
Virtual or Medical Imaging

Performed utilizing imaging technology only,
primarily magnetic resonance imaging (MRI) and
computed tomography (CT).
The Medico-Legal or hospital autopsy is
obtained from the person with the proper
authority to take charge of the body after
death. When a family member request that an
autopsy should be performed, sometimes
there is a fee involved that must be paid prior
to the autopsy. In some instances the autopsy
will be performed in your funeral
establishment.
The Medico-Legal or hospital autopsy
When this type of autopsy is ordered, it is to
determine:
When doctors have not made a firm diagnosis.
When death follows unexpected medical
complications.
When death follows the use of an
experimental drug or device, a new
procedure, or unusual therapy.
The Medico-Legal or hospital autopsy
When death follows a dental or surgical
procedure done for diagnostic purposes and
the case does not come under the jurisdiction
of the medical examiner or coroner.
When death occurs suddenly, unexpectedly, or
in mysterious circumstances from apparently
natural causes and the case does not come
under the jurisdiction of the medical examiner
or coroner.

The Medico-Legal or hospital autopsy
When environmental or workplace hazards
are suspected.
When death occurs during or after childbirth.
When there are concerns about a hereditary
disease that might affect other members of
the family.

The Medico-Legal or hospital autopsy
When there are concerns about the possible
spread of a contagious disease.
When the cause of death could affect insurance
settlements (policies that cover cancer or that
grant double indemnity for accidental death).
When death occurs in a hospital and the patient
comes from a nursing home and the quality of
care is questioned.

The Clinical or Pathological examiner
autopsies
ordered to determine
1. Cause of death.
2. Manner of death.
3. Time of death.
4. Recovering, identifying and preserving evidence.
5. Provide factual objective information for legal
authorities.
6. Separate deaths due to disease from deaths due
to external causes.

Report to the medical examiner
immediately


1. Victims of homicide.
2. Victims of deaths in the workplace
3. Motor vehicle drivers who have been
involved in accidents.
4. Pedestrians who have been involved in
accidents.

5. Passengers who have been involved in
accidents but who lack clear evidence of
trauma.
6. Victims of intra and perioperative accidental
deaths.
7. Epileptics.
8. Possible victims of sudden infant death
syndrome.

Report to the medical examiner
immediately

9. Infants or children with evidence of bodily
injury.
10. Inmate fatalities in correctional facilities,
nursing homes or medical institutions.
11. Victims of trauma.
12. Victims of non-traumatic, sudden
unexpected deaths.
Report to the medical examiner
immediately

13. Victims of anorexia nervosa
14. Multiple victims of coincidental unexplained
death at on location.
15. Victims of possible poisoning or overdose
deaths.
16. Any other case in which the pathologist holds
a bona fide belief that the death is
unexplained and or an autopsy is in the best
interest of the public or that it is necessary for
the proper administration of the statutory
duties of the office of the coroner.
Report to the medical examiner
immediately

IF EVER IN DOUBT
PLEASE CONTACT YOUR
LOCAL MEDICAL
EXAMINER.

Anatomical or academic autopsies


Performed by students of anatomy for study
purpose. This is usually possible when a person
has given permission in advance of their death
for their body to be donated to science.

Virtual or medical imaging autopsies
are dubbed virtopsy, ignited interest in
applying postmortem imaging to other forms of
traumatic injury.
Since 2004 the U.S. military has performed x-
rays and CT or CAT scans (computerized axial
tomography) on the bodies of every service
member killed where the armed forces have
exclusive jurisdiction, not just on battlefields
abroad but on U.S. bases as well.
Virtual or medical imaging autopsies
It allows for identification of any foreign
bodies present, such as projectiles. X-rays give
you the edge detail of radio-opaque or
metallic objects, so you can sort out what the
object might be, and CT, because it is three-
dimensional, shows you where the object is in
the body
Virtual or medical imaging autopsies


In Egypt when a post mortem exam must be
performed on a 2000 year pharaoh imaging is
an adjunct to the traditional external and
internal postmortem exam.

Work Practice Controls
Health and safety issues associated with
embalming are addressed by compliance with
The Bloodborne Pathogen Rule.

The Bloodborne Pathogen Rule is administered
by the United States Department of Labor
through OSHA.

Work Practice Controls
The embalmer and his/her assistant are
professionally responsible for his /her own
personal hygiene, health and safety because
of the direct contact with the decedent.
The use of universal precautions and personal
protective equipment (PPE) should be
provided by the employer and used by the
embalmer and his/her assistant and is
necessary for the preparation of all bodies.

Work Practice Controls
Proper ventilation and air flow throughout the
preparation room should be on at all times.
According to OSHA:
The Formaldehyde Standard Rule states
that the air supply in the room should be
exchanged at a minimum of 12 -20 times
per hour for a single table room. You
should keep in mind the size, shape and
the contents within the room as well.
Work Practice Controls

The work practice controls when
handling autopsied bodies should
be that of extreme caution.
Work Practice Controls
Here are some work practice controls you can
use.
Be aware of where cutting and sharp
instruments are laid during preparation.
a. put sharp instruments at the head of the
table on the opposite side you are working
b. put sharp instruments on the counter
away from the working area.


work practice controls you can use
Cover broken or cut bones (e.g. ribs) prior to
placement of embalmers hands into a body
cavity.
a. cover with hand towel
b. cover with webril cotton prep towels
c. autopsy rib covers

work practice controls you can use
Wash gloved hands or change gloves often
during the embalming procedure.

Avoid use of high water pressure when water
is used to flush blood and fluids from the
embalming table.

work practice controls you can use
Continuous aspiration of the cavities during
arterial injection to remove drainage and
excess arterial fluid.
a. control blood drainage & blood
contaminants, if death is a bloodborne
infection, drainage can be a great risk to
the embalmer.

work practice controls you can use

Clamp leaking arteries and small veins to
avoid excessive embalming solution loss and
improve solution distribution during arterial
injection.
Run table water continuously to dilute and
carry away any blood or chemicals on the
table surface.
work practice controls you can use

Pack external orifices: rectum, esophagus,
trachea, ears, and vagina.
During embalming, the calvarium and the
removed portions of the sternum can be
soaked in a preservative solution in a closed
container or sealed plastic bag.
Preparation

As stated before most autopsies are classified as
a partial or the complete autopsy. The hospital
can be either partial or complete and the
medical examiner is more than likely to be a
complete autopsy. We can review the difference
in both types.
Preparation
Partial autopsy:
During these types of autopsies they are
limited by the person giving permission. In
most cases the immediate next of kin. The
cavities which can be dissected during the
autopsy are the cranial, thoracic, abdominal
and the pelvic cavities. The partial autopsy
looks at specifics such as mentioned
previously.
Preparation

Partial autopsy
The abdominal and pelvic cavities are also called
the abdominopelvic cavity region. When a
partial autopsy will be performed the examiner
will usually open one of these body cavities.
Preparation
complete autopsy:
During these types of autopsies all of the
above mentioned body cavities will be
dissected. Also if the neck is in question such
as an auto accident, a sharp fall, or shaken
baby syndrome, the cervical spine will also be
dissected for fractures. The partial autopsy
looks at specifics such as mentioned
previously.
Preparation
complete autopsy

The cervical spine is divided into two parts; .
The upper cervical region (C1 and C2). C1 is
termed the Atlas and C2 the Axis.
The lower cervical region (C3 through C7).
Preparation
complete autopsy
To reach the cervical area the body is turned
over from the lateral plane and placed on its
frontal plane, (flip the body over). The Atlanta
medical examiner and sometimes the GBI
medical examiner will dissect the wrist area to
see if the victim was holding a weapon during
the occurrence of death.
Preparation
The transverse carpal ligament and flexor
tendons will be examined to see if the area is
in a tense (locked) position.
Embalming
Raising vessels, hypodermic treatment, drying tissue,
suturing
When embalming a partial autopsy case it should not
be too difficult for the embalmer. Depending on the
organ that has been removed this can be a two point
injection. The vessels can be ligated and the body can
be embalmed from the position of the removed organ
by injecting toward the upper extremities and toward
the lower extremities. If this proves difficult a six point
injection can be employed. Hypodermic treatment
should be employed.
Embalming
When embalming a complete autopsy case a
six point injection must be used. The vessels
can be ligated and the body can be embalmed
from the Lf. and Rt. Common carotid arteries
injecting toward the head, Lf. and Rt.
subclavian or axillary arteries injecting toward
the arms and hand, and the Lf. and Rt. iliac or
external femoral arteries injecting toward the
legs and feet. Hypodermic treatment should
be employed.
Embalming
Many embalmers have dropped the ball when
hypodermically treating parts of the neck, across
the scapula (shoulder blades) and small of the back,
middle of the back, torso, and buttock regions.
Some embalmers will embalm using one of the
above mentioned methods but fail to use
hypodermic treatments. What consist of proper
hypodermic treatments? The body lies on the hard
surface of the embalming table which is made of
porcelain or stainless steel.
Embalming

Hypodermic treatment of parts of the neck,
across the scapula (shoulder blades) and small
of the back, middle of the back, torso, and
buttock regions should be hypodermically
treated to ensure good fluid distribution of
these areas.
Embalming
You should pay close attention when
hypodermically treating the lower back and
the upper buttock regions, this area has a
tendency to decay fast and have a
tremendous odor due to the lack fluid
distribution. It becomes evident as you move
the body for dressing that this area has failed
to be treated.

Embalming
On the inside of the body the ribs can be
incised (between each intercostal space) with
the scalpel from the point where the breast or
sternum plate has been removed as far back
as you can get to the spin. There will be some
leakage in this area due to the hypodermic
treatment. Some embalmers will allow the
body to drain over night before continuing the
process.
Embalming
At this point you can further dry the tissue
area with a towel or cotton. A cauterizing
agent can be used to aid in the prevention of
leakage in the cranium area once the facial
tissue has been pulled over. The cauterizing
agent should be placed on cotton and dabbed
on the exposed tissue areas such as the neck
and torso regions as well.
Embalming

You can then place autopsy gel in the exposed
cranium area and the inside of the neck and
torso areas with a paint brush or saturate
cotton and dab the exposed regions. This will
further penetrate and preserve the tissue.
Embalming
Drying compound, hardening compound or a
mixture of both can be used to further dry and
preserve the tissue and prevent leakage. The
calvarium and the breast or sternum plate
should be treated using the same methods as
just mentioned before being replaced inside
the body area.
Viscera the proper treatment
When the medico-legal or hospital autopsy has
been performed, the organ that has been studied
may or may not be returned.

If the autopsy has been performed at a hospital
that is classified as a teaching institution you may
or may not have the viscera returned.
These institutions use the viscera as teaching aids
for students.
Viscera the proper treatment
The clinical or pathological examiner autopsy,
the viscera is returned with the decedent.

The anatomical or academic autopsies and the
virtual or medical imaging autopsies we do
not have to discuss because of the type of
autopsy being performed.

Viscera the proper treatment
We must keep in mind that each county and
state has different protocols when
performing autopsies.
Viscera the proper treatment
What are the proper treatments of the
viscera and the cavities of the body
once the viscera have or have not
been returned with the decedent?

We have to explore two different methods.
Viscera the proper treatment
What to do if you want to replace the viscera
within the body cavity.
a. within the viscera bag.
b. without the viscera bag.

Viscera the proper treatment
What to do if the viscera were not returned, or if
you wish not to return the viscera to the body
cavity.
a. viscera placed in a fluid box within the
casket.
Viscera the proper treatment
First method:

Lets look at replacing the viscera bag within the
body cavity.
Viscera the proper treatment
A method that was taught to me by the late
Sgt. Willie Adams was to open the viscera bag
and cut the large intestines to allow all air to
escape. If you wish you can cut as much of the
viscera as you can into smaller pieces and
allow the cavity fluid to penetrate thoroughly.
Manipulate the viscera bag into a cigar shape.
The cigar shape along with incising the ribs
(intercostal space) will ensure the viscera fits
properly back into the cavity.

Viscera the proper treatment
Fill a sink with hot water submerge the viscera
bag within the hot water within the sink.

This will speed the reaction of the cavity fluid
from a liquid to a gas and penetrate the
viscera causing immediate tissue fixation.
Viscera the proper treatment
Once you are ready to replace the viscera bag you
can aspirate the remaining liquid from the viscera
bag, press all the air from the viscera bag.
If you wish you can add drying and or hardening
compounds within the viscera bag and replace
the viscera bag within the cavity of the body.
Once the viscera bag has been properly fitted to
the cavity region of the autopsied body you can
tie the viscera bag with ligature.

Viscera the proper treatment
If wish not to drain the cavity fluid from the
viscera bag that is ok as well, but the remaining
air must be pushed from the viscera bag and
properly tied with ligature.
Some may wish to place small slits within the
viscera bag to allow gas to escape, no more than
two or three. If the bag leaks you have more than
enough drying agents within the cavity area to
control this problem. The breast or sternum plate
can be replaced at this time.
Viscera the proper treatment

If the bag leaks you have more than enough
drying agents within the cavity area to control
this problem.
The breast or sternum plate can be replaced
at this time.
Viscera the proper treatment
Second method:

Lets look at replacing the viscera without the
viscera bag back into the body cavity.

Viscera the proper treatment
Open the bag and cut the large intestines to allow
all air to escape. If you wish you can cut as much
of the viscera as you can into smaller pieces and
allow the cavity fluid to penetrate thoroughly.
Fill a sink with hot water submerge the bag within
the hot water within the sink.
This will speed the reaction of the cavity fluid
from a liquid to a gas and penetrate the viscera
causing immediate tissue fixation.

Viscera the proper treatment
Once you are ready to replace viscera you can
aspirate the remaining liquid from the viscera
bag.
Press all the air from the viscera bag, add
drying and or hardening compounds within
the viscera bag.
Shake the viscera bag making sure that all the
viscera have been coated with the drying and
or hardening compounds.
Viscera the proper treatment

Pick up each piece ensuring that the drying
and/or hardening compounds have coated
properly.
Fit the viscera within the body cavity. You may
wish to add more drying and or hardening
compounds.

What to do if the viscera were not
returned
Reading what I could find online a few older
embalming pamphlets and some of the older
embalming text books, the body cavity could
be refilled by using sawdust mixed with
powdered lime, charcoal and plaster of paris.
What to do if the viscera were not
returned

The sawdust would act an absorbent and as
filler, the lime and charcoal would control
odor and the plaster of paris would act as a
drying agent and harden the tissue.
They did use white packing paper which is like
a newspaper without the text.

What to do if the viscera were not
returned

What to do if the viscera were not
returned

What to do if the viscera were not
returned

What to do if the viscera were not
returned

What to do if the viscera were not
returned
Talking to the veterans of funeral service and the
text books and the methods they employed, was
sawdust mixed with plaster of paris, drying and
or hardening compounds, and saturated cotton
with cavity fluid placed over the ribs and within
the bottom (back) of the cavity.
What to do if the viscera were not
returned
To fill the cavity, they used white linen sheets, or
wadded up newspaper. The paper was placed
within the cavity as the body was being sutured.
The paper acts as an absorbent and filler for the
body cavity.
What to do if the viscera were not
returned

What to do if the viscera were not
returned

What to do if the viscera were not
returned

What to do if the viscera were not
returned
Using newspaper was widely used by all
embalmers and it is still being used today.
Because it is an older method some newer
embalmers as well as outside sources feel that
this method should be retired.
In the days before the computer and the smart
phone every business or house hold received a
newspaper. In some areas there were two papers,
a morning and an evening paper delivered.

What to do if the viscera were not
returned
The newer text books rely on using autopsy gels,
drying and or hardening compounds to dry,
preserve and deodorize the tissue while using
cotton, or clean white linen sheets to fill the body
cavity.
At The Cincinnati School of Mortuary Science, we
were taught that packing paper was ok but not to
use newspaper. If the paper had been printed on
then it was considered trash and should not be
used even to fill out the casket
What to do if the viscera were not
returned
You can use what is called waste cotton which
is unbleached course cotton used in making
furniture, beds or some casket companies use
this for padding.
It is much cheaper than bleached process
cotton and can also be used for padding a
casket or the decedent.
What to do if the viscera were not
returned
It comes in a very large bale that will last
much longer than processed cotton if trying to
fill the body cavity or padding the decedent.

You cannot use waste cotton like bleached
cotton; you cannot saturate waste cotton and
use it such as a cavity pack.
Disposition of the viscera
What to do if you wish not to return the viscera
to the body cavity.
Open the viscera bag and cut the large intestines
to allow all air to escape. If you wish you can cut
as much of the viscera as you can into smaller
pieces and allow the cavity fluid to penetrate
thoroughly.
Disposition of the viscera
Fill a sink with hot water submerge the viscera
bag within the hot water within the sink. This will
speed the reaction of the cavity fluid from a liquid
to a gas and penetrate the viscera causing
immediate tissue fixation.
Take an empty fluid box line the box with another
plastic bag place some drying and or hardening
compounds within this bag. Remove the viscera
bag from the water and dry the bag with a towel.
Disposition of the viscera
You can aspirate the remaining liquid from the
viscera bag, press all the air from the viscera bag,
if you wish you can add drying and or hardening
compounds within the viscera bag and place the
viscera bag within the bag in the box.
Press all air from the bag and use ligature to tie
the viscera bag and tie the second bag. Tape the
box closed, and place this box within another
plastic bag.
Disposition of the viscera
Remove the casket bedding and spread the
springs apart at the foot end of the casket. Be
careful not to cut yourself or tear the plastic
bag when spreading the springs apart. Place
the box under the springs replace the casket
bedding.

Suturing
We can begin to suture the cranium.
The cranial cavity is filled with drying and or
hardening compounds and packed with
bleached cotton to absorb any leakage that
may occur.
The calvarium can be secured in many ways.
You should choose what is best comfortable
for you.
Suturing

Start the suture from the viewing side and
continue to the non-viewing side and secure.
Or start from the viewing side and suture over
half the distance to the non-viewing side.

Suturing
Next start second suture on the non-viewing
side and continue over half the distance to the
viewing side.
Pull and tie both ends of the ligature together
and the puckle will be in the pillow giving the
two sutured halfs a nice tight appearance.

Suturing
At this time we can begin to suture the body.
The neck area can be replaced with saturated
cotton of autopsy gel or cavity fluid. I have also
used a piece of card board rolled up and placed
within the neck area.
If you dont roll the cardboard to tight it makes
the inside of the neck perfectly. You can bring the
Y incision together with tissue gathering forceps
or use ligature to hold the Y incision in place.
Suturing
I personally like to start at the middle of the Y
incision and work my way down to the pelvic
region. This will allow me to continue to shape
the contour of the viscera bag within the
cavity region as I stich closer to the pelvic
region.
Next I usually start at the outer edge of one
side of the Y incision (shoulder area) and work
my way back to the middle of the Y incision.
Suturing
If you start at the outer edge of the Y incision,
this will allow you to make a pocket and place
incision sealer or mortuary putty within the
incision as you work your way back to the middle
of the Y incision.
This method will help control any leakage that
may occur. I then repeat this process on the
opposite side of the Y incision and work back to
the middle of the Y incision repeating the same
previous step.
Suturing
We have to look at both a child and an adult
autopsy case.
A new born up to at least 5 years.
The viscera sometimes will not fit properly in
the thoracic and pelvic cavities properly or the
mother may want to hold the child.
You can double bag the viscera and place the
viscera bag under the casket bedding.
Suturing
6 years to 12 years
You can use either method leaving the viscera
out of the cavity and placing the viscera under
the casket bedding or placing the viscera in
the cavity area and following the above steps.
13 years to adult
The viscera should be replaced but you can
use either method mentioned above.
Viscera disposition of the viscera.

When the viscera are returned with the
decedent, the viscera should remain with the
decedent at all times until proper disposition.
The viscera should never be left in the
embalming room while the visitation or funeral
service is being performed.
Viscera disposition of the viscera

When the viscera have been properly treated,
there should be no odor and the viscera should
remain with the body at all times using methods
that were previously mentioned. There should
be no cross contaminating of human remains
such as putting the viscera with another
decedent for the process of cremation.
Viscera disposition of the viscera
There should be no co-mingling of human
remains such as putting the viscera with another
decedent for the process of cremation.
Viscera disposition of the viscera
Stericycle will start to check the biohazard
boxes periodically that come from funeral
homes for pace makers and human remains
such as viscera. Pace makers should be
properly disposed of within a small hazardous
box designed for the disposal of radioactive
materials. If any such items are found in the
biohazard box upon inspection the funeral
home will be brought up on charges.

Bibliography


1. Strasser, Russell S. (2008). "Autopsies". In Ayn Embar-seddon, Allan
D. Pass (eds.). Forensic Science. Salem Press. p. 95. ISBN 978-1-58765-
423-7.

2. Roberts, I. S.; Benamore, R. E.; Benbow, E. W.; Lee, S. H.; Harris, J. N.;
Jackson, A.; Mallett, S.; Patankar, T.; Peebles, C.; Roobottom, C.; Traill,
Z. C. (2012). "Post-mortem imaging as an alternative to autopsy in the
diagnosis of adult deaths: A validation study". The Lancet 379 (9811):
136142. doi:10.1016/S0140-6736(11)61483-9. PMC 3262166. PMID
22112684.

3. Robert Mayer, fifth edition, 2012. Embalming History, Theory and
Practice. Pages 327-344.

Bibliography
4. Stericycle beginnings in 1989. Focused on helping
businesses protect people and brands,
promote health, and safeguard the environment. Also offers
specialized waste disposal services
to healthcare facilities and other businesses (mortuaries),
such as:
Pharmaceutical Waste Disposal
Hazardous Waste Management
Sustainability Services





Bibliography
5. Occupational Safety and Health. 1910.1200
Hazard Communication (standards and
nterpretations)

6. Dr. Hans J. Peters, New York Times, July 21, 1998.
The College of American Pathologists

7. Steve Parker, 2012. The Human Body:
Complete illustrated Guide to its Structure,
Function, Disorders and Anatomy. DK Publishing
pages 5465. ISBN 978-5-0010-0705-0
Bibliography
8. Edward Mazuchowski, chief deputy medical
examiner in the Armed Forces Medical Examiner
System.

9. Schafer, Elizabeth D. (2008). "Ancient science and
forensics". In Ayn Embar-seddon, Allan D. Pass
(eds.). Forensic Science. Salem Press. p. 43.
ISBN 978-1-58765-423-7.

10. Howard Eckels S. (1900). Derma surgery: with
complete catalogue of embalmers' supplies

Full Autopsy-Two PT injection
Full Autopsy- 6 PT injection