Death by Compressive Asphyxia

Can an adult die from having weight on the chest?

Absolutely. It’s called compressive asphyxia.

The lungs work like a bellows. The muscles between the ribs and the diaphragm operate together to expand the chest cavity and draw in air—inhalation. Relaxation of these muscles results in exhalation. Anything that restricts this movement leads to decreased oxygen coming into the lungs and then into the bloodstream. Carbon dioxide builds up, oxygen levels drop; the victim passes out and eventually dies from lack of oxygen.

Anything else that depresses the respiratory center in the brain makes it more likely asphyxia will occur—alcoholic intoxication, sedatives, extreme cold exposure, illness, and extremes of age.

Examples include:

Constrictor snake—like a python

An adult sharing a bed with a small child or infant rolls over on them

Crowds and panic, resulting in individuals crushed and unable to breathe

Pinned by a large weight, such as becoming trapped under a heavy box or piece of equipment

Restraint—the victim is facedown and the individual doing the restraining may press or kneel

Burking

A combination of compression and smothering (occluding the airway) was utilized by William Burke and William Hare in 1828 in a series of homicides. The two men got their victim intoxicated and sat on the chest of the victim (compression) while occluding the mouth and nose (smothering).

Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.

Find Kelly’s fiction at www.kellywhitley.com

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Plausible Reasons for Collapse

I have a character in his fifties. He’s in good health. In the scene he’s walking along, then just crumples to the ground and is unresponsive. It can’t be a cardiac arrest. What are the possibilities?

There are quite a few. Here are some easy ones to consider:

 

Simple faint is the easiest.

Heart-wise, there can be problems like a very slow heart rate or a very fast heart rate, either of which can cause the blood pressure to be low. If it’s low enough, there isn’t good circulation to the brain and the victim collapses. There may be little to no warning.

Severe pain can cause a victim to pass out.

A blood clot to the lung (pulmonary embolus) can cause the victim to pass out. Associated symptoms include chest pain and shortness of breath. A risk factor for this is immobility, like prolonged sitting with travel or staying in a position like a crouch for a prolonged time. Surgery, especially of the pelvis or hip is a risk factor. Uncommonly a clotting disorder that makes the blood clot too well (hypercoagulability) can be the cause.

Low blood oxygen can cause collapse, but generally this would be due to something going on, like worsening lung disease or infection.

Low blood sugar can cause collapse—like a diabetic who has taken too much insulin (or an oral medication for diabetes) and not taken in adequate food.

Infection that gets into the blood stream can do it, but again, the victim is going to have symptoms beforehand.

Seizure—a big one—can look like collapse if not seen close up.

Dehydration—due to low volume in the vascular system—causes low blood pressure and collapse.

Internal bleeding—similar mechanism to dehydration. Ulcer, ruptured abdominal aortic aneurysm (the aorta is the major artery leaving the heart and descending along the spine. An aneurysm is an enlargement of the vessel, is under increased wall pressure, and can rupture).

If there are other details that might aid in tailoring the scenario, please let me know!

Good luck.

Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.

Find Kelly’s fiction at www.kellywhitley.com

 *Photo courtesy of Photobucket/amoore36846*

Bleeding a Victim to Death--Intentional Hemorrhage

I have a kidnapper that wants to slowly bleed his victim to death. How long will it take, and how much blood loss (the villain is collecting the blood in a jar).

First, let’s consider how much blood the average adult has. Ten to twelve units, or pints. A substantial portion will have to be lost to kill a healthy adult.

Second, the rate of blood loss is important—acute versus chronic.

When lost slowly (chronic), the blood count can drop to half normal and the individual may still be upright and walking around. This is something that happens over weeks to months, like with an ulcer in the stomach.

The proposed scenario is acute—rapid loss of blood—otherwise known as hemorrhage. The speed at which the blood is lost will depend on what’s bleeding and how. If it’s an artery, the blood loss will be faster; the flow is under pressure. With a vein, the loss is slower. There is a chance of clotting off whatever you’re using to extract the blood. An IV line in a vein in the arm is likely to clot off, and not yield much blood flow before this happens.

Sticking a large IV line in the carotid artery (in the neck) would give rise to a lot of blood loss; the velocity (due to the pressure) helps prevent clotting.

Loss of forty percent of the blood volume is usually fatal, so four to four-and-a-half units. The collection jar will need to hold that much if all the blood is to be collected. Consider using an IV line in the carotid artery, and have the line attach to a vacuum jar. The suction accelerates the blood loss, it has markings on it for volume collected, and it keeps the area clean. Four units can be extracted perhaps as rapidly as fifteen minutes.

With regard to the victim, if the blood loss proceeds over hours, he/she may experience racing heart, shortness of breath, dizziness, and tingling in the extremities. Upright posture is poorly tolerated and may lead to fainting. As the blood loss approaches forty percent, the victim may feel cold and anxious, or may become sleepy. With continued blood loss, the patient will go into cardiac arrest and die due to lack of volume in the vascular system (hypovolemic shock).

Good luck!

Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.

Find Kelly’s fiction at www.kellywhitley.com

 

 

Killing Someone With a Pumpkin

Can a pumpkin be used to kill someone?

Short answer: yes.
Long answer: Yes, but it takes some planning about how you want the pumpkin to be deadly.

My first thought was trauma. A pumpkin dropped off a bridge has the potential to kill someone.

It’s that time of year. The big orange gourds are everywhere from supermarkets to front porches.

Unfortunately, a pumpkin combined with gravity can be lethal—or not, depending on the scenario.

There are multiple reports of pumpkins being dropped onto moving vehicles resulting in accident. With adequate height and a large pumpkin, the windshield can cave in. Depending on what happens to the car after impact, yes, a deadly accident can result.

A dropped pumpkin striking a person directly—such as on the head—would be tougher to pull off, but could be done. The timing and placement of the injury would be somewhat difficult to write in a plausible manner. Of course, if the impact resulted in the victim falling and hitting a hard surface with the head, a more serious injury would occur.

There are competitions with catapults and pumpkins; these missiles can be dangerous. This would make a possible scenario.

An anaphylactic (a dangerous allergic reaction) to touching or eating pumpkin could work.

Last, there’s always choking to death on pumpkin pie, pumpkin seeds, or pumpkin soup.

Good luck!

Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.

Find Kelly’s fiction at www.kellywhitley.com

Death by Black Widow Spider Bite

I want to set up a scenario where my victim dies from black widow spider bites. I’d like it to look “natural.” How many bites would it take? Would this work?

A tricky question.

Black widow spiders are recognizable by their glossy, bulbous black bodies and the red hourglass mark on the abdomen. Their legs are long and slender. They are found all over the world, and are everywhere in the USA. These creatures prefer dark, quiet, undisturbed areas like woodpiles and unfinished basements—places where “food” is plentiful. They will bite if disturbed/provoked.

There are multiple factors that go into how severe a person’s reaction to a bite might be.

--The evenomation (bite): how much venom is injected.

--The health and size of the victim: children, the chronically ill, and the elderly are more susceptible.

--The reaction of the individual to the bite: some people have minimal reaction, some have much more.

 

Let’s take for example a single bite in an adult male, and a general reaction.

The bite itself is likely to feel like a pinprick. Within an hour, a localized reaction of pain, swelling, and redness develops at the site of the evenomation. These symptoms can be treated at home by washing the wound and elevating the extremity (if possible). Ice at the site may help.

More severe symptoms require a trip to the Emergency Department:

Sweating, along with muscle cramps and abdominal pain, which can be severe (patients with unrecognized bites may seem to have appendicitis). Backache can be a problem. Sweating, elevated heart rate and blood pressure, and chest pain can occur. Fainting is occasionally seen.

Life-threatening symptoms include shortness of breath and seizures.

Pregnant women may go into labor.

Treatment in the ED:
Pain control—generally with morphine.
Anxiety control—with a valium-like drug for sedation.
Antivenin—like a snake bite, antivenin may be given for a severe reaction to a black widow bite. Because this is a “horse serum,” (produced by making a horse produce antibodies to the venom) there is a chance of an allergic reaction. Therefore a skin test is recommended before administration. Giving the antivenin results in significant improvement within a day.

For death by black widow, the best scenario would be an ill individual suffering multiple untreated bites. How many bites and how long untreated is up to you. As there’s no good data about multiple bites, I think you can pretty much create what you’d like. If you intend to kill a healthy adult male, it may take lots of bites—more than the number of spiders likely to be at the location by chance. An underlying heart condition would work for having the bites kill your victim. That scenario could even look like a heart attack, but the bites will be noted at autopsy.

Good luck!

Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find Kelly’s fiction at www.kellywhitley.com

Rattlesnake Attack--All About It

A rattlesnake is a “pit viper,” so named because of the pits on the nose.


Western Diamondback Rattelsnake

These snakes are commonly found in the Midwest and Western United States. As the weather moves into the high seventies, rattlesnakes become active and often seek out heated surfaces to warm themselves. These snakes may be encountered by the unsuspecting hiker, rancher, or in some rural areas, close to the house sunning on the driveway.
A coiled rattlesnake will shake its tail, making the hissing rattle the snake is known for. Because of the length and strength of the body, the snake can launch (ie, strike) at a distance of several feet, making the strike zone larger than might be obvious.

About 75% of bites contain some venom. 25% are so-called “dry” bites with little or no venom, but these are still potentially dangerous.
Bites by vipers are painful and tender. They can become severely swollen, bleed and blister. More systemic effects of the venom include changes in the victim’s ability to clot.
A bite by any snake—venomous or otherwise—should be treated by a medical professional. Even non-venomous bites can contain teeth and/or dirt, and be at risk for infection.
Identification of the snake is important, but not at the risk of another individual being bit. Rattlesnakes can continue to bite and inject venom until they deplete their supply.

WHAT TO DO IN CASE OF SNAKE BITE:
Calling ahead to the Emergency Department helps them to prepare and obtain antivenin if needed.
Transport the victim to the hospital, keeping the heart above the level of the wound if possible. Remove rings or other potentially constricting items.

WHAT NOT TO DO:

Do not cut into and/or attempt to “suck out the venom.” This includes not using older snakebite kits that contain suction devices.
Do not use ice on the bite site.
Do not attempt to sterile/neutralize the bite with alcohol. This increases tissue damage and increases venom absorption.
Do not apply a tourniquet. This can lead to limb-threatening damage.

The Emergency Department will examine the bite and make a determination if antivenin should be given. Some locations will stock antivenin if rattlesnake bites occur with any frequency. Some zoos or other animal exhibits that feature rattlesnakes have the antivenin on hand.

Antivenin can cause its own set of complications, including fever, joint and muscle aches, fatigues and swollen lymph nodes.
Antibiotics are often given to prevent infection, but have no effect on the venom. All snakebite victims should receive a tetanus booster if none has been given in the last five years.
Blood clotting abnormalities can continue for a few weeks after a bite. It’s important to let any healthcare professional know about the history of the bite.

PREVENTION: Wear boots and long pants when hiking. Be aware of your surroundings.

Questions? Comments?

~*~

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find Kelly’s fiction at www.kellywhitley.com

Hypothermia--Slowly Freezing to Death

A normal internal (core) body temperature is 98.6 F (37 C). Hypothermia occurs when the body is subjected to a cold environment for a long enough period of time that the internal body temperature drops to less than 95 F (35 C). Hypothermia can also occur when the body’s temperature regulation system is deranged.

Inside the brain, the hypothalamus (a primitive part of the brain) is responsible for temperature control. Normal metabolic processes generate the body’s heat. When too much heat is lost through the skin (or in the case of fever) shivering produces heat through muscle action.

Continued heat loss results in shunting of blood away from the skin internally, to support the internal organs—especially heart and brain. As the body’s core temperature drops, metabolic processes slow, and the heart rate, respiratory rate, and brain waves all slow down. As the internal temperature continues to drop, death will ensue.

Environmental exposure accounts for the vast majority of hypothermia. Individuals with alcohol on board are more susceptible as alcohol dilates the skin vessels and accelerates heat loss; drinking brandy to “stay warm” while scooping snow is a bad idea! Low thyroid, advanced age, drug abuse, and some medications (vasodilator drugs) increase the likelihood of environmentally-induced hypothermia. Psychiatric conditions like dementia—that might cause an individual to wander away without a defined destination—are a risk factor.

Brain conditions that affect thermoregulation ability can put someone at risk.

The gradual onset of hypothermia makes it harder for someone to know what’s happening. Onset may lead to a phenomenon known as paradoxical undressing, where the person sheds clothing even though they’re freezing to death. Drowsiness, followed by drifting into sleep and death follows.

Treatment involves getting the person to a warm environment, out of wet clothes (if applicable) and rewarming. External warmth—hot water bottles, warming blanket, even body-to-body contact—is applied. In a medical setting, warm IV fluids, warmed air, and heated blankets can be used. Warm fluid can be infused into the abdominal cavity.

In worst-case scenarios, the patient can be rewarmed using heart-lung bypass, warming the blood as it goes through the machine.

Caution for heart rhythm disturbances involves avoiding moving the patient more than necessary. As people with profound hypothermia have been successfully resuscitated, most doctors consider a hypothermic patient to be potentially salvageable until they are warm.

The biggest consideration is to avoid situations that may lead to hypothermia, primarily avoiding prolonged exposure to cold weather.

 

Questions? Comments?

~*~

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find Kelly’s fiction at www.kellywhitley.com