Part I - The Symptoms

Imagine that you work at the medical examiner's office for a major metropolitan city. As Chief Medical Offi cer, you investigate suspicious deaths and provide toxicology services for the county. Unfortunately, it's been a busy week. In the past five days, seven people have died, all with similar symptoms. It is your job to examine the data and determine the cause of death for these victims.

The first was a 12-year-old girl. Her parents said that she was awake in the middle of the night complaining of a stuff y nose and sore throat. Th ey gave her an extra strength Tylenol and sent her back to bed. At 7am the next morning, the parents discovered that the girl had collapsed on the bathroom fl oor. An ambulance rushed the girl to a nearby hospital, where she was pronounced dead.

That same day, paramedics found the second victim unconscious on his kitchen fl oor after what they thought was an apparent heart attack. Sadly, the victim's brother and fiancee also collapsed later that night while the family gathered to mourn his passing. Both had taken Tylenol to help them cope with their loss shortly before collapsing; neither survived.

In the next four days, four other similar deaths were reported, all in the same neighborhood and all with similar symptoms.

Are these seven deaths related? What is causing these people to die? It is your job to answer these questions before more deaths are reported.

Symptoms exhibited by most patients:

• Dizziness
• Confusion
• Headache
• Shortness of breath/rapid breathing
• Vomiting

Most deaths were very rapid, occurring within a few hours of symptoms.

Questions

1. Are there any similarities or connections between these seven individuals? What questions would you want to ask the families to answer these questions?

2. In your opinion, are these seven deaths connected? Why or why not?