Accepted Manuscript Title: Suicidal carbon monoxide poisoning using a gas-powered generator Author: Katharina Bl¨asser Thomas Tatschner Michael Bohnert PII: DOI: Reference:
S0379-0738(13)00539-2 http://dx.doi.org/doi:10.1016/j.forsciint.2013.12.016 FSI 7444
To appear in:
FSI
Received date: Revised date: Accepted date:
4-10-2013 3-12-2013 15-12-2013
Please cite this article as: K. Bl¨asser, T. Tatschner, M. Bohnert, Suicidal carbon monoxide poisoning using a gas-powered generator, Forensic Science International (2013), http://dx.doi.org/10.1016/j.forsciint.2013.12.016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Acknowledgments
Acknowledgments We would like to thank the police and the fire brigade for their quick and uncomplicated assistance. Only their effective support enabled us to authentically simulate the event with suitable measuring instruments just a few
Ac
ce pt
ed
M
an
us
cr
ip t
hours after autopsy.
Page 1 of 11
Title Page (with authors and addresses)
Title page
Katharina Blässer, Thomas Tatschner, Michael Bohnert
Title:
Suicidal carbon monoxide poisoning using a gas-powered generator
Affiliation of all authors:
Institute of Legal Medicine, Julius-Maximilians-Universität Würzburg,
Address of all authors:
Versbacher Straße 3, 97078 Würzburg, Germany
cr
ip t
Authors:
Dr. med. Katharina Blässer
us
Full name, E-mail address, telephone and fax number of corresponding author:
an
katharina.blaesser@uni-wuerzburg,de telephone no.: 0049931/31-47020
Ac
ce pt
ed
M
fax no.: 0049931/31-47000
Page 2 of 11
*Manuscript (without author details)
Suicidal carbon monoxide poisoning using a gas-powered generator
Abstract
Purpose. The presented case deals with an unusual suicide by carbon monoxide poisoning. In a car parked in a highway rest area, the body of a middle-aged man was found. In the open trunk of the car there was a gas-
ip t
powered generator which was switched on, but no longer running. The tank was three quarters full. At autopsy, bright-red livores, cherry-pink fingernails, cherry-red blood and salmon-red skeletal musculature were found. According to the toxicological analysis performed during autopsy, the COHb content in the corpse blood was
cr
68%.
Methods. To reconstruct the event, the emergency generator was started again in the man’s car. By means of
us
measuring probes placed in the interior of the car, carbon monoxide, carbon dioxide and oxygen were measured and recorded in a concentration-time curve; the concentration of cyanide was measured at the end of the experiment.
an
Results. The lower explosion limit of 500 ppm CO was reached after 30 sec. already. For technical reasons, no further values could be recorded. After about 14 min. the engine started stuttering with approximately 14 vol%
The final concentration of cyanide was 7.5 ppm.
M
of oxygen in the air, but continued to run at a lower speed until the experiment was stopped after 25 minutes.
Conclusion: In view of the rapid CO increase in the interior of the vehicle it is to be assumed that the victim lost consciousness very fast.
ed
Introduction
Manuscript
ce pt
Key words: suicide, suicide method, carbon monoxide, gas-powered generator
Carbon monoxide is a colorless, odorless and tasteless gas, which originates from the incomplete combustion of carboniferous materials with a reduced presence of oxygen. Carbon monoxide poisoning is often seen in accidents or suicides; homicides using this method are rare [1, 2]. Cases of accidental carbon monoxide
Ac
poisoning are mostly observed with the use of gas heaters as an alternative energy source and also with indoor barbecues using charcoal briquettes [3]. Before coal gas was replaced by natural gas for residential heating and cooking, inhaling gas for carbon monoxide poisoning was one of the most common suicide methods in the USA, England and Western Europe [4]. In the USA, suicidal carbon monoxide poisoning by inhaling car exhaust gases has declined substantially since the introduction of federal emission standards in 1986. In England, where no comparable standards were introduced, the suicide rate of this suicide method did not drop [5]. In Germany, carbon monoxide poisoning also declined between 1987 and 1999 [6]. According to the authors, this seems to be due to the increasing number of cars equipped with catalytic converters. In a catalytic converter, carbon monoxide is oxidized to carbon dioxide. Furthermore, the authors were of the opinion that people choosing this method for committing suicide know that today it is technically no longer possible to use car exhaust for carbon monoxide poisoning. In Australia, however, the number of suicides committed by inhaling carbon monoxidecontaining exhaust gases continues to be high [7].
Page 3 of 11
The present case report deals with an unusual suicide by carbon monoxide poisoning in a car using a gaspowered generator.
Case report In a car parked in a rest area of a highway, the corpse of an about 50-year-old man was found at 7:40 a.m. (Fig.
ip t
1). The car had already been seen there by a truck driver the day before, but he had assumed that the man in the car was sleeping. The doors of the vehicle were closed, and apparently nothing of value had been removed from the vehicle. In the open trunk of the car, there was a gas-powered generator which was switched on, but no
cr
longer running; the tank was about three quarters full. Next to the exhaust pipe of the gas-powered generator, an about one meter long plastic tube was found running to the driver’s seat with minor melting marks in its initial
us
section (Fig. 2). On the passenger side of the car, an empty little bottle labeled "Promethazine" was lying in the foot well. Moreover, a small bag containing 3 g of marijuana was detected in the glove compartment. In his report, the investigating police officer stated that the deceased had been under psychiatric treatment for
an
depression and was taking promethazine. About 2 weeks before his death, his wife had decided to separate from him. She had seen him for the last time 2 days before his death when he told her that he would leave for a few days to clear his mind. No suicide note was found. The evaluation of the man’s BlackBerry showed that he had
M
deleted the data card before his death.
As the circumstances suggested suicide, a judicial autopsy was ordered to clarify the cause of death. The
ed
autopsy showed bright-red livores, cherry-pink fingernails, salmon-red skeletal musculature as well as cherry-red blood. The mucous membranes and the internal organs were bright-red in color. In the area of the entrance to the larynx, some streak-like black smears were found. The bronchi contained a small amount of a mucous material.
ce pt
There was marked brain swelling. No external or internal injuries were found. In the toxicological analysis done during autopsy, a carbon monoxide-hemoglobin content of 68% was determined in the cardiac blood. Microscopic examination revealed blood congestion and edema of the cerebrum, cerebellum and medulla oblongata. In the lungs, massive edema and acute emphysema were discernible. The promethazine level in the
Ac
blood was very high (1.5 µg/ml) (therapeutic dose from 0.05 to 0.2 µg/ml) [8].
Reconstruction
To answer the questions how long the gas-powered generator had been running and how quickly the concentration of carbon monoxide would go up, the progression of events was simulated using the decedent’s car. A measuring probe was placed on the driver’s seat to determine the concentrations of the gases in the air. The doors were closed and the gas-powered generator was started; the concentrations of carbon monoxide, carbon dioxide and oxygen were measured every 30 sec. The cyanide concentration was determined at the end of the experiment.
Results
Page 4 of 11
The lower explosion limit of 500 ppm carbon monoxide was reached after 30 sec already. Because of the limited measurement range of the probe no further measurements of carbon monoxide could be made. As expected, a linear decrease of the oxygen and an increase of the carbon dioxide was seen during the first 14 minutes. With approximately 14 vol% of oxygen in the air the engine started sputtering because of the lack of fresh air, but continued to run at a lower speed until the experiment was stopped after 25 minutes. The final concentration of cyanide in the interior of the car was 7.5 ppm. The engine was running at a lower speed until the end of the
ip t
experiment. The exact gas concentrations of O2 and CO2 in the car are indicated in diagram 1.
Discussion
cr
Scientific literature does not contain many case reports about carbon monoxide poisoning using a generator in a closed space; one case reports a suicide in an electric car by inhaling carbon monoxide from the exhaust of a
us
generator [9]. Nowadays, carbon monoxide poisoning by inhaling exhaust gases seems nearly impossible because of the catalytic converter technology. Most deaths caused by inhaling auto exhausts today are attributed to carbon dioxide poisoning and lack of oxygen [10]. In one case, an attempted suicide is reported where the
an
victim inhaled exhaust gases for about 5 hours, but thanks to the catalytic converter of the car “only” lost consciousness in spite of a carbon monoxide-hemoglobin concentration of 21% [11]. Nevertheless it is to be mentioned that the detoxification by a catalytic converter is less effective immediately after the engine is started
M
so that carbon monoxide intoxications can even occur in cars equipped with a catalytic converter.
In the case presented here, death was caused by chemical asphyxia due to the inhalation of carbon monoxide-
ed
containing exhaust gases. The pathophysiological mechanism of this process is based on the high affinity of the carbon monoxide molecule to the human hemoglobin molecule, which is about 250-300 times stronger than the affinity of the oxygen molecule. As a consequence, the hemoglobin circulating in the human body is increasingly
ce pt
"taken" by the carbon monoxide and is no longer available for the transport of oxygen. The result is a deficient supply of oxygen and finally death by chemical asphyxia. Inhaling carbon monoxide-containing exhaust gases in the open air can already be fatal after 1-2 minutes; the carbon monoxide-hemoglobin content can rise up to 80%
Ac
[12, 7].
Conclusion
It is to be assumed that the man became unconscious after a very short time due to the quickly rising carbon monoxide concentration in the interior of the vehicle. The autopsy findings showed changes typical of carbon monoxide intoxication. The facts reported about the man’s life revealed emotional problems and the use of psychotropic drugs. Thus, suicide seemed plausible. Overview studies found that in the blood of people inhaling carbon-monoxide-containing gases with suicidal intent psychotropic drugs were the most frequently detected drugs compared with other drugs [13].
We were surprised how long the engine of the gas-powered generator kept running; after 25 minutes, the engine was still running at a reduced speed although the oxygen content in the interior of the vehicle was less than 14 vol%.
Page 5 of 11
References [1] P. Theilade, Carbon monoxide poisoning. Five years' experience in a defined population, Am. J. Forensic Med. Pathol. (1990);11:219-225. [2] N. Cobb, R.A. Etzel, Unintentional carbon monoxide-related deaths in the United States, 1979-1988,
ip t
J.A.M.A. (1991);266:659-663.
[3] A. Llana, T.Raffin, Management of carbon monoxide poisoning, Chest (19909;97:165-169.
[4] N. Kreitman, The Coal gas story-United Kingdom suicide rates 1960-71, Br. J. Prev. Soc. Med. (1976);30:86.
the United States, J. Epidemiol. Community Health (1987);41:114-120.
cr
[5] R.V.Clarke, D.Lester, Toxicity of car exhausts and opportunity for suicide: Comparison between Britain and
us
[6] T. Riepert, R. Iffland, H. Käferstein, Rückgang der Suizide durch Autoabgase nach Einführung der Katalysatortechnik, Rechtsmed. (2002); 12:24-27.
[7] A. Ruszkiewicz, B. De Boer, S. Robertson, Unusual presentation of death due to carbon monoxide poisoning:
an
a report of two cases, Am. J. Forensic Med. Pathol.(1997);18(2):181-184.
[8] M. Schulz, A. Schmold, Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics, Pharmazie (2003);58:447-474.
M
[9] M. Bohnert, U. Zollinger, Suizidale Kohlenmonoxidvergiftung im Elektromobil, Arch. Kriminol. (1994);194:145-148.
[10] G.A. Schmunk, J.A. Kaplan, Asphyxial Deaths Caused by Automobile Exhaust Inhalation not Attributable
ed
to Carbon Monoxide Toxicity: Study of 2 Cases, Am. J. Forensic Med. Pathol. (2002);23:123–126. [11] J.T. O'Brien, A.F. Tarbuck, Suicide and vehicle exhaust emissions, B.M.J. (1992); 304:1376. [12] V.J.M. DiMaio, S.E. Dana, Deaths caused by carbon monoxide poisoning in an open environment
ce pt
(outdoors), J. Forensic Sci. (1987);32:1794-1795.
[13] L.M. Przepyszny, A.J. Jenkins, The Prevalence of Drugs in Carbon Monoxide–Related Deaths A Retrospective Study, 2000–2003, Am. J. Forensic Med. Pathol. (2007);28:242-248.
Ac
Figures
Fig.1 Body of the deceased as found in the car.
Fig.2 Gas-powered generator in the trunk of the car with green plastic tube running from the exhaust pipe to the driver’s seat.
Page 6 of 11
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Figure
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Figure
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Figure
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Figure
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diagram 1: Development of the breathing gas concentration.
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Figure
Page 11 of 11
S0379-0738(13)00539-2 http://dx.doi.org/doi:10.1016/j.forsciint.2013.12.016 FSI 7444
To appear in:
FSI
Received date: Revised date: Accepted date:
4-10-2013 3-12-2013 15-12-2013
Please cite this article as: K. Bl¨asser, T. Tatschner, M. Bohnert, Suicidal carbon monoxide poisoning using a gas-powered generator, Forensic Science International (2013), http://dx.doi.org/10.1016/j.forsciint.2013.12.016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Acknowledgments
Acknowledgments We would like to thank the police and the fire brigade for their quick and uncomplicated assistance. Only their effective support enabled us to authentically simulate the event with suitable measuring instruments just a few
Ac
ce pt
ed
M
an
us
cr
ip t
hours after autopsy.
Page 1 of 11
Title Page (with authors and addresses)
Title page
Katharina Blässer, Thomas Tatschner, Michael Bohnert
Title:
Suicidal carbon monoxide poisoning using a gas-powered generator
Affiliation of all authors:
Institute of Legal Medicine, Julius-Maximilians-Universität Würzburg,
Address of all authors:
Versbacher Straße 3, 97078 Würzburg, Germany
cr
ip t
Authors:
Dr. med. Katharina Blässer
us
Full name, E-mail address, telephone and fax number of corresponding author:
an
katharina.blaesser@uni-wuerzburg,de telephone no.: 0049931/31-47020
Ac
ce pt
ed
M
fax no.: 0049931/31-47000
Page 2 of 11
*Manuscript (without author details)
Suicidal carbon monoxide poisoning using a gas-powered generator
Abstract
Purpose. The presented case deals with an unusual suicide by carbon monoxide poisoning. In a car parked in a highway rest area, the body of a middle-aged man was found. In the open trunk of the car there was a gas-
ip t
powered generator which was switched on, but no longer running. The tank was three quarters full. At autopsy, bright-red livores, cherry-pink fingernails, cherry-red blood and salmon-red skeletal musculature were found. According to the toxicological analysis performed during autopsy, the COHb content in the corpse blood was
cr
68%.
Methods. To reconstruct the event, the emergency generator was started again in the man’s car. By means of
us
measuring probes placed in the interior of the car, carbon monoxide, carbon dioxide and oxygen were measured and recorded in a concentration-time curve; the concentration of cyanide was measured at the end of the experiment.
an
Results. The lower explosion limit of 500 ppm CO was reached after 30 sec. already. For technical reasons, no further values could be recorded. After about 14 min. the engine started stuttering with approximately 14 vol%
The final concentration of cyanide was 7.5 ppm.
M
of oxygen in the air, but continued to run at a lower speed until the experiment was stopped after 25 minutes.
Conclusion: In view of the rapid CO increase in the interior of the vehicle it is to be assumed that the victim lost consciousness very fast.
ed
Introduction
Manuscript
ce pt
Key words: suicide, suicide method, carbon monoxide, gas-powered generator
Carbon monoxide is a colorless, odorless and tasteless gas, which originates from the incomplete combustion of carboniferous materials with a reduced presence of oxygen. Carbon monoxide poisoning is often seen in accidents or suicides; homicides using this method are rare [1, 2]. Cases of accidental carbon monoxide
Ac
poisoning are mostly observed with the use of gas heaters as an alternative energy source and also with indoor barbecues using charcoal briquettes [3]. Before coal gas was replaced by natural gas for residential heating and cooking, inhaling gas for carbon monoxide poisoning was one of the most common suicide methods in the USA, England and Western Europe [4]. In the USA, suicidal carbon monoxide poisoning by inhaling car exhaust gases has declined substantially since the introduction of federal emission standards in 1986. In England, where no comparable standards were introduced, the suicide rate of this suicide method did not drop [5]. In Germany, carbon monoxide poisoning also declined between 1987 and 1999 [6]. According to the authors, this seems to be due to the increasing number of cars equipped with catalytic converters. In a catalytic converter, carbon monoxide is oxidized to carbon dioxide. Furthermore, the authors were of the opinion that people choosing this method for committing suicide know that today it is technically no longer possible to use car exhaust for carbon monoxide poisoning. In Australia, however, the number of suicides committed by inhaling carbon monoxidecontaining exhaust gases continues to be high [7].
Page 3 of 11
The present case report deals with an unusual suicide by carbon monoxide poisoning in a car using a gaspowered generator.
Case report In a car parked in a rest area of a highway, the corpse of an about 50-year-old man was found at 7:40 a.m. (Fig.
ip t
1). The car had already been seen there by a truck driver the day before, but he had assumed that the man in the car was sleeping. The doors of the vehicle were closed, and apparently nothing of value had been removed from the vehicle. In the open trunk of the car, there was a gas-powered generator which was switched on, but no
cr
longer running; the tank was about three quarters full. Next to the exhaust pipe of the gas-powered generator, an about one meter long plastic tube was found running to the driver’s seat with minor melting marks in its initial
us
section (Fig. 2). On the passenger side of the car, an empty little bottle labeled "Promethazine" was lying in the foot well. Moreover, a small bag containing 3 g of marijuana was detected in the glove compartment. In his report, the investigating police officer stated that the deceased had been under psychiatric treatment for
an
depression and was taking promethazine. About 2 weeks before his death, his wife had decided to separate from him. She had seen him for the last time 2 days before his death when he told her that he would leave for a few days to clear his mind. No suicide note was found. The evaluation of the man’s BlackBerry showed that he had
M
deleted the data card before his death.
As the circumstances suggested suicide, a judicial autopsy was ordered to clarify the cause of death. The
ed
autopsy showed bright-red livores, cherry-pink fingernails, salmon-red skeletal musculature as well as cherry-red blood. The mucous membranes and the internal organs were bright-red in color. In the area of the entrance to the larynx, some streak-like black smears were found. The bronchi contained a small amount of a mucous material.
ce pt
There was marked brain swelling. No external or internal injuries were found. In the toxicological analysis done during autopsy, a carbon monoxide-hemoglobin content of 68% was determined in the cardiac blood. Microscopic examination revealed blood congestion and edema of the cerebrum, cerebellum and medulla oblongata. In the lungs, massive edema and acute emphysema were discernible. The promethazine level in the
Ac
blood was very high (1.5 µg/ml) (therapeutic dose from 0.05 to 0.2 µg/ml) [8].
Reconstruction
To answer the questions how long the gas-powered generator had been running and how quickly the concentration of carbon monoxide would go up, the progression of events was simulated using the decedent’s car. A measuring probe was placed on the driver’s seat to determine the concentrations of the gases in the air. The doors were closed and the gas-powered generator was started; the concentrations of carbon monoxide, carbon dioxide and oxygen were measured every 30 sec. The cyanide concentration was determined at the end of the experiment.
Results
Page 4 of 11
The lower explosion limit of 500 ppm carbon monoxide was reached after 30 sec already. Because of the limited measurement range of the probe no further measurements of carbon monoxide could be made. As expected, a linear decrease of the oxygen and an increase of the carbon dioxide was seen during the first 14 minutes. With approximately 14 vol% of oxygen in the air the engine started sputtering because of the lack of fresh air, but continued to run at a lower speed until the experiment was stopped after 25 minutes. The final concentration of cyanide in the interior of the car was 7.5 ppm. The engine was running at a lower speed until the end of the
ip t
experiment. The exact gas concentrations of O2 and CO2 in the car are indicated in diagram 1.
Discussion
cr
Scientific literature does not contain many case reports about carbon monoxide poisoning using a generator in a closed space; one case reports a suicide in an electric car by inhaling carbon monoxide from the exhaust of a
us
generator [9]. Nowadays, carbon monoxide poisoning by inhaling exhaust gases seems nearly impossible because of the catalytic converter technology. Most deaths caused by inhaling auto exhausts today are attributed to carbon dioxide poisoning and lack of oxygen [10]. In one case, an attempted suicide is reported where the
an
victim inhaled exhaust gases for about 5 hours, but thanks to the catalytic converter of the car “only” lost consciousness in spite of a carbon monoxide-hemoglobin concentration of 21% [11]. Nevertheless it is to be mentioned that the detoxification by a catalytic converter is less effective immediately after the engine is started
M
so that carbon monoxide intoxications can even occur in cars equipped with a catalytic converter.
In the case presented here, death was caused by chemical asphyxia due to the inhalation of carbon monoxide-
ed
containing exhaust gases. The pathophysiological mechanism of this process is based on the high affinity of the carbon monoxide molecule to the human hemoglobin molecule, which is about 250-300 times stronger than the affinity of the oxygen molecule. As a consequence, the hemoglobin circulating in the human body is increasingly
ce pt
"taken" by the carbon monoxide and is no longer available for the transport of oxygen. The result is a deficient supply of oxygen and finally death by chemical asphyxia. Inhaling carbon monoxide-containing exhaust gases in the open air can already be fatal after 1-2 minutes; the carbon monoxide-hemoglobin content can rise up to 80%
Ac
[12, 7].
Conclusion
It is to be assumed that the man became unconscious after a very short time due to the quickly rising carbon monoxide concentration in the interior of the vehicle. The autopsy findings showed changes typical of carbon monoxide intoxication. The facts reported about the man’s life revealed emotional problems and the use of psychotropic drugs. Thus, suicide seemed plausible. Overview studies found that in the blood of people inhaling carbon-monoxide-containing gases with suicidal intent psychotropic drugs were the most frequently detected drugs compared with other drugs [13].
We were surprised how long the engine of the gas-powered generator kept running; after 25 minutes, the engine was still running at a reduced speed although the oxygen content in the interior of the vehicle was less than 14 vol%.
Page 5 of 11
References [1] P. Theilade, Carbon monoxide poisoning. Five years' experience in a defined population, Am. J. Forensic Med. Pathol. (1990);11:219-225. [2] N. Cobb, R.A. Etzel, Unintentional carbon monoxide-related deaths in the United States, 1979-1988,
ip t
J.A.M.A. (1991);266:659-663.
[3] A. Llana, T.Raffin, Management of carbon monoxide poisoning, Chest (19909;97:165-169.
[4] N. Kreitman, The Coal gas story-United Kingdom suicide rates 1960-71, Br. J. Prev. Soc. Med. (1976);30:86.
the United States, J. Epidemiol. Community Health (1987);41:114-120.
cr
[5] R.V.Clarke, D.Lester, Toxicity of car exhausts and opportunity for suicide: Comparison between Britain and
us
[6] T. Riepert, R. Iffland, H. Käferstein, Rückgang der Suizide durch Autoabgase nach Einführung der Katalysatortechnik, Rechtsmed. (2002); 12:24-27.
[7] A. Ruszkiewicz, B. De Boer, S. Robertson, Unusual presentation of death due to carbon monoxide poisoning:
an
a report of two cases, Am. J. Forensic Med. Pathol.(1997);18(2):181-184.
[8] M. Schulz, A. Schmold, Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics, Pharmazie (2003);58:447-474.
M
[9] M. Bohnert, U. Zollinger, Suizidale Kohlenmonoxidvergiftung im Elektromobil, Arch. Kriminol. (1994);194:145-148.
[10] G.A. Schmunk, J.A. Kaplan, Asphyxial Deaths Caused by Automobile Exhaust Inhalation not Attributable
ed
to Carbon Monoxide Toxicity: Study of 2 Cases, Am. J. Forensic Med. Pathol. (2002);23:123–126. [11] J.T. O'Brien, A.F. Tarbuck, Suicide and vehicle exhaust emissions, B.M.J. (1992); 304:1376. [12] V.J.M. DiMaio, S.E. Dana, Deaths caused by carbon monoxide poisoning in an open environment
ce pt
(outdoors), J. Forensic Sci. (1987);32:1794-1795.
[13] L.M. Przepyszny, A.J. Jenkins, The Prevalence of Drugs in Carbon Monoxide–Related Deaths A Retrospective Study, 2000–2003, Am. J. Forensic Med. Pathol. (2007);28:242-248.
Ac
Figures
Fig.1 Body of the deceased as found in the car.
Fig.2 Gas-powered generator in the trunk of the car with green plastic tube running from the exhaust pipe to the driver’s seat.
Page 6 of 11
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Figure
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Figure
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Figure
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Ac ce p
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Figure
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Ac
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ed
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an
diagram 1: Development of the breathing gas concentration.
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Figure
Page 11 of 11
