Accidental fatal intoxication with Carbon Monoxide

Despite repeated warnings, newspaper reports of fatalities and public health and safety campaigns; accidental deaths from carbon monoxide poisoning continue to occur. They can be from accident, ignorance, criminal negligence or foolhardiness; what ever the reason such deaths are tragic and often avoidable. The case presented here was some of these. The physiology and biochemistry is discussed as well as other unusual causes of death by suffocation. This includes the use and abuse of helium from party balloons and nitrous oxide from the misuse of whipped cream dispensers provoking near suffocation and the occasional deaths, though fortunately rare. The request to attend a "sudden death", al though the death may often be many days, if not weeks old, is never pleasant. However, it is always instructive and often the most interesting, challenging and satisfying of all the work that a forensic medical examiner (FME) does. The approach should be methodical and with care and attention to detail. An awareness of the causes of injuries, forms and types of self-harm, presence of knives, drugs or weapons, and the changes after death are all part of the consideration that the experienced FME can bring to bear in assisting the police. Initial assessment if this is a natural death, a death by misadventure, a death by suicide or perhaps murder is all part of the work of the FME. Paramedics are now increasingly allowed to pronounce life extinct without any of the experience or forensic training of the FME and, in the case presented here, it is doubtful if the former would have spotted what had actually caused this death.