by D P Lyle
Xanax comes in white oval tablets of .25 milligram (mg), 0.5 mg (peach), and 1 mg (light blue). It also comes in a white oblong 2 mg tablet. It dissolves easily and is well absorbed by the GI tract. It reaches its peak effect about one to two hours after ingestion, but its effects would begin to appear in less than half an hour.
Now to your specific questions:
Yes, it would begin to act quickly—a half hour or perhaps less if the victim consumed a large amount of alcohol beforehand. The victim would become lethargic and have slurred speech, poor coordination, and confusion. He might stagger and even fall. He would
speak slowly with a thick tongue, and his words may not make sense. In short, he would appear very intoxicated. He would soon lose consciousness, after which his respirations would decline and finally cease. Death would then follow in a few minutes.
The rapidity with which this process unfolds would depend on many factors, but if you give him an hour, you'll be okay. More is better, but as little as thirty minutes would also work.
One problem with Xanax is that it requires several tablets to do the trick. This depends, of course, on how much alcohol the victim downed. If he is intoxicated before the loaded drink is given, less Xanax is required. If your killer crushes ten of the 2 mg tablets, that should do it. If the victim is already intoxicated, he likely won't notice any alteration in the taste of his drink. This is particularly true if you use some flavored concoction rather than Scotch.
What Substance Can Be Added to a Fire-Eater's "Fuel" to Cause a Sudden and Dramatic Death?
Q: I want to kill off a street performer, a fire-eater in Madrid, by substituting or adding a substance to the clear liquid these people swish in their mouth and then blow out to be ignited. Since they don't actually swallow the liquid, I need something that is very deadly, won't alter the clear nature of the liquid, and hopefully won't be immediately detected when the liquid enters the mouth. Also, I'd like the death to be relatively quick and dramatic.
A: Cyanide is quick, nasty, and very effective. It kills instantly. The person will suddenly become short of breath, may clutch his chest as if having a heart attack, may suffer a seizure, may foam at the mouth, and will definitely fall over dead. Since cyanide is a metabolic poison, which means it poisons the body's cells so that they
cannot use oxygen, even if some bystander began CPR or other life-saving measure, the victim would die anyway. Effective CPR would supply blood and oxygen to the tissues, but the cyanide would prevent the tissues from using the oxygen, so death would be the result regardless.
Cyanide comes as a powder in the form of potassium cyanide (KCN) and sodium cyanide (NaCN). It dissolves easily in most liquids and requires only a tiny amount to be deadly. It has a slight bitter almond smell and taste, which would be undetectable in the flammable liquid.
In your scenario the fire-eater would take a mouthful of the liquid and within a few seconds clutch his throat or chest, spit out the liquid, gasp for breath, cry out for help, collapse to the ground (with or without a seizure), and die quickly.
One caveat: The person handling the cyanide should not let it contact his skin since it is readily absorbed through the skin. The use of rubber gloves would be safest.
Cyanide is used in metal plating and tanning and can be obtained from many chemical supply houses or stolen by your villain from any place that plates jewelry or uses it in other ways.
MEDICAL MURDER
How Can Someone Who Is Undergoing Heart Surgery Be Murdered?
Q: I need help with a hospital scene. The bad guys decide to execute a very successful and powerful enemy while he is in the hospital undergoing a heart bypass operation. The plan is a strike against the hospital's primary and redundant power sources, effectively imperiling all patients in the hospital or wing, not just the intended. Now the questions: How does one take down the hospital power grid and its backup systems? Where is the most ticklish point of the bypass surgery to have a power loss?
A: Most hospitals have backup generators that switch on automatically when the power supply is interrupted. I suspect that most of these systems are computer controlled, so your villain can approach the problem in several ways.
He could attack the computers and effectively shut down both the main power and the backup generator at will. A good hacker could tamper with the control program, and then they could be shut off on command—maybe by remote control with a wireless modem.
Or he could disengage or disable the backup and then cut the main power supply by severing the hospital's incoming power line or knocking out the local power station. That would deal with the power supply to the entire hospital but would not completely resolve your problem.
In cardiac surgery the patient is typically placed on a heart-lung machine, which acts as his heart and lungs by circulating and oxygenating the blood while the operation is being performed. The pump is dependent on a power supply to function, but these gadgets have both an internal backup battery supply as well as a hand-crank system for just such power loss situations. This means that your bad guys would have to tamper with the heart-lung pump itself. They would need to damage or disconnect the battery or its cables, or mangle the gears and pulleys that are part of the hand-crank system.
These heart-lung machines are typically kept within the surgical suites (operating rooms) of the hospital, an area that has restricted access. Still, someone with knowledge of the layout could sneak in, especially at night when fewer staff members are on duty.
Or an insider could be involved. The best person for this would be either someone in the bioengineering department (called biotechs for short) or one of the technicians who run the heart-lung machine (called pump techs).
The biotechs maintain and repair most of the medical gadgetry in the hospital. Some techs can fix anything, while others have to call in repairmen from the various manufacturers or independent biomedical repair companies more frequently. Your tech could be the insider, or the accomplice could be the outside tech he called in. Either would work.
Most major medical centers have pump techs on staff, while smaller hospitals contract to outside companies for techs who come in and work on a case-by-case basis. The in-house techs have easy access to the machines any time they aren't in use. For the contracted tech, things would be more difficult. Since he goes into the OR only when a case is scheduled and since there are always several nurses and operating room technicians around preparing for surgery, he would have to be fairly slick to tamper with the backup systems. It's possible, just more difficult.
The best time to attack the power supply would be during the operation. That is when the patient/victim would be most vulnerable. If your villains could accomplish their tampering after the patient/victim is "on bypass," on the heart-lung machine, a loss of power would be potentially fatal. During the surgery, the heart is stopped by a combination of cooling the blood and delivering a large dose of potassium. (We call this "cold cardioplegia.") After the operation, the heart-lung machine rewarms the blood and washes out the potassium; then the heart resumes beating on its own. This takes ten to fifteen minutes or more to accomplish.
If the power and the backup systems failed, the surgeon would be left with only internal cardiac massage to maintain blood flow and keep the patient alive. Internal cardiac massage is simply squeezing the heart rhythmically with your hand. The surgeon would then begin giving the patient warmed blood and intravenous fluids in an attempt to rewarm the patient and wash out the potassium. This would be difficult and could take as much as half an hour to an hour without the aid of a functioning heart-lung machine. But this is what they get the big bucks for. Failure to do so would certainly result in the patient's death, which is what you want.
Of course, the patient/victim could survive this event or not, as you wish. Either way is plausible. If he is to survive, the surgeon must give the warmed blood and fluids rapidly, close up any of the coronary arteries he had been working on, close up the patient's chest, and get him to the ICU as quick
ly as possible. Meanwhile, the biomedical people would work frantically to repair the machine.
This is good stuff, an exciting scene.
What Dose of Morphine Would Kill a Man Undergoing Cancer Treatment?
Q: My victim is in the final stages of metastatic lung cancer and is taking morphine intravenously at home, administered by a pump. For a 145-pound male who is seventy-six years of age, what might a typical dosage be? Would twice that amount cause a deadly overdose?
A; Metastatic lung cancer can be a very painful disease. Cancers that originate in the lung often metastasize (spread) to the liver, the brain, and the bones. In medical jargon these metastatic lesions are often referred to as "mets." Brain mets tend to enlarge within the closed space inside the skull and also cause swelling of the surrounding brain tissue. The net effect is a rise in intracranial (inside the skull or cranium) pressure. This can cause severe continuous headaches. Mets to bones such as the ribs and the spine can be extremely painful. For this reason narcotics such as morphine sulfate (MS), Demerol, Dilaudid, and others are commonly used. In an individual with terminal cancer the risk of addiction is of little concern.
The chosen analgesic (pain reliever) may be given by intermittent injections or by use of one of the automated methods. Continuous infusion pumps and patient-controlled analgesia (PCA) are commonly employed in this circumstance. The former is by definition a continuous infusion of fluid containing the sedating drug, usually MS. PCA is a system of IV delivery that allows the patient to control the timing of delivery within preprescribed parameters. Here, a syringe filled with the MS is placed in an automatic injector that is attached to the patient's IV line. The injector delivers a prescribed amount of the drug when the patient depresses a handheld button. Parameters are set to limit the amount that can be
requested per hour. Within these limits, the patient may use as much or as little as he feels is necessary.
As with many medications, the dosing of MS is determined by the patient's weight. The dosing schedule in most patients ranges from 0.2 to 0.4 milligram (mg) per kilogram (kg) of body weight per hour and then is titrated (a gradual increase in dose) upward as needed. Since one kilogram equals 2.2 pounds, your 145-pound (66 kg) patient would require approximately 13 to 26 mg per hour. However, in patients who have been on the continuous drip or PCA for weeks or months, tolerance to the drug develops, just as it does in addicts. Therefore, larger and larger doses are needed to obtain the same sedating and pain-relieving effect. Some patients in this situation require doses as high as 500 mg per hour, which is enough to kill even the strongest person not habituated to the drug.
In large doses MS depresses respiration and drops the blood pressure. If enough is given, the recipient will stop breathing, his blood pressure will fall to dangerously low levels, and he will die from apnea (absence of breathing) and shock. The dose required to kill someone depends on the rate of delivery, the underlying medical condition of the victim, and whether the victim has developed tolerance to the drug.
Doubling the dose at any given level may or may not be enough to be lethal. For example, if a patient was receiving 60 mg per hour and the rate was doubled to 120 mg per hour, it probably wouldn't do him in, though it certainly could do in a debilitated man with terminal lung cancer. Raising it to 240 mg per hour (quadruple) probably would work. A half hour to two or three hours at this increased rate may be required to do the victim in.
On the other hand, if given as a single injection, an extra 20 to 40 mg might be enough. Since the person on a drip of 60 mg per hour receives 1 mg per minute, giving 20 to 40 mg over a few seconds is a large increase in dose and would probably work. MS works rapidly, within a minute or so, when given as a bolus (a single, rapid injection), so you are actually increasing the dose from 1 mg per minute to 41 mg per minute—a huge increase that would likely cause apnea and shock almost instantaneously.
So either markedly increasing the rate of administration (by increasing the drip rate or the concentration of the drug per cubic centimeter of fluid, or both) or giving a bolus of the drug would accomplish your goal in this situation.
Additionally, patients with lung cancer often have sicker lungs, not just from the cancer itself but from surgery that removes part or all of one lung and radiation therapy or chemotherapy, which may damage the good lung tissue. In this case, even smaller amounts might work.
I suggest either quadrupling the rate or giving 40 mg as an IV bolus, depending on which scenario fits your story best.
Can a Transfusion Reaction Be Used for Murder?
Q: In my story an elderly and seriously ill man is murdered by a nurse who switches the blood he is to receive, causing a reaction that kills him. How does this reaction occur, and what symptoms would the victim have?
A: Transfusion reactions come in many varieties. They may be as mild as a rash or perhaps chills and fevers, or be so severe as to cause death. First let's look at why these reactions occur.
The red blood cells (RBCs) are the carriers of oxygen from the lungs to the tissues and of carbon dioxide from the tissues to the lungs. This is accomplished by using the hemoglobin inside the RBCs. The RBCs also have antigens on their surface, and they are at the root of transfusion reactions.
These antigens are designated either A or B. From these our blood-typing system (ABO system) has been derived. Type A blood lias only A antigens, type B only B antigens, type AB both, and type O neither.
Simple, so far. But the serum of the blood (the liquid part) also carries antibodies. It is the reaction of these antibodies with the antigens of the transfused blood that causes problems.
Type A serum (that is, the serum of people with type A blood) has anti-B antibodies. Type B has anti-A antibodies. Type AB has neither. Type O has both anti-A and anti-B antibodies.
Reactions occur when blood with the right antigen is given to a person with the its corresponding antibody. For example, if a type A person (who has anti-B antibodies in the serum) receives type B blood (which has the B antigen on its RBCs) or type AB blood (which has both A and B antigens), an adverse reaction will occur because the anti-B antibodies in the recipient's serum will react with the B antigens on the transfused RBCs. This is a transfusion reaction. The result is agglutination, or clumping, of the blood cells and the release of several harmful chemicals that cause the symptoms and signs of this basically "allergic" reaction.
It gets more complicated than this because there are other antigen/ antibody problems with blood matching such as the well-known Rh factor, which is either positive or negative, and many others, mostly named after the physicians that discovered them. Your blood type is typically expressed only in terms of the ABO and Rh systems. For example, a person who is A-positive has type A blood and the Rh factor antigen is present, while a person who is O-negative has type O blood and the Rh factor is absent.
Because of the multitude of potentially problematic antigens, blood is typed and cross-matched prior to transfusion. This tests the blood that is to be given directly against the recipient's blood to determine if any antigens and antibodies exist that might cause the blood to be incompatible and thus lead to reactions. In very emergent situations such as gunshots, stabbings, or automobile accidents where the victim is bleeding to death and there isn't time to do a complete cross-match, type-specific blood is given. A person's blood type can be determined in a few minutes, but cross-matching may take hours. In these cases a type A person receives type A blood, and everyone hopes for the best.
In your story I would suggest that you have your victim be type A and have the nurse switch the blood to type B. This would definitely cause a reaction. The patient would develop fever, chills, and a diffuse, irregular red rash over his entire body. This could begin within minutes or be delayed for a few hours. This type of reaction would not likely result in death.
However, your victim could develop a full-blown anaphylactic allergic reaction, which would be the above symptoms plus swelling of the face, lips, hands, and fe
et, shortness of breath, low blood pressure, and severe shock with pallor, cold and clammy skin, and a bluish tinge (called cyanosis) to his lips, fingers, and toes. He would ultimately suffer cardiac arrest and death. Since this represents the severest form of allergic reaction, anaphylaxis would develop fairly quickly after the blood was infused.
If the victim survived an anaphylactic reaction, there is a strong probability that his kidneys would be severely and irreparably damaged, requiring dialysis. This damage results from the kidneys' attempt to filter the clumped RBCs from the blood. The iron found in the hemoglobin molecules of the RBCs is particularly toxic to the kidney tissues.
Can a Bee Sting Kit Be Altered to Result in the Death of the User?
Q: I have a scene in which someone who is allergic to bee stings dies after being given a shot from his bee sting kit. Is there a substance that when combined with medicine in the bee sting remedy would prove fatal?
A: The deadly allergic reaction that follows bee stings in susceptible individuals is called anaphylaxis. It is a severe allergic reaction that causes spasm of the lung's bronchial tubes (breathing airways), which basically causes a severe asthmatic attack with shortness of breath and wheezing. Anaphylaxis also is associated with a profound drop in blood pressure, leading to shock. Without treatment, death can quickly follow.
Common causative agents of anaphylaxis and other allergic reactions include antibiotics (penicillin, sulfa), local anesthetics (lido-caine, procaine), antisera (gamma globulin, tetanus), foods (nuts, shellfish, eggs), iodine (used in certain X-ray exams), and insect stings (yellow jacket wasps, honeybees, fire ants). When an allergic individual is exposed to the allergenic substance, the reaction may be immediate and profound.
The emergent treatment is an injection of epinephrine (adrenaline), which is the substance in the bee sting kits that allergic persons should keep on hand. Epinephrine reverses many of the allergic processes immediately. The person is then transported to the hospital, where further treatment is carried out that typically consists of oxygen, medications for blood pressure support, antihistamines (such as Benadryl), and steroids.