Emergency management after attempted suicide due to inhalation of a gas mixture in environmental depletion of oxygen and high nitrogen concentration – a case report
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Mazowieckie Centrum Rehabilitacji Sp. z o.o., Szpital Chirurgii Urazowej św. Anny, Oddział Anestezjologii i Intensywnej Terapii, Polska
Jacek Wadełek   

Mazowiekie Centrum Rehabilitacji Sp z o.o Szpital Chirurgii Urazowej sw.Anny Oddział Anestezjologii i Intensywnej Terapii, ul. Barska 16/20, 02-315, Warszawa, Polska
Med Og Nauk Zdr. 2020;26(3):309–313
Because 78% of the air we breathe is nitrogen gas, many people assume that nitrogen is not harmful. However, nitrogen is safe to breathe only when mixed with the appropriate amount of oxygen. Depending on the concentration of nitrogen a person is exposed to, the signs and symptoms progress from sudden unconsciousness to death due to asphyxiation. The study presents a case of an unconscious patient after attempted suicide, due to breathing air depleted in oxygen.

Case report:
A 38-year-old male fruit-grower was brought from his home by emergency services and admitted to the hospital emergency room in an unconscious state, with brief episodes of myoclonus and seizure. The patient had been found by family members in the controlled atmosphere of a cooling storage room. The controlled atmosphere was carefully regulated with an atmosphere containing a very low level of oxygen – 1.5%, carbon dioxide – 1.5% and gaseous nitrogen – 98%. Patient’s family carried him out of controlled atmosphere storage room and called for emergency services and a Medical Team brought the patient to the Emergency Department of the regional hospital. In the ambulance, the patient was given oxygen via face mask – 6l/min, and the peripheral vein was secured for intravenous infusion, which was started with 500ml of electrolyte solution. Myoclonus and seizure was treated with iv, diazepam in a dosage of 10mg. The patient had no signs of head injury. During hospital diagnostics and treatment, the patient required medication to control a brief episodes of myoclonus and seizure. Patient regained consciousness with logical verbal contact.

Lack of sufficient oxygen concentration due to a rise in the nitrogen concentration of breathing gases endangers human and animal life.

Azot; Wikipedia.
European Industrial Gases Association, Hazards of Inert Gases and Oxygen Depletion. 2009; IGC Doc 44/09/E.
MacIntyre NR. Tissue hypoxia: implications for the respiratory clinician. Respir Care. 2014; 59(10): 1590–6.
Gaseous nitrogen. Safetygram 2. Air Products. Internet.
Inerting in the chemical industry.
Use Nitrogen Safely. 2012.
Edlow J, Rabinstein A, Traub S, Wijdicks E. Diagnosis of reversible causes of coma. Lancet. 2014; 384: 206476.
Cooksley T, Holland M. The management of coma. Medicine. 2017; 45: 115–19.
Braun M, Schmidt WU, Mockel M, Romer M, et al. Coma of unknown origin in the emergency department: implementation of an in-house management routine. Scand J Trauma Resusc Emerg Med. 2016; 24: 61.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 304: 81–84.
Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010; 17(3): 348–55.