Chapter 7 medicine?poison?
The hospital is in a mess right now: a patient in the emergency department died last night after rescue efforts failed. The family members did not allow the body to be carried out of the intensive care unit and reported the case immediately.
The hospital's security guards were trying their best to maintain order, but they were obviously powerless. The crowd of spectators crowded the entrance of the intensive care unit tightly, discussing something with their heads probed. A middle-aged woman was sitting on a chair, leaning back and forth, screaming.
I heard someone in the crowd say: "Don't be another medical accident, right?" I knew he meant that this might be another common medical accident. There is no objection to the treatment, even if there is, they should go to the Health Bureau first, but this time they went to the Public Security Bureau.
From Xiao Wang, who received the police, I learned the general course of the matter: yesterday was the birthday of the deceased.
The deceased and his girlfriend invited a group of friends. First they ate together in a restaurant, and everyone drank a lot. Later, they went to karaoke and drank a lot of alcohol. The deceased obviously drank too much. I staggered home with my girlfriend, it was about one o'clock in the middle of the night.
Two hours later, my girlfriend called the ambulance from the hospital. At about 5:00 in the morning, the deceased died after rescue efforts failed. The words "alcohol poisoning" were impressively written on the bedside of the hospital bed. I found that there was no question mark this time.
But the family members became suspicious, and the object of suspicion turned out to be the deceased's girlfriend, a nurse who worked in this hospital!I really don't see anything suspicious about this nurse. Now she is sitting in the duty room. She has not taken off the cotton coat to resist the coldness of the late autumn night. Her face is full of pear blossoms and rain. It is obvious that she has not recovered from yesterday's accident. out.
It was a round face, not even childish; her long hair was tied up in a bun according to the requirements of nurse work, and the bun was fixed by a chic ballpoint pen; her hand was trembling, holding a glass of wine from a kind colleague. The hot water came.
I estimate that she is no more than twenty years old.
This kind colleague obviously also participated in the rescue last night. She was fighting for the little nurse - last night the little nurse kept running in and out, but absolutely did not give any treatment to the deceased. Moreover, the little nurse was in love with the deceased. In the middle, the parents of the deceased were too much!At this time, she and I were thinking about the same question, why were the parents of the deceased suspicious?
The father of the deceased described two reasons for their suspicion: first, his son was a good drinker, usually drinking seven or eight bottles of beer was fine, but today he drank up to four bottles, but he died of drunkenness; second, The couple had an awkward fight some time ago and said they were going to break up. Could it be that the little nurse wanted to dump his son?This is indeed a reason. But there was another reason they definitely thought about it but didn't say it: she was a nurse. I have heard of a case where a nurse injected a large amount of absolute alcohol into her drunken husband and died, but the nurse who is proficient in medicine did not expect that the injection left a professional habit-disinfection. This simply left a guidepost for the forensic doctor, the yellow complexed iodine is too conspicuous. The case was so typical, both criminally and psychologically, that I had heard the story in many school classes. I found the medical records in the hospital. This is not a medical dispute, and the medical record has not been sealed. It is lying quietly in the medical record car of the hospital. From the medical records, this is a typical case of acute alcoholism. Alcoholism has actually been seen by many people in life, such as blushing and thick neck, telling the truth after drinking, etc. These idioms describe the first stage of alcoholism; in the second stage, the so-called staggering Yes, that's a manifestation of cerebellar ataxia; in the third stage, the patient's face turns pale, he is as drunk as mud, and often cannot be lifted up, and at this time, he begins to be in danger. Further development of alcohol will inhibit the nerve center in charge of breathing and cause the death of the patient, and the patient died of this central respiratory depression. However, this does not explain anything. What if this time it is a repeat of the story of the nurse killing her husband?If this is a repeat of that story, there will always be needle holes left, right?I carefully checked every inch of the deceased's skin, except for the injection needle holes near the elbow (which was caused by hospital treatment), I didn't find any injection needle holes, I was still worried, and checked the places such as the oral mucosa ,nor. I was still worried (in case this nurse did the crime, she is a professional master, although I don't want to believe it), I sent my blood to test the alcohol concentration: 94mg/100ml, which is not even a serious poisoning dose (100mg/100ml), not to mention the lethal dose (400mg/100ml), if calculated according to this concentration, all the alcohol in the dead body is a little less than drinking. I was a little ecstatic in my heart. Obviously this can completely rule out the nurse injecting him with alcohol. I have to admit that I really don't want her to be a murderer. But soon my head seemed to slowly start to grow bigger: my autopsy did not find any fatal disease or trauma, and the deceased was not a particularly bad drinker. Why?When I found the little nurse again, she was on duty. Obviously at first she regarded me as the spokesperson for her boyfriend's parents, she was reluctant to talk to me, and there was a trace of stubbornness in the corner of her mouth. In order to ease the atmosphere, I poured a glass of water for her and myself, and slowly changed the topic. But when I asked why she broke up with her boyfriend a while ago, she seemed to be a little embarrassed: after all, this is her personal privacy. Under my repeated questioning, she finally said it out. Recently, she discovered that her boyfriend has congenital epilepsy. Congenital epilepsy!Suddenly, a flash of inspiration came to my mind.
The phrase "congenital epilepsy" really reminded me a lot. I understand what kind of disease it is: the patient may lose consciousness at any time and any place during the attack, and falls to the ground convulsing and foaming at the mouth. At times like these, any tragedy can happen. To make matters worse, the disease can also be hereditary. I fully understand why the little nurse wants to break up with her boyfriend, and I understand what kind of love it takes to finally decide to stay. At the same time, it made me think about the cause of my boyfriend's death, of course, I still need to confirm. Soon I learned the details about my boyfriend’s congenital epilepsy: my boyfriend has been found to have this disease since he was very young, but fortunately, there are obvious signs every time he has a seizure—either his temper suddenly becomes strange, or some part of his body is abnormal. Convulsions spontaneously, the family has long mastered this rule, and know to give him a period of prophylactic phenobarbital (the first choice drug for epileptic seizures, this drug works well, but can not be stopped quickly, otherwise it will only make the attack worse), that's why the little nurse didn't know he had this problem until recently. "Has he taken any medicine recently?" I asked. "I have been taking it for three days recently. I drank alcohol yesterday and was afraid of an attack, so I took an extra tablet." (I later confirmed this through my boyfriend's parents: my boyfriend did have symptoms of an attack recently and was taking medicine.), little nurse Obviously realized something, and asked: "Why, does it matter?" I hesitated for a long time, not knowing whether I should tell her the truth, but I finally decided to tell the truth. I understand that people in other professions are not aware of this issue because it is not their area of expertise, but as a medical worker, I think it is necessary for her to know this; besides, it will definitely not be hidden from her in the end. "Alcohol is a central nervous system depressant, and so is phenobarbital. Taking them together makes them both much more toxic. We call this a synergistic effect," I explained. "Is it so powerful?" asked the nurse who was a little dazed. "Yes. Oral administration of regular doses of phenobarbital can reduce the lethal dose of ethanol several times, not to mention taking an extra tablet yesterday?" Tears suddenly poured out from between her fingers, and her shoulders were also violently shaking. Trembling, my words broke the confidence and stubbornness that the nurse had been insisting on for several days: obviously she understood why her boyfriend died, and she thought she was responsible. However, I want to tell her that we don't think she is responsible, that phenobarbital has been taken for medical treatment; the boyfriend drank the alcohol himself, and no one gave him it, not to mention that none of them knew about it. The two drugs react; we can only attribute this misfortune to accident, which is the logic of forensic medicine and the logic of the law... But I couldn't say it in the end. How can this kind of logic work in front of family members who have lost their loved ones? I don't want to mislead you, the vast majority of the cases I've been involved in have been fairly unremarkable. For example, what I have now is a very simple case of fighting and fighting. Of course, like everyone else, I must have a deeper memory of some special things. All the stories I publish here are the true records of some special cases buried in a large number of ordinary cases. For example, the most common cases of unknown causes of death are the "rich man's disease" I mentioned in one of the series, which account for almost half of the deaths of unknown causes; another example is poisoning, the most common case we encounter is carbon monoxide poisoning . It is common in gas-fired water heaters in the south, and it is common in winter heating in the north. Followed by organophosphorus pesticides and rodenticides, the vast majority of these cases are accidental, and the performance is very typical, and these cases account for more than half of the poisonings. Of course, I choose these two cases for a purpose: I want to tell you in the first case that you should be careful when you come into contact with poisonous substances. Some things we think are harmless may actually be fatal: To "improve eyesight", swallow fish gall, and many fish galls are poisonous, such as grass carp gall. In the second case, I want to tell you that "the drug is three-point poisonous". As far as alcohol is concerned, very common sedatives such as diazepam can greatly enhance its toxicity. However, I also don't want people to be too nervous, some of which is caused by the myth of fear of poison. For example, the statement "VITC plus seafood is equal to arsenic" found in the comments of netizens. I took a look and found that this statement was widely circulated on the Internet. It is said that a Taiwanese died because of this, but the following is the official statement from Taiwan: The Department has asked the Poison and Drug Consultation Center of Taipei Veterans General Hospital to inquire about relevant documents , did not find any medical reports on shrimp poisoning caused by vitamins. In addition, the center stated that although crustaceans such as shrimp, crab, lobster and shellfish such as clams and oysters contain arsenic, most of it exists in the form of organic arsenic, accounting for more than 90% or even 99%. , while organic arsenic can be quickly excreted from the body and has almost no toxicity. Inorganic arsenic (including trivalent arsenic and pentavalent arsenic) is indeed toxic. If the content of inorganic arsenic is conservatively estimated to be one-tenth of the arsenic content in seafood, and the content of shrimp is calculated as 4ppm, in order to achieve the lowest possible lethal dose of 20 mg, one must Eat fifty kilograms of shrimp. Theoretically, if purified vitamin C and pentavalent arsenic are chemically catalyzed in a laboratory environment, it may be possible to convert the original non-toxic pentavalent arsenic into trivalent arsenic (commonly known as arsenic). However, the lemon and shrimp eaten in the meal contain very low amounts of vitamin C and pentavalent arsenic, and there is no chemical catalyst and appropriate reaction conditions, so there is actually no doubt about producing arsenic.
The father of the deceased described two reasons for their suspicion: first, his son was a good drinker, usually drinking seven or eight bottles of beer was fine, but today he drank up to four bottles, but he died of drunkenness; second, The couple had an awkward fight some time ago and said they were going to break up. Could it be that the little nurse wanted to dump his son?This is indeed a reason. But there was another reason they definitely thought about it but didn't say it: she was a nurse. I have heard of a case where a nurse injected a large amount of absolute alcohol into her drunken husband and died, but the nurse who is proficient in medicine did not expect that the injection left a professional habit-disinfection. This simply left a guidepost for the forensic doctor, the yellow complexed iodine is too conspicuous. The case was so typical, both criminally and psychologically, that I had heard the story in many school classes. I found the medical records in the hospital. This is not a medical dispute, and the medical record has not been sealed. It is lying quietly in the medical record car of the hospital. From the medical records, this is a typical case of acute alcoholism. Alcoholism has actually been seen by many people in life, such as blushing and thick neck, telling the truth after drinking, etc. These idioms describe the first stage of alcoholism; in the second stage, the so-called staggering Yes, that's a manifestation of cerebellar ataxia; in the third stage, the patient's face turns pale, he is as drunk as mud, and often cannot be lifted up, and at this time, he begins to be in danger. Further development of alcohol will inhibit the nerve center in charge of breathing and cause the death of the patient, and the patient died of this central respiratory depression. However, this does not explain anything. What if this time it is a repeat of the story of the nurse killing her husband?If this is a repeat of that story, there will always be needle holes left, right?I carefully checked every inch of the deceased's skin, except for the injection needle holes near the elbow (which was caused by hospital treatment), I didn't find any injection needle holes, I was still worried, and checked the places such as the oral mucosa ,nor. I was still worried (in case this nurse did the crime, she is a professional master, although I don't want to believe it), I sent my blood to test the alcohol concentration: 94mg/100ml, which is not even a serious poisoning dose (100mg/100ml), not to mention the lethal dose (400mg/100ml), if calculated according to this concentration, all the alcohol in the dead body is a little less than drinking. I was a little ecstatic in my heart. Obviously this can completely rule out the nurse injecting him with alcohol. I have to admit that I really don't want her to be a murderer. But soon my head seemed to slowly start to grow bigger: my autopsy did not find any fatal disease or trauma, and the deceased was not a particularly bad drinker. Why?When I found the little nurse again, she was on duty. Obviously at first she regarded me as the spokesperson for her boyfriend's parents, she was reluctant to talk to me, and there was a trace of stubbornness in the corner of her mouth. In order to ease the atmosphere, I poured a glass of water for her and myself, and slowly changed the topic. But when I asked why she broke up with her boyfriend a while ago, she seemed to be a little embarrassed: after all, this is her personal privacy. Under my repeated questioning, she finally said it out. Recently, she discovered that her boyfriend has congenital epilepsy. Congenital epilepsy!Suddenly, a flash of inspiration came to my mind.
The phrase "congenital epilepsy" really reminded me a lot. I understand what kind of disease it is: the patient may lose consciousness at any time and any place during the attack, and falls to the ground convulsing and foaming at the mouth. At times like these, any tragedy can happen. To make matters worse, the disease can also be hereditary. I fully understand why the little nurse wants to break up with her boyfriend, and I understand what kind of love it takes to finally decide to stay. At the same time, it made me think about the cause of my boyfriend's death, of course, I still need to confirm. Soon I learned the details about my boyfriend’s congenital epilepsy: my boyfriend has been found to have this disease since he was very young, but fortunately, there are obvious signs every time he has a seizure—either his temper suddenly becomes strange, or some part of his body is abnormal. Convulsions spontaneously, the family has long mastered this rule, and know to give him a period of prophylactic phenobarbital (the first choice drug for epileptic seizures, this drug works well, but can not be stopped quickly, otherwise it will only make the attack worse), that's why the little nurse didn't know he had this problem until recently. "Has he taken any medicine recently?" I asked. "I have been taking it for three days recently. I drank alcohol yesterday and was afraid of an attack, so I took an extra tablet." (I later confirmed this through my boyfriend's parents: my boyfriend did have symptoms of an attack recently and was taking medicine.), little nurse Obviously realized something, and asked: "Why, does it matter?" I hesitated for a long time, not knowing whether I should tell her the truth, but I finally decided to tell the truth. I understand that people in other professions are not aware of this issue because it is not their area of expertise, but as a medical worker, I think it is necessary for her to know this; besides, it will definitely not be hidden from her in the end. "Alcohol is a central nervous system depressant, and so is phenobarbital. Taking them together makes them both much more toxic. We call this a synergistic effect," I explained. "Is it so powerful?" asked the nurse who was a little dazed. "Yes. Oral administration of regular doses of phenobarbital can reduce the lethal dose of ethanol several times, not to mention taking an extra tablet yesterday?" Tears suddenly poured out from between her fingers, and her shoulders were also violently shaking. Trembling, my words broke the confidence and stubbornness that the nurse had been insisting on for several days: obviously she understood why her boyfriend died, and she thought she was responsible. However, I want to tell her that we don't think she is responsible, that phenobarbital has been taken for medical treatment; the boyfriend drank the alcohol himself, and no one gave him it, not to mention that none of them knew about it. The two drugs react; we can only attribute this misfortune to accident, which is the logic of forensic medicine and the logic of the law... But I couldn't say it in the end. How can this kind of logic work in front of family members who have lost their loved ones? I don't want to mislead you, the vast majority of the cases I've been involved in have been fairly unremarkable. For example, what I have now is a very simple case of fighting and fighting. Of course, like everyone else, I must have a deeper memory of some special things. All the stories I publish here are the true records of some special cases buried in a large number of ordinary cases. For example, the most common cases of unknown causes of death are the "rich man's disease" I mentioned in one of the series, which account for almost half of the deaths of unknown causes; another example is poisoning, the most common case we encounter is carbon monoxide poisoning . It is common in gas-fired water heaters in the south, and it is common in winter heating in the north. Followed by organophosphorus pesticides and rodenticides, the vast majority of these cases are accidental, and the performance is very typical, and these cases account for more than half of the poisonings. Of course, I choose these two cases for a purpose: I want to tell you in the first case that you should be careful when you come into contact with poisonous substances. Some things we think are harmless may actually be fatal: To "improve eyesight", swallow fish gall, and many fish galls are poisonous, such as grass carp gall. In the second case, I want to tell you that "the drug is three-point poisonous". As far as alcohol is concerned, very common sedatives such as diazepam can greatly enhance its toxicity. However, I also don't want people to be too nervous, some of which is caused by the myth of fear of poison. For example, the statement "VITC plus seafood is equal to arsenic" found in the comments of netizens. I took a look and found that this statement was widely circulated on the Internet. It is said that a Taiwanese died because of this, but the following is the official statement from Taiwan: The Department has asked the Poison and Drug Consultation Center of Taipei Veterans General Hospital to inquire about relevant documents , did not find any medical reports on shrimp poisoning caused by vitamins. In addition, the center stated that although crustaceans such as shrimp, crab, lobster and shellfish such as clams and oysters contain arsenic, most of it exists in the form of organic arsenic, accounting for more than 90% or even 99%. , while organic arsenic can be quickly excreted from the body and has almost no toxicity. Inorganic arsenic (including trivalent arsenic and pentavalent arsenic) is indeed toxic. If the content of inorganic arsenic is conservatively estimated to be one-tenth of the arsenic content in seafood, and the content of shrimp is calculated as 4ppm, in order to achieve the lowest possible lethal dose of 20 mg, one must Eat fifty kilograms of shrimp. Theoretically, if purified vitamin C and pentavalent arsenic are chemically catalyzed in a laboratory environment, it may be possible to convert the original non-toxic pentavalent arsenic into trivalent arsenic (commonly known as arsenic). However, the lemon and shrimp eaten in the meal contain very low amounts of vitamin C and pentavalent arsenic, and there is no chemical catalyst and appropriate reaction conditions, so there is actually no doubt about producing arsenic.