At one of the inns, a man dialed 110 and 120 saying he woke up in the morning to find his girlfriend unconscious. When police and doctors arrived, they found the man's girlfriend dead.
During the police questioning the man, the man also developed symptoms of dizziness, headache and nausea, and the man was subsequently taken to the hospital for treatment.
During the investigation of the scene, the forensic doctor found that the doors and windows of the scene were closed, the female deceased was lying on the bed in pajamas, and there was a small amount of vomit next to the body.
After examination, the female deceased had no trauma on her body, and in addition to incontinence, the biggest anomaly was that the color of her corpse spots was close to cherry red.
During the investigation, it was found that a gas water heater was installed in the bathroom of the hotel, but the water heater was turned off.
Could it be carbon monoxide poisoning?
The bathroom floor is very dry and there is no trace of a bath for a while.
The most bizarre thing is that in the previous inquiry, the man stated that the night before, the two had eaten a barbecue and then slept, and did not take a bath during the period.
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Could that be food poisoning?
After all, in addition to the bright red corpse spots caused by carbon monoxide poisoning, the cyanide poisoned corpses will also appear bright red corpse spots, and it is difficult to distinguish the two from the corpse spots alone.
Just when the forensic doctor was preparing to send the food scraps back to the laboratory at the scene, the hospital gave feedback on the preliminary laboratory results, and the carboxyhemoglobin (COHb) content in the man's body was 27.5%, which was clinically in line with the typical manifestations of carbon monoxide poisoning, and after hyperbaric oxygen therapy, the symptoms were initially relieved.
Subsequently, the heart blood sample of the female deceased was also sent to the laboratory, and after testing, the content of carboxyhemoglobin (COHb) in her blood was 52.6%, and no cyanide was detected.
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Although the evidence points to carbon monoxide poisoning, but obviously did not use a water heater to bathe, why is there a manifestation of carbon monoxide poisoning?
Forensic doctor Ah Yi came to the scene again to investigate, and found that the room where the poisoned man and woman lived shared the same gas water heater as the next room.
Field experiments found that as long as the hot water is used in the next room, the water heater in the couple's room will be ignited and activated. Although the water heater has a strong drain pipe, after testing, in the state of closed doors and windows, in just twenty minutes, the exhaust gas will be backfilled, and the indoor carbon monoxide content has obviously exceeded the standard.
After investigation, the night before, there were indeed other guests living next door, and the water heater was used for a long time many times, and the cause and effect of carbon monoxide poisoning of the couple were revealed.
Every winter, gas poisoning is not uncommon, why is winter a frequent time period for carbon monoxide poisoning?
Carbon monoxide (CO) is a colorless, odorless, non-irritating gas, which makes it difficult for carbon monoxide to be detected when it is scattered in the air.
Carbon monoxide, on the other hand, replaces oxygen and binds to hemoglobin (Hb) in the blood, forming carboxyhemoglobin (COHb), causing the blood to lose its ability to transfuse oxygen, which in turn leads to tissue hypoxia and inhibition of cellular respiration, and in severe cases, death [1].
In the early stage of carbon monoxide poisoning, dizziness, headache, nausea, limb weakness and even blurred vision and tinnitus are often manifested.
Isn't it familiar to see here, and it feels a bit similar to how you behave after getting drunk?
However, unlike central nervous system suppression caused by drunkenness, the decrease in oxygen levels in the blood after carbon monoxide poisoning can lead to hypoxic damage to brain tissue [2].
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If at this time, timely detection and separation from the scene of poisoning, most of the symptoms can disappear on their own;
If the situation is not detected in time, the symptoms of further poisoning will appear irritability, rapid heartbeat, gait instability, urinary incontinence, confusion, drowsiness, and seizures;
More severe intoxication can lead to toxic encephalopathy and pulmonary edema, persistent coma, and eventually respiratory and circulatory failure and death [3].
Carbon monoxide poisoning after timely rescue and hyperbaric oxygen treatment, symptoms will be significantly alleviated in the short term, but can not be taken lightly.
Some poisoned people have worsened their symptoms again a few days or weeks after their symptoms have improved. Transient improvement in symptoms is often "deceptive" and is clinically referred to as a false healing period.
After the false healing period, the symptoms of poisoned people suddenly worsen, often manifested as mental and behavioral abnormalities, obvious mental decline, even dementia, uncoordinated movements, tremors, increased muscle tone, gait disorders, urinary incontinence, impaired consciousness and even coma.
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When these problems arise, the possibility of delayed encephalopathy after carbon monoxide poisoning needs to be considered, and the complications of severe white matter damage in the brain are more likely to occur in people with long, severe, untimely treatment of carbon monoxide poisoning, middle-aged and elderly people, and people with underlying intracranial lesions, and once they occur, they require active treatment to minimize disability [2,3].
Why is it that in the same room, the man is only unwell, while the woman is causing death? Is there a gender difference in the risk of carbon monoxide poisoning?
There are also many cases of carbon monoxide poisoning in China. Statistics have found that in the same poisoning environment, women with mild diseases of acute poisoning have a milder degree of poisoning and a better prognosis;
However, in the case of severe poisoning and even death, women did not show a clear gender advantage. Not only did studies of severe deaths show no gender differences, but no significant differences were found in age [3].
That is to say, in the case of severe carbon monoxide poisoning, both men, women and children face the equally serious risk of lethality. Therefore, the prevention of carbon monoxide poisoning is the most critical means of avoiding tragedy.
In 2006, the former Ministry of Health issued the Emergency Plan for Non-occupational Carbon Monoxide Poisoning Incidents [4].
Carbon monoxide poisoning occurs outside production sites, mainly due to coal-fired heating and charcoal heating in the north, and the main cause of carbon monoxide poisoning in the south is improper use of gas water heaters [5,6].
In the north, especially in rural areas, when using ordinary simple iron stoves to burn coal, carbon, firewood, etc. for heating in winter, if the doors and windows are closed, it is possible that carbon monoxide accumulation will occur due to insufficient indoor oxygen and incomplete combustion, resulting in carbon monoxide poisoning.
For safety, we should use safe heating devices, such as heating, fireplaces or electric heating equipment.
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In simple hotels and rental houses, due to space limitations, gas water heaters installed inside the washrooms can often be seen.
This kind of gas water heater, in the case of closed doors and windows, it is easy to produce a large amount of carbon monoxide, and in winter, due to the cold weather, the bathing time is correspondingly longer, and the ventilation is insufficient, so the greater the risk of poisoning [6].
Therefore, it should be avoided to install the gas water heater indoors, if the indoor water heater has been installed and can not be migrated, even if there is a strong exhaust device, it is recommended to shorten the use time as much as possible, and pay attention to the appropriate opening of doors and windows for ventilation and ventilation when using.
In barbecues and hot pot restaurants that use gas or carbon fires, carbon monoxide poisoning incidents also occur from time to time.
These safety incidents all have a common feature - the lack of exhaust devices in the room, while the doors and windows are closed, and the air circulation is not smooth, resulting in carbon monoxide poisoning.
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When eating, if you drink alcohol, it is easy to be ignored by people because the symptoms of early carbon monoxide poisoning are similar to drunkenness, and the best time for treatment is missed.
When a person is exposed to an environment in which carbon monoxide exceeds the standard, accompanied by alcohol inhibition of the central nervous system, it will aggravate the damage caused by hypoxia to the whole body, especially the damage to the central nervous system, resulting in confusion, cerebral edema, compensatory respiratory rate increase, and the increase in respiratory rate leads to an increase in lung ventilation, further exacerbating the degree of carbon monoxide poisoning [5].
In addition, with the popularity of cars in the home, the tragedy of death caused by carbon monoxide poisoning in cars often occurs.
Most of this situation is caused by the car in the idle state, or due to the blockage of the exhaust pipe, the exhaust gas is not smooth, and the exhaust gas is poured into the closed car for a long time.
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When the car stops but does not turn off, the power system is in the working state for a long time, we must pay attention to the window ventilation to reduce the potential risk. If you stay in the car for a long time, the safest option is to stop and turn off the ignition.
With the improvement of production technology and the promotion of popular science education, the incidence of carbon monoxide poisoning has generally shown a downward trend [7,8]. But the awareness of risk prevention and control needs to sound the alarm bell for a long time.
I wish you all a safe journey through the warmth of every winter.
Review expert: Wang Chunxue | Chief Physician of the Department of Neuropsychiatry and Clinical Psychology, Beijing Tiantan Hospital
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Hu Huijun. Clinical features of brain injury in carbon monoxide poisoning and the protective mechanism of hyperbaric oxygen to improve the demyelination of cerebral white matter[D].Second Military Medical University, 2017.
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[5] YE Shan-shan, HU Zhuo-jun, RUAN Hai-lin, WANG Yao, DENG Wang-sheng, HUANG Ying-hua, CHEN Jian-bing, HONG Wei-liang.Epidemiological characteristics of non-occupational acute carbon monoxide poisoning patients in Liuzhou city from 2014 to 2017[J].China Disaster Rescue Medicine,2019,7(07):374-379.
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[7] Martin Janík, Michaela Ublová, tepánka Ku erová, et al. Carbon monoxide-related fatalities: A 60-year single institution experience. 2017, 48:23-29.
[8] Seyed Mohammad Hosseininejad, Hamed Aminiahidashti, Iraj Goli Khatir, et al. Carbon monoxide poisoning in Iran during 1999–2016: A systematic review and meta-analysis. 2018, 53:87-96.
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