Majdanik Sławomir, Orowicz Wiesława, Borowiak Krzysztof, Potocka-Banaś Barbara
Zakład Medycyny Sadowej Pomorskiej Akademii Medycznej w Szczecinie, al. Powstańców Wlkp. 72, 70-111 Szczecin.
Ann Acad Med Stetin. 2007;53 Suppl 2:125-8; discussion 128.
Carbon monoxide intoxications mainly occur as a result of fires in houses and failures of heating systems. Case of fatal accident involving a charcoal factory worker is described in this paper.
Authors based on a medico-legal autopsy protocol and material collected in prosecutor files. Medico-legal autopsy of a 46 year old male was performed in the forensic medicine department. Interlocutory proceedings indicated that the immediate cause of death was a head-crush caused by a hydraulic cover. Previously self-ignition in the factory was noted.
Autopsy revealed crushes of cervical spine involving the medulla. Where there were no sings of carbon monoxide intoxication. Due to unusual circumstances of the accident (self-ignition was detected by a carbon monoxide sensor and was treated by steam) additional toxicological test of autopsy material was performed. Twenty percent of carboxyhemoglobin was detected in blood collected from the heart cavity. In our opinion carbon monoxide may have been responsible for the accident.
Relatively low carboxyhemoglobin concentration in the blood is known to be an important cause of central nervous system abnormalities. Exposure to carbon monoxide may also result in an impaired response to danger. Sometimes carbon monoxide exposure does not lead to fatal intoxication, but may lead to a fatal accident. Regardless of a well noted immediate cause of death, a specific toxicological test must be involved in each medico-legal procedure, if exposition to various chemical substances is suspected.
一氧化碳中毒主要是由房屋火灾和供暖系统故障引起的。本文描述了一起涉及木炭厂工人的致命事故案例。
作者依据法医尸检报告及检察官档案中收集的材料。在法医学部门对一名46岁男性进行了法医尸检。中间程序表明，直接死因是液压盖导致的头部挤压伤。此前工厂曾发生自燃。
尸检显示颈椎挤压伤累及延髓。未发现一氧化碳中毒迹象。由于事故情况特殊（一氧化碳传感器检测到自燃并采用蒸汽处理），对尸检材料进行了额外的毒理学检测。从心脏采集的血液中检测到20%的碳氧血红蛋白。我们认为一氧化碳可能是事故的原因。
血液中碳氧血红蛋白浓度相对较低是中枢神经系统异常的重要原因。接触一氧化碳还可能导致对危险的反应受损。有时接触一氧化碳不会导致致命中毒，但可能导致致命事故。无论已明确的直接死因如何，如果怀疑接触了各种化学物质，在每一次法医程序中都必须进行特定的毒理学检测。
