Lesson 2.

General Age Considerations

Read the following from Embalming: History, Theory, & Practice by Sharon Gee-Mascarello (6th Ed.):

Chapter 16

Before progressing through the lesson, go to the Terms page and define each term
using the course glossary (or the book/notes if necessary.)

Discussion of Specific Points

I. Other factors that influence embalming technique

A. Size & Weight

B. Moisture considerations: an infant body normally contains a large amount of

moisture.

1. For this reason, pre-injections should be avoided and a regular arterial fluid
should be employed.

2. You may not need as volume but the strength should be similar to an adult case

C. Postmortem changes

D. Discolorations

II. Embalming the Infant: The text gives a detailed description of the embalming
process but here are a few things to note:

A. It is almost impossible to use a needle injector for mouth closure: a suture is

normally used.

B. Vessel Selection

1. Common carotid

a. Largest of non-aortic arteries

2. Femoral/External iliac
a. The text recommends injecting the distal leg first to observe the effects of the
fluid and dye on the skin.

3. Abdominal aorta

a. Accessed by a large incision in the mid-abdomen

4. Ascending aorta

a. Accessed by an incision down the midline of the sternum

* This can be difficult as you will need retraction to hold the incision open.

C. Fontanelle Closure

D. Premature Infants

1. If a viewing is desired, arterial injection may be attempted but, more often than
not, the infant will be immersed in a container of undiluted arterial fluid for at least
24 hours.

III. Embalming the 4-12 Year Old

A. Two Major Injection Sites

1. Common Carotid Artery/Internal Jugular Vein

2. Femoral Artery & Vein

B. Fluid Strengths and Volume

1. Index of 18-25 is common

2. Smaller volume than adults but greater than infants

C. Common Causes of Death in this age group

D. Pressure vs. Rate of Flow

1. The text suggests rate of flow is of much greater concern than pressure,
especially in embalming a child. If the fluid is injected too quickly (high rate of
flow), the tissues may distend.

a. The instructor feels that this "rule of thumb" is true in the majority of cases, not
just children.
b. An excessive rate of flow will swell a body more quickly than a high pressure
setting.

E. Features

1. Facial hair (lanugo) should be removed to facilitate good cosmetic application.

IV. Embalming the Adolescent & Adult

Note: Be familiar with the information in this section as it will be covered on the
quiz/exam. For practical purposes, the notes will not cover much of this area as it
has been touched upon in many preceding chapters.

A. Terms

1. Preinjection: this can mean a supplemental fluid OR an embalming technique

a. There is much debate over the effectiveness of a preinjection and over the types
of cases in which it should be performed.

b. A common example of a preinjection would be mixing a surfactant (e.g. Dodge's

Metaflow) and a water corrective (e.g. Dodge's Rectifiant) in a half gallon of total
solution. This is injected (often times against a closed vein) to break up clots and
"lubricate" the vascular system, if you will. Because there is no preservative (i.e.
arterial fluid) added, this is known as a preinjection.

c. Once the preinjection is complete, the embalmer will often use those same fluids
(i.e. the surfactant and water corrective) in conjunction with a preservative; in
other words, make the same solution as the preinjection, but add an arterial fluid.
Now, those fluids used as preinjection fluids have become coinjection fluids simply
because they are being used with the arterial fluid/preservative.

2. Coinjection: to control harsh reactions of fluid without adding more water

a. Common examples would be surfactants, water correctives, humectants, etc.

3. Concept of a waterless solution

B. Purpose of pre-injection

C. Types of cases for pre-injection

D. Pressure & Rate of Flow

1. The text suggests that an "ideal" rate of flow would be "10-15 minutes per
gallon" for the first gallon of solution.

a. Because most rate of flow meters express this as "ounces per minute", this
translates to 12.8 oz/minute to 8.5 oz./minute

b. It can be said then that the "ideal" rate of flow would be anywhere
from 8 - 13 oz./minute on the first gallon.

c. It is not uncommon for an embalmer to use a rate of flow around 20-30

oz./minute

*Remember, a rate of flow that is too high will swell a body well before high
pressure will.

2. The text also suggests that a pressure setting of 5-20 pounds should overcome
most body resistance.

a. It is not uncommon for embalmers to utilize 30 pounds or higher of pressure on

a normal case.

b. You'll read a Dodge article in the Discolorations lesson by an embalmer who uses
140 lbs. of pressure

V. Embalming the Elderly

A. Arthritic conditions can make positioning VERY difficult.

1. Arm and leg bones can easily be broken if too much force is exerted in trying to
restore them to their natural position.

2. Clenched, arthritic fingers are almost impossible to restore

a. Ask the family for a kerchief to cover the hands

B. Mouth Closure

1. The maxilla can atrophy and be soft or "mushy" making it very difficult to attach
a needle injector barb.

2. Quite often, a frenulum suture or even a mandibular suture (which is more

secure than the frenulum/musculature suture) will be required to close the mouth.

3. Another method of closure when the maxilla is too soft to accept the barb is as
follows (this is not testable, just FYI):
Place the needle injector wire into a half-moon needle so that the free (non-barb)
end is bent through eye of the needle. Insert the needle into the upper palate of the
mouth and bring it out through the maxilla in the area where the barb would
normally be injected with the needle injector.

When the wire is pulled through the bone, the barb on the wire will "catch" on the
upper palate and the wire can then be used in the normal fashion (i.e. in
conjunction with the lower wire on the mandible) to achieve mouth closure.

This method is often utilized by embalmers concerned with the "dimple" often
created by employing the frenulum (muscular) suture.

C. Arteriosclerosis

1. The femoral artery is the most common site for severe blockages.

a. This particular type of arteriosclerosis is known as atherosclerosis: a condition in

which plaque buildup in the lumen can occlude blood flow through the vessel. In
some cases, the vessel is so sclerotic (i.e. full of plaque/atherosclerosis), the
embalmer can feel it in the vessel before making an incision.

D. Senile Purpura (Ecchymosis)

1. Often appears on arms and back of hands

2. Caused by fragility of capillaries

3. These areas many times do not clear and may swell during arterial injection.

4. Vigorous massage can tear the skin when purpura is present.

VI. Other Considerations

A. Malignant tumors

B. Colostomy

1. Some embalmers will not remove the colostomy bag before dressing &
cosmetizing. This is NOT a good practice! Imagine the problems if the bag leaked or
filled with gas during a visitation or funeral.

C. Cardiac disease
1. Extensive incisions in chest wall and many times down the inner leg if
the greater saphenous vein has been taken for transplant in a coronary bypass
operation.

D. Diabetes mellitus

1. In cases of diabetes, gangrene is common in the lower extremities.