When it comes to drunkenness, some people think of the euphoria that comes with alcohol, and others think of the headaches of a hangover.
And for forensics, drunkenness often corresponds to all kinds of accidents.
One day, the district police station notified a police situation. In a company dormitory, a 23-year-old man was found dead on his bed.
We arrived immediately. This is a three-bedroom, one-bedroom residence where the deceased lived with two colleagues. The room was filled with a sour smell, and the deceased was lying on his back in his bed, fully clothed, with a small amount of vomit on the pillow and on the floor.
The two colleagues and roommates of the deceased reported that at the company dinner last night, the deceased drank 1 catty of liquor and 3 bottles of beer, then began to sit unsteadily, and finally collapsed to the ground. fell asleep.
The two colleagues took him back to the dormitory, laid him flat on the bed, and then went back to their rooms to rest. Unexpectedly, the next day, he died in his bed.
The scene was very simple, and no one came in but two colleagues. No injuries were seen on the deceased, nor was it found that the deceased was taking medicine. A subsequent autopsy found that the deceased’s blood alcohol concentration reached 4.68 mg/ml.
It is generally believed that blood alcohol levels above 4-5 mg/ml can be fatal [1]. Excessive alcohol intake can easily pass through the blood-brain barrier and enter the brain, inhibiting the motor center and respiratory center, and in severe cases, respiratory and circulatory failure may occur and death [2].
However, although the deceased’s blood alcohol concentration was in the lethal range, it remains to be tested whether he died of a high blood alcohol concentration.
Because in the practice of identification, there have been cases of death with a blood alcohol concentration of only 2.5 mg/ml, and reports of survival as high as 6 mg/ml [1].
Next, we found bleeding spots in the conjunctiva of the deceased’s eyes, and purple lips and nails, all signs of suffocation. The deceased may have died of suffocation.
So, could it be respiratory failure caused by high blood alcohol concentration?
We then examined the respiratory tract of the deceased and found obvious food and mucus in his respiratory tract (bronchioles and bronchioles), presumably from inhalation of vomit. Subsequent examinations found no serious lesions or damage to other organs of the deceased’s body.
Combining these details, we determined that the cause of death was inhalational asphyxia, which means that the deceased suffocated his own vomit and died .
The above cases of death by inhalation asphyxiation after drinking are actually very common in life.
It’s easy to vomit when drunk.
●On the one hand, after intoxication, the pharyngeal muscles relax and the swallowing reflex weakens or disappears. At this time, if you are in a supine position, when you are drunk and vomiting, the vomit will easily reflux directly in the throat and slide into the trachea, causing the trachea to be blocked and suffocated.
●On the other hand, if an intoxicated person sleeps on their back, vomit can easily be sucked into the respiratory tract by the nose, leading to blockage of the respiratory tract and suffocation [3].
At this point, the intoxicated person himself is in a state of lethargy, unconscious or unresponsive, often leading to tragedy.
And to avoid the recurrence of the tragedy, both the drinker and the caregiver should be aware of the need to “lie down on the side when drunk” to prevent aspiration of vomit and keep the airway open [ 4].
If an intoxicated person is found to have choked by aspiration, call 120 as soon as possible.
While waiting for emergency personnel to arrive, first remove vomit or food debris from the intoxicated person’s mouth and nose, never try to slap the back out of the obstruction, as this may cause the obstruction The substance penetrates deep into the respiratory tract, which is counterproductive.
If an intoxicated person is found to have cardiac arrest, chest compressions should be used for first aid to restore his cardiopulmonary function.
Methods for chest compressions:
●Cross and overlap both hands, palms down, one hand up, the other down, arms straight, and press the bone between the two breasts vertically.
●With its own gravity, it is transmitted vertically to the sternum through the arms and palms, and the pressure is transmitted to the heart and blood vessels to promote blood flow.
●The compression frequency should be 100~120 times/min, and the compression depth should be between 5~6 cm[5].
Drinking, the body’s ability to perceive and respond will decline, it is a very dangerous state, and various accidents often occur.
The easiest and most straightforward way to prevent accidents is to not drink alcohol.
Reviewer: Zhang Yuanchun| American Heart Association Cardiovascular Emergency Training Program Director Instructor
References
[1] Liu Liang. Forensic Toxicology [M]. 4th Edition. Beijing: People’s Health Publishing House, 2009.
[2] Chen Haozhu, Lin Guowei, Wang Jiyao. Practical Internal Medicine [M]. People’s Health Publishing House: Beijing, 2016: 820.
[3] Huang Xiaohong, You Meizhu. First aid experience of aspiration caused by acute alcohol poisoning [J]. China Health Nutrition (Middle Journal), 2014, 24(4): 2517.< /p>
[4] Liu Shiping, Cao Xiaoping, Qiu Li, Feng Fei. Application of tracheal intubation in the rescue of patients with acute alcoholism, vomiting and suffocation [J]. China Practical Medicine, 2016,11( 15):265-265,266.
[5]Tencent Medical Code: Cardiopulmonary Resuscitation
