From: Alan Hall <oldeddoc**At_Symbol_Here**GMAIL.COM>
Subject: Re: [DCHAS-L] Tragic Asphyxiation
Date: Wed, 3 Oct 2018 10:46:28 -0500
Reply-To: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU>
Message-ID: CALDugaa_1TyC3cT==RC+3VzR2QttF+ctFP7nTgD6Yfz7nVfOZg**At_Symbol_Here**mail.gmail.com
In-Reply-To


Beth,

I suspect, but do not know, that your relative had more significant COPD (Chronic Obstrctive Lung Diseas which includes usually elements of both chronic bronchitis and emphysema) in which the respiratory centrally-mediated respiratory drive becomes inured to low pO2 levels and is only stimulated by high pCO2 levels, but is still sensitive to high pO2 levels. In such cases, administering high conventrations of oxygen can be detrimental. It causes the central nervous system mehanism to act as though everything is fine, and this can interrupt normal breathing. In such cases, if you get there in time, endotracheal intubation and mechanical ventialation may be of help, but the long-term outcome is poor.

And yes, any time breathing becomes too diffucult or absent, CO2 will accumulate from the body's usual metabolism. There's a formula for looking into this which I will not bore you with.

I such cases, it isn't the CO2 that causes death, it's hypoxia and the long term effects on the lungs (imparired O2/CO2 exchange) and the right side of the heart (cor pulmonale). Everyone dies from cardiac failure, in the end. Sampling arterial blood gases can help with case management, but you have to draw arterial samples which are somewhat painful and as we always taught our students: if the results of a test won't change your diagnosis or therapy, then don't order the test.

Glad you don't play a medical professional on TV. We've got enoguh and overflowing with such questionable persons whose advice is worth exactly what you pay for it. Nothing.

Hope this helps.

Alan
Alan H. Hall, M.D.
Medical Toxicologist

On Wed, Oct 3, 2018 at 10:02 AM Beth Shepard <beth.shepard**At_Symbol_Here**milliporesigma.com> wrote:

Hi all-

******

Perhaps someone can advise the physiological pathways that elevated partial
pressure of CO2 adversely influences the body, even when the oxygen partial
pressure is maintained at normal levels.
******

Well, while I am not a medical professional (nor do I play one on TV),

my grandmother happened to die after contributing factors from a related

issue, so I can contribute some small information here. Perhaps Alan or one

of the other medical folks on the list can expand upon the physiological effects.

My Gran had been having trouble breathing from a mild case of emphysema, so she

went to the hospital to see her doctor. He put her on 100% oxygen to help her

breathing, but did not order her blood gases to be monitored. My understanding

of the issue was while on 100% oxygen her body could not release the CO2 waste

gas, which then built up in her system, causing a (minor) stroke.

Lessons learned: Ask questions

Your previous excellent doctor's son may not also be an excellent doctor

Smoking is BAD for you!

Beth

Disclaimer: My own personal opinion & comment. This is not attributable or related to my employer in any way.

From: ACS Division of Chemical Health and Safety [mailto:DCHAS-L**At_Symbol_Here**PRINCETON.EDU] On Behalf Of Michael Schaffer
Sent: Wednesday, October 03, 2018 8:18 AM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] Tragic Asphyxiation

Great story. Thanks for sharing-.mike schaffer

Sent from Mail for Windows 10


From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> on behalf of Alan Hall <oldeddoc**At_Symbol_Here**GMAIL.COM>
Sent: Wednesday, October 3, 2018 5:45:53 AM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] Tragic Asphyxiation

Et al and Monona,

My medical toxicology 2 cents worth. An autopsy, even with a medical examiner and the types of lab toxicologists avvailable (which I am not) might not confirm the cause of death as exposure to either a simple or sysemic asphyxiant. I spent a whole year wandering around all over and lecturing to such folks about why you can't just assign the cause of death in fire smoke fatalities based only on a post-mortem CO level of 30% or greater, when at least 50% of such victims have died of cyanide poisoning (preventable with specific antidotes if the paramedics get there soon enough and have them available and know how use them use them).

Monona, your are quite rright about the time when you are still conscious but couldn;t help yourselft. In the Air Forece in the old days when I was a Reserve Flight Surgeon, they talked about the time of "useful consciousness" and then a period on consciousness when you could not. So we went into the altidtde chamber to a simulated altitude on 40,000 feet MSL. Being younger and even more foolish then, I agreed to do the hypoxia demonstration. Took off my face mask and respirator. Supposedly, you can't do more than 30 seconds in these conditions. I made it to a minute+, and then the inside safety instructor asked me if I needed my mask back on. I said yes, and just looked down at it my hand and was not able to move. At a minute 45 seconds, he put it on me and several breaths later wiiht 20 cm H2O PEEP (you have to work to breath out, and let the respirator blow up your lungs for you), I became as good as I am now. Air Foce uniform pants are quite blue, and my fingernails were darker bluet han that. I now believe in the "period of useful consciousness". Pure hypoxia isn't all that unpleasant, but it's certainly deadly if continured too long. .

Old school: I was always led from the front. If you can't be smart, be lucky.

Alan

AlanH. Hall, MD

Medical Toxicologist

Major, USAFR, MC, FS (Hon.Ret.)

Senior Advisor, Forensic Science

Weatherford College

Weatherford, TX

On Wed, Oct 3, 2018 at 6:33 AM Eugene Ngai <eugene_ngai**At_Symbol_Here**comcast..net> wrote:

Does it really matter how they died? CO2 does have the effect you mentioned,
only, an autopsy would tell us what happened. In this case it was an
accidental discharge of CO2
that killed them. This is not an isolated case. A women sitting on a toilet
at a MacDonalds in Florida was asphyxiated since the liquid CO2 fill line
leaked. The key issue for me is that CO2 actually poisons a O2 detector
making it useless.

I was an expert witness on a case where liquid Argon was illegally loaded
below deck on a ship, the foreman and two of his crew were asphyxiated.in
that tragic case. CO2 since it's heavier than air can do the same very
easily. The medical effect is longer term exposure

Eugene
-----Original Message-----
From: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU> On
Behalf Of Osprey, James
Sent: Tuesday, October 2, 2018 7:31 PM
To: DCHAS-L**At_Symbol_Here**PRINCETON.EDU
Subject: Re: [DCHAS-L] Tragic Asphyxiation

I don't doubt the lethality of carbon dioxide at elevated concentrations but
I take issue with the describing CO2 as an asphyxiant. Unlike nitrogen which
functions as a displacer of oxygen, CO2 at elevated partial pressure has a
direct effect on human physiology. Concentration in excess of 10% v/v are
immediately dangerous to life. I recall some authorities reporting pretty
near instantaneous incapacity (possibly due to heart failure) at 20% v/v In
brewing/baking industries where operators have leant into vats/dough bins
and been unable to assist themselves. (I would add that in these last
incidents the concentrations were estimated post mortem).

However I can report that in my student days, whilst making home brewed beer
and leaning on the lid of the brew bin I was exposed to a puff of
fermentation gas which I can best describe as an explosion in my nasal
passages like being kicked in the face with a violent recoil. That was a
learning moment.

Post graduation I developed a range of IR analyzers, one of which was used
in saturation diving. At depth, the gas mix in the bell is heliox and the
CO2 concentration is strictly monitored to maintain a very low ppm.

At face value one might assume partial pressure should not exceed 500 Pa.
However the risk of stratification is very much higher at the extreme
pressures (especially as balance is predominately helium) and alarm action
levels may be set at much lower levels.

Perhaps someone can advise the physiological pathways that elevated partial
pressure of CO2 adversely influences the body, even when the oxygen partial
pressure is maintained at normal levels.

James Osprey C Phys

Novatech Analytical Solutions Inc.
+1 514 378 9076

Sent from my iPhone


> On Oct 2, 2018, at 5:59 PM, DCHAS Membership Chair <membership**At_Symbol_Here**DCHAS.ORG>
wrote:
>
> From: eugene_ngai**At_Symbol_Here**comcast.net <eugene_ngai**At_Symbol_Here**comcast.net>
> Subject: Tragic Asphyxiation
>
> A lot of discussion recently on Liquid Nitrogen safety. Here is a
> tragic example of asphyxiation
>
> http://www.koreaherald.com/view.php?ud=20180904000834
>
> Eugene Ngai
> Chemically Speaking LLC
>
> ---
> For more information about the DCHAS-L e-mail list, contact the
> Divisional membership chair at membership**At_Symbol_Here**dchas.org Follow us on
> Twitter **At_Symbol_Here**acsdchas

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