Tissue Gas Alert - Assignment Example

 1. What are the scientific bacterial names for tissue gas? Tissue gas is most often caused by anaerobic and rod-shaped bacterium called Clostridium perfringens belonging to the genus Clostridium. However, Gas Gangrene or similar infection can also be instigated by Vibrio vulnificus and Staphylococcus aureus (Vorvick, Vyas and Zieve). 2. Where does tissue gas originate from within the body? Outside the body? The gas forms inside the body. The bacterial growth happens in fresh surgical wound or a site of physical injury. Bacteria produce gas and hazardous toxins (called Clostridium perfringens alpha toxin) that ruin tissues, blood vessels and cells (Hart, Lamb and Strauss.). 3. List at least 3 intrinsic & 3 extrinsic conditions or factors that contribute to tissue gas. 3 intrinsic conditions that contribute to tissue gas are: 1. Shortage of blood supply due to blockage of blood vessels or lack of blood in the body. One’s blood carries oxygen, nutrients for cells, and vital disease countering antibodies to prevent infections. Without sufficient blood supply, cells die and body tissue starts decaying. 2. Hernia: A condition in which intestines cannot be restrained by the abdominal wall within the abdominal cavity. This happens due to the weakening or damage of abdominal muscles. Intestines bulge out and become twisted. 3. Infection in the genital region or unclean gunshot/accident/surgical wound. 3 extrinsic conditions that contribute to tissue gas are: 1. Embalmer’s carelessness in preserving the bodies of the following dead people or lack of care by the victim of Tissue gas in the following areas leads to the formation of Tissue gas: a. gunshot victims with infected and unclean wounds; b. Drowning victims in whose body dirty water has been ingested in which there are chances of infection, c. Deaths after recent surgeries in which the instruments used had not been sterilized properly and victims of accidents (Adams). 2. Delay in burial of a dead person with Tissue Gas increases the chances of Tissue gas spreading from one body to another in the mortuary. 3. Embalmer not using concentrated embalming fluid to eliminate bacteria which cause Tissue Gas. After handling a tissue gas containing dead body embalmer forgets to clean the mortuary using disinfectants to completely eliminate Clostridium. It is possible for a freshly wounded dead body without tissue gas kept in the same mortuary to become infected with Clostridium. 4. How is tissue gas identified in a dead human body and how does it affect dead human tissue? There are multiple ways to know if a dead body has been affected by tissue gas or not. Some of these ways are such that by making use of touch and observation it can be discovered which part of the body has Tissue gas. However, there can be cases where symptoms cannot be openly seen. Swollen eyes with air bubble formation around them and if a part of the body makes a snapping and crackling sound on being touched than tissue gas is likely to be found. Excessive ulceration with reddish brown colored fluid in the boils and rapid decomposition of a dead body are all signs of the dead body being a tissue gas case. Also, the fluid in the boils has an unpleasant smell. Moreover, the skin of a victim of Tissue gas is likely to be yellowish in color similar to what happens during Jaundice. Other ways to know for sure that the dead body is of a tissue gas victim is to test cultures of fluid and tissues for the presence of the bacterium known to cause Tissue gas. Magnetic Resonance Imaging or CT scans are body imaging techniques which can be used for knowing where exactly the Tissue gas in the body is. Tissue gas takes place of body liquid and tears body tissues since it has greater volume like all gases. This causes the dead tissues to get separated from tissues not affected by tissue gas and fall off. Separation of tissues and scarring are noticeable. Tissue gas causes crepitation in human tissues which can be heard by embalmers on touching the affected body area. 5. Describe how tissue gas can be passed from one body to another. The problem with handling Tissue Gas cases is that the causative bacterium Clostridium is capable of transferring itself from one body to another. If the embalmer does not disinfect the examination table or area after treating a Tissue gas victim this can result in the bacterium getting transferred into the improperly stitched and fresh wound of the next dead body. In this way this condition can spread among many dead bodies in the mortuary. Negligence by the embalmer in using a concentrated anti-bacteria solution (such as not specifically injecting the fluid into soft tissues like the brain) to eliminate bacteria and prevent it from being given a chance to shift from one body to another nearby living body’s wound can further promote the spreading of Tissue Gas among the dead bodies. 6. Describe the appropriate physical treatment of a tissue gas case. Surgery is required for removal of decaying and infected tissue in living people. This surgery is known as debridement. Amputation of limbs might be required to restrict the spreading of infection throughout the victim’s body. However, amputation is hardly ever a viable option for the embalmers if they come across a Tissue Gas Case. The reason is that family members and friends who come to view the dead body before burial can feel bad about an amputated leg or arm. Egyptian embalmers used to remove brain via the nose by using a special instrument. This was done during the process of Mummification. Modern day embalmers can do the same using similar or other less complicated techniques. Removal of the brain is helpful in preventing spread of Tissue gas because the gas seems to have a higher affinity for soft body tissues. However, this does not need to be done since chemical treatment is effective in killing bacteria even in brain. To this date channeling of body tissues remains as more helpful in allowing Tissue Gas to escape from the dead body. Similarly, incisions can be made in the affected areas to allow Tissue Gas to leave the dead body. HBOT- hyperbaric oxygen therapy is used for physically decreasing the amount of gas bubbles within the living or dead body by keeping the body in an enclosed chamber with a very high concentration of Oxygen (WH and Hogendijk J). 7. Describe the appropriate chemical treatment of a tissue gas case. (Please attach Appendix 1 to this report (see your instructor for details). There will be 10 points deducted for not including at least two of the following chemical company’s tissue gas formulas: Dodge, Champion, ESCO & Frigid. Note: If you work in a mortuary and use other embalming chemicals, contact their embalming chemical company to find out what chemicals and procedures they recommend or read their technical manual for proper chemicals and their uses. You may use any other chemical company in addition to the companies shown above for extra credit. If the person with Tissue Gas dies before treatment then it is the embalmers responsibility to use antibacterial chemicals and concentrated embalming fluid to kill the bacteria hence preserving the body temporarily until burial or in the long-run. The bacteria prefer to move to the soft tissue of the brain and so introducing embalming fluid into the brain is vital for complete elimination of bacteria. Embalming fluids are usually produced by expert manufacturers. The oldest and largest producers of embalming fluid are The Champion Company and The Dodge Company. Formaldehyde with chemical formula CH2O is the substance found in the embalming fluid of the Dodge Company. The Champion Company uses a combination of Formaldehyde, Phenol and another aldehyde in its embalming chemical (Refer to appendix 1 at the end of the report). 8. Describe other conditions of the body that are similar to tissue gas and how they occur. Form of Disease CAUSES SYMPTOMS SOLUTION Subcutaneous emphysema Punctured lung(s) or membrane around lungs; observed after CPR; lesions in thorax or fractured ribs; making of an incision in trachea to help breathing. Odor-les; gas formed may gather in distal points such as elbow or toes; can result in severe swelling. Gas formed escapes via incisions; setting up of arterial conservation; channeling of body tissues in order to release gasses Gas gangrene Rod-shaped and Anaerobic bacteria called C. perfringens Unpleasant smell, infection with boils filled with brownish fluid. Concentrated arterial fluid; cavity chemical injected into tissue area beneath skin Decomposition Bacteria cause decay of body tissues. Possible smell; purging; skin removal with time; change in color Concentrated Arterial fluid injected into the affected parts of the body; Use of Formaldehyde ; channeling of body tissues to allow release of gases Air from embalming equipment Air injected and left inside the body by embalming air machine or hand pump. Swollen eyelids; no skin-slip or foul smell If distension happens then channeling of body tissues is done after arterial fluid injection. (G.Mayer, Embalming: History, Theory and Practice, Fifth Edition) 9. List the steps, procedures and chemicals in detail needed for the disinfecting the body, instruments, equipment and environment of the embalming room. The entire embalming process is divided into five stages. The five stages have been explained in the diagram ahead. Works Cited Adams, Jack. Tissue Gas Alert. 3 Apr 2011. Web. 19 Oct 2012. . G.Mayer, Robert. Embalming: History, Theory and Practice, Fifth Edition. Bronson: McGraw-Hill Medical, 2012. Hart, George B., Robert C. Lamb and Michael B. Strauss. "Gas Gangrene." The Journal of trauma (1983): 991-1000. Print. Vorvick, Linda J., Jatin M. Vyas and David Zieve. Gas Gangrene. 12 June 2011. Web. 19 Oct 2012. . WH, Brummelkamp and Boerema I. Hogendijk J. "Treatment of anaerobic infections (clostridial myositis) by drenching the tissues with oxygen under high atmospheric pressure." Surgery (1961): 299-302. Appendix 1 Dodge Chemical Company Formula for Tissue Gas Tissue Gas Present ~ Prior to Embalming Dis-Spray 16 oz per gallon with Introfiant and add Metaflow to help penetrate the cells Tissue Gas developing after Embalming DO NOT USE WATER Add: 32 oz of Introfiant 32 oz of Dis-spray 32 oz of Metaflow 32 oz of Rectifiant Puncture tissue with a 14 gauge needle to release gas Leave incisions open Essco Chemical Company Formula for Tissue Gas TO PREVENT TISSUE GAS TO STOP TISSUE GAS ONCE IT HAS STARTED Arteries: 4 oz arterial fluid Arteries: 4 oz arterial fluid Add Add 1 oz liquid soap in ½ gallon water 1 oz liquid soap in ½ gallon water Add Add 4 oz San-Veino liquid 4 oz San-Veino liquid Add more water rapidly to Add more water rapidly to equal 1 gallon of mixture equal 1 gallon of mixture Inject the above solution Inject the above solution Cavities: 4 oz San Veino liquid Cavities: 8 oz San Veino liquid and and 16 oz cavity chemical 16 oz cavity chemical after thorough aspiration NOTE: All chemical names are actual brand names for each individual company. Appendix 1 Champion Chemical Company Formula for Tissue Gas Tissue Gas Present - Prior to Embalminq Inject Specialist diluted at the rate of sixteen (16) ounces with enough hot water to make a half- (1/2) gallon. and inject a sufficient volume of this concentration to saturate all tissues. On this type of case, it may be necessary to trocar large areas with Specialist in concentrated form (hypodermic channeling). Specialist is a 30-index fluid; 1/2 gallon is 64 ounces. C x V = C’ x V 30 x 16 = C’ x 64 480 = 64C’ 480/64 = 64C’/64 7.5 = C’ Note, therefore, that you will be injecting a 7.5% primary dilution factor solution into a case exhibiting tissue gas. Generally, Specialist should be diluted at the rate of 10-12 ounces with water (room temperature) to make a gallon. Frigid Fluid Company Formula for Tissue Gas Tissue Gas Present — Surface Treatment 4 oz of Stop fluid with 12-16 oz of cavity fluid; apply this mixture directly to the affected tissues using a trocar, syringe or cotton packs. Tissue Gas Present — Arterial Treatment 2 - 4 oz of Stop fluid mixed in each gallon of solution using a diluted high index (28+) arterial injection fluid. Restrictive Cervical Injection (RCI) is the best recommended method for injection and intermittent drainage is the best recommended method for drainage. NOTE: All chemical names are actual brand names for each individual company. Read More