Embalming the opioid case Opioids cause physiological changes within the body. As an example, heroin can cause premature arteriosclerosis, most commonly seen in young adults. This hardening of the vessel walls creates a significant disruption in the arterial system and restricts the flow of formaldehyde to the distal parts of the tissues. Blood vessels in the heroin user may also become clogged with contaminants. The additional substances added to heroin may not completely dissolve and may become lodged in the vessels of the kidneys, lungs, and even the brain. Also, heroin breaks down muscles and tissues, so it is advisable to formulate a mixture that will produce the best preservation (Renzoni, 2019). Because proteins are prematurely broken down before death, rapid autolysis (cellular destruction) can occur at the time of death. With the tissues already compromised from autolysis, decomposition could set in rather quickly. Thus, the embalmer is already at a disadvantage before the embalming operation begins. It would be wise to inject with a low and slow pressure and rate of flow, as repeated intravenous injections of heroin or crushed opioid pills can lead to cumulative damage to the veins and cause them to collapse. The flow of formaldehyde will go only where there is the least amount of resistance. Using too high of a pressure or rate of flow will cause either distention or inadequate embalming in the dependent or distal parts of the body. Another significant complication is pseudoaneurysm, which causes necrosis on the outside of the artery that results in a contained rupture within the artery wall. While injecting, this arterial wall may rupture and disrupt the enclosed flow of formaldehyde. This may cause swelling and poor distribution to the body. Because opioid vascular deviation occurs through collapsed veins, contaminates, arteriosclerosis, and pseudoaneurysm, it might be necessary to complete a full six-point injection, raising the carotids to the head, the axillaries to the arms, and the femoral arteries to the legs. If the hand does not receive fluid, the embalmer will need to raise the radial artery. Because of the delicate size and premature arteriosclerosis of the radial artery, the embalmer should be gentle to avoid tearing or rupturing the vessel walls. Before beginning the embalming operation, the embalmer might get better results if they preinject with warm water that has a vascular conditioner. This will assist in flushing out the circulatory system, as some opioid products coagulate the blood in the vessels. If the individual is elderly and was taking prescription opioids, this preinjection will help remove the buildup of waste materials in the vascular system. As previously mentioned, kidney damage or other complications can lead to an abundance of nitrogenous waste in the tissues and blood such as ammonia, urea, and uric acid (Mallappallil et al., 2017). These byproducts can dilute and neutralize the effectiveness of the formaldehyde. Because of severe coagulation associated with certain opioids, it is common to distal areas to ensure proper diffusion and adequate preservation. For
maximum preservation, it is imperative to formulate a stronger formaldehyde solution with a water conditioner because opioids can have an adverse effect on HCHO (formaldehyde). In cases involving both heroin and kidney disease, it is of extreme importance to use at least three bottles of 30% index with 256 fluid ounces of water for a 140-pound individual. When a death is caused by an overdose, usually there is a postmortem examination. When there is no autopsy, it is recommended to use the restricted cervical technique. This procedure isolates the head from the body and allows the embalmer to control the flow of pressure to the head. To properly use this procedure, the embalmer raises the right carotid artery and places a cannula inferiorly toward the trunk of the body as when typically embalming the body. The next step is to take an additional cannula and insert it into the right carotid artery superiorly toward the head, being sure to leave the stopcock open. The next step is to open the left carotid artery and insert a cannula with the stopcock open toward the left side of the head, carefully tying off the inferior portion of the left carotid artery to prohibit any returning fluid. Using the right jugular vein as the drainage point, the embalmer then injects the body through the right carotid artery. The embalmer can also raise the left jugular vein to keep blood from returning to the head, thus preventing a “flushed” look. Throughout the procedure, fluid may reach the tissues of the face through collateral circulation. This is why it is important to leave the cannula stopcocks open, as these will be the drainage sites. Once the body is thoroughly embalmed with the appropriate index solution, the embalmer can move to the head and inject the right side and left side of the head with a slow and steady rate of flow and pressure, which will give satisfactory results. It is highly recommended to use a delayed aspiration, preferably 6 to 12 hours later. This will allow the vascular pressure from the embalming fluid in the vessels to perforate the interstitial tissues for maximum preservation. As mentioned earlier, because of the onset of hypostasis, it is imperative to postpone the early stages of decomposition from opioid use. It is recommended to use 32 ounces of cavity fluid to treat the viscera—one bottle for the thoracic cavity and one bottle for the abdominal cavity. Because the vascular system may be compromised or interrupted by the opioids, the embalmer should use pulse instead of continuous flow so as not to force the fluid into the vessels. After the embalming operation, all PPE should be carefully removed and discarded in the medical waste container. A thorough cleaning of the instruments, floor, and other contaminated areas in the prep room is highly recommended. As opioid powders may have fallen on the floor, staff should not dry sweep with a broom, as this can cause aerosolization. A preferred method is to soak some paper towels with water and then sweep the towels around the room, which will cause any opioid residue to stick to the wet paper rather than become airborne.
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Book Code: FAR0626
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