CASE

ON MONDAY MORNING , 2017 , COIMBATORE , LOCAL RESIDENTS SAW A MAN ASLEEP IN THE DRIVING SEAT
OF HIS CAR , WHICH WAS PARKED FOR MORE THAN AN HOUR. SOME BROKE THE WINDOW , WHEN REPEATED
KNOCKS FAILED . PERSON WAS FOUND UNCONSCIOUS , AIR CONDITIONER RUNNING AND THE CAR WAS
FILLED WITH HOT AIR. BUT IN CASUALTY THE PERSON WAS DECLARED DEAD ON ARRIVAL.
CHERRY RED POSTMORTEM LIVIDITY WAS PRESENT OVER CHEST AND ABDOMINAL WALL.
• IRRITANTS – INJURE AIR PASSAGES AND LUNGS. EG : SMOKE, AMMONIA, FORMALDEHYDE, CHORINE,
PHOSGENE, NO2, SO2.
• CHEMICAL ASPHYXIANTS – COMBINE WITH HB , PREVENT O2 FROM REACHING TISSUES. EG: CO, H2S,
CARBON DISULPHIDE, CN.
• SIMPLE – INERT GASES LIKE CO2,CH4 , HELIUM, NITROGEN..
• VOLATILE DRUGS – ACTS AS ANAESTHETIC . EG : ALIPHATIC,AROMATIC,HALOGENATED HYDROCARBONS.
• SYSTEMIC POISONS – LIKE INSECTICIDES,ARSINE, STIBINE
CARBON MONOXIDE

• COLOURLESS, TASTELESS, NON IRRITATIVE GAS PRODUCED DUE TO INCOMPLETE COMBUSTION OF

CARBON . BURNS WITH BLUE FLAME .LIGHTER THAN AIR
• IN A CLOSED ENVIRONMENT , GREATER CONCENTRATION IS PRESENT AT 1.5 – 2 METRES ABOVE THE
GROUND AND ESCAPES THROUGH DOOR AND CRACK IN WALLS .
SOURCES
• COAL GAS
• SMOKE FROM FIRE AND FUMES FROM DEFECTIVE APPLIANCES- FURNACE, HEATER , STOVE , OIL LAMPS,
• EXPLOSION IN MINES
• SMOKING – IN ONE PACK OF CIGARETTE PER DAY CO LEVELS ARE RAISED TO 5-6%
MOA

• CO READILY ABSORBED AND COMBINES WITH HB

• CO AFFINITY TO MYOGLOBIN IS 40 TIMES GREATER THAN OF O2 AND CAUSE MYOCARDIAL DEPRESSION
• CO AFFINITY TO HB IS 200-300 TIMES GREATER THAN OF O2 AND FORMS CARBOXY HAEMOGLOBIN AND
CAUSE DEATH DUE TO ANAEMIC ANOXIA.
• THIS COMPOUND INHIBITS ETC BY BLOCKING CYT P 450 , SHIFTS OXYHAEMOGLOBIN DISSOCIATION
CURVE TO THE LEFT.
• HALF LIFE IS 5-6 HOURS, ELIMINATED ONLY THROUGH LUNGS .
SYMPTOMS
TREATMENT

• FRESH AIR
• ABOVE 25% COHB MUST BE TREATED
• 100% O2 THERAPY WITH MASK AND ENDOTRACHEAL INTUBATION
• HYPERBARIC O2 THERAPY
• BLOOD TRANSFUSION
POSTMORTEM APPEARANCES

• CHERRY RED COLOURATION OF SKIN, MUCOUS MEMBRANES, NAILS BED, AREAS OF HYPOSTASIS,
• BLISTERING OF SKIN OF DEPENDANT AREAS LIKE BUTTOCKS, CALVES , WRISTS, KNEES, DUE TO
CUTANEOUS EDEMA
• THE COLOUR WILL NOT BE CHANGED BY EMBALMING OR PRESERVATION
• CHERRY RED CHANGES TO DARK GREEN AND BROWN WITH ONSET OF DECOMPOSITION
CARBON DIOXIDE
• HEAVY COLOURLESS GAS WITH FAINT SWEET ODOUR ,PRESENT 0.03% IN AIR.
• NOT TOXIC BUT ACTS AS SIMPLE ASPHYXIANT
• 5%-LABOURED BREATHING AND MENTAL CONFUSION
• 10%- ATAXIA
• 40%-DYSPNOEA
• 80%-DEATH DUE TO VASOVAGAL REFLEX
• TREATMENT- O2 THERAPY
• POSTMORTEM APPEARANCE- CYANOSIS, CONGESTION, PETECHIAL HAEMORRHAGES, DILATION OF PUPIL.
HYDROGEN SULPHIDE
• COLOURLESS , HEAVY , FLAMMABLE GAS
• AT 25PPM ROTTEN EGG SMELL
• 50PPPM SENSE OF SMELL IS RAPIDLY PARALYSED
• IN GREATER DILUTION IT CAUSE SLEEPINESS , DULLNESS AND DEATH
• TREATMENT – ARTIFICIAL RESPIRATION WITH 100% O2, AMYL NITRITE INHALATION WILL HASTEN THE
FORMATION OF SULPMET HB WHICH CAN B EXCRETED EASILY.
• POSTMORTEM APPEARANCE – ROTTEN EGG ODOUR , BLOOD IS GREENISH PURPLE
METHYL ISO CYANATE
• LIQUID AT 27 C AND GAS AT 31 C , PUNGENT , SWEETISH SMELL, DEADLIEST CHEMICAL.
• SYMPTOMS- ACUTE IRRITATION OF EYES, LACHRYMATION, BLUR VISION, CHEST PAIN ,PULMONARY
EDEMA THEN DEATH.
• POSTMORTEM- INCREASED WEIGHT OF LUNGS 2-3 TIMES OF NORMAL, VICTIMI DYING WITHIN 5 DAYS
HAVE PINK BLOOD , AFTER 5TH DAY HAVE DARK RED BLOOD.
• TREATMENT- CURING THE SYMPTOMS . SODIUM THIOSULPHATE IS BENEFICIAL.
WAR GASES

• ON APRIL 22, 1915, GERMAN FORCES SHOCK ALLIED SOLDIERS ALONG THE WESTERN FRONT BY FIRING
MORE THAN 150 TONS OF LETHAL CHLORINE GAS AGAINST FRENCH COLONIAL DIVISION AT BELGIUM.
• IT CAUSED NEARLY 1000 CASUALITIES
• WAR GASES INCLUDES ANY CHEMICAL (GAS,LIQUID,SOLID) WHICH IS USED TO PRODUCE DESTRUCTION
OR DAMAGE MOSTLY IN TIMES OF WAR.
• BLISTERING GASES- SULPHUR, MUSTARD, PHOSGENE, OXIMES , ARSENIC. THEY CAUSE IRRITATION OF
EYES, NOSE , THROAT, SKIN, VOMITING , ABDOMINAL PAIN, ULCERATION , VESICATION.
TREATMENT- WASH THE AFFECTED PARTS
• LUNG IRRITANTS – CHLORINE AND PHOSGENE. CHLOROPICRIN AND DIPHOSGENE ARE LIQUIDS USED IN
GAS SHELLS. THEY CAUSE DYSPNOEA , CYANOSIS , VOMITING DEATH IN 24-48 HOURS.
TREATMENT – WASH, USE O2 AND ADRENALINE ,
• LACHRYMATORS – CHLORACETOPHENONE , ETHYLIODOACETATE , BROMOBENZYL CYANIDE .
THEY CAUSE IRRITATION OF EYES , VOMINTING , BLISTER.
THEY ARE USED TO DISPERSE RIOTS
TREATMENT – FRESH AIR
• STERNUTATORS - DIPHENYL CHLORARSINE , DIPHENYLAMINE CHLORARSINE . THEY CAUSE INTENSE PAIN
AND IRRITATION IN NOSE , SNEEZING , HEADACHE , VOMIT, TIGHTNESS OF CHEST.
• PARALYSANTS- HYDROCYANIC ACID , SULPHURETTED HYDROGEN AND CO.
• NERVE GASES- ESTERS OF PHOSPHORIC ACID .
THE MAJOR AGENTS ARE TABUN, SARIN , SOMAN , VE, VM , VX . THE VAPOURS ARE HEAVIER THAN AIR ,
COLOURLESS, ODOURLESS.
THEY INHIBIT ACETYL CHOLINE ESTERASE .
THEY CAUSE UNCONSCIOUSNESS, CONVULSION , BRONCHOSPASM , CARDIAC ARREST.
HYDROCYANIC ACID
• HYDROCYANIC ACID IS A SOLUTION OF HCN IN WATER EITHER 2% OR 4%.
• IT IS CALLED AS SCHEELE’S ACID.
• IT’S A VEGETABLE ACID FOUND IN ALMOND, APRICOT , PLUM, OIL SEEDS , BEANS . WHERE THEY EXIST IN
GLUCOSIDE AMYGDALIN WHICH IS HARMLESS.
• ABILITY TO SMELL HCN IS SEX LINKED RECESSIVE TRAIT.
ACTION
• CYANIDE INHIBITS CYTOCHROME OXIDASE , CARBONICE ANHYDRASE AND BLOCKS OXIDATIVE
PHOSPHORYLATION , SO NO ATP PRODUCED.
• IT KILLS BY CREATING HISTOTOXIC OR CYTOTOXIC ANOXIA , PREVENTING THE UPTAKE OF O2 FOR
CELLULAR RESPIRATION.
• IT IS ABSORBED BY RS , GIT , SKIN . ABSORPTION IS DELAYED WHEN TAKEN ON FULL STOMACH .
• WHEN ALKALINE CYANIDE IS INGESTED IT REACTS WITH HCL IN STOMACH AND FORMS HYDROCYANIC
ACID.
• IT IS MAINLY EXCRETED IN URINE
SYMPTOMS
• WHEN INHALED AS GAS ITS ACTION IS SPONTANEOUS
• CNS – HEADACHE , VERTIGO , FAINT , PERSPIRATION , OPISTHOTONOS , TRISMUS , HYPERTHERMIA ,
CONVULSIONS , PARALYSIS , DEATH .
• GIT – BURNING TASTE , NUMBNESS , SALIVATION
• RS – DYSPNOEA , CYANOSIS
• CVS – COLLAPSE
• TREATMENT- REVERSE THE CYANIDE CYTOCHROME COMBINATION BY GIVING NITRITES.
POSTMORTEM

• CHERRY RED APPEARANCE , ODOUR OF HCN IS PRESENT , DEGENERATIVE EROSIVE CHANGES ARE
PRESENT
THANK YOU