Dr White
Walgren
Did you do any research to make sure that the 0.3% used by Onellis (0.3% of the propofol is excreted unchanged) was accurate ? My feeling is that it was the most conservative number.
Walgren shows an article used by Dr Onellis as a basis for her analysis. It was published in 1988. It indicated that less than 0.3% of propofol is excreted unchanged, but the model uses 0.3% . Dr White recalls a paper that said 1 % .
Based on this paper (less than 0.3%), could it be 0 ? . Dr White doesn't agree.
Walgren says that the article says that 0.3 could be an overstimate. Dr White says that the difference with a 3 hour infusion would still be huge.
Walgren shows a 1991 article about animals (dogs, pisces, rat) : there was no unchanged propofol at all , wether it was bolus or infusion. Dr White doesn't rely on articles about animals, he would prefer to rely on articles about humans.
Walgren shows a 1999 article : they found no free propofol in the urine.
Dr White indicates he did not search the subject
Walgren shows a 2002 article : they found much smaller... objection, sustained. The judge asks walgren to change the subject.
Re direct
Flanagan :
about 911 not being called dor 20mn : In a large house, fenced, gate closed that can only be opened by security , guards were just outside the kitchen, incident happens upstairs , there are no landlines, would it be unreasonable to ask a person in the kitchen for help ?
Dr white : I would resuciate the patient, and ask the person in the kitchen, it sounds more reasonable than going to security .
Dr White says that CPR should be given within 1 to 2 mn, and sustained for at least 3 mn , before leaving the patient.
What kind of CPR ? : mouth to mouth, an ambu bag would be better, but mouth to mouth is a possibility .
What would be his assessment if the patient was not breathing, eyes open, mouth open : Dr White would asses if the patient is alive, it's often a sign of death.
If patient was dead at 12, could anything have been done ? It's not likely
keeping a chart wouldn't have changed anything if the patient was dead
Would you suspect propofol had anything to do with the death : would not have suspected any effects at that time (patient dead at 12, propofol given at 10 .40 )
When EMTs receive the autorisation to declare the patient dead, do you think making further attempts was useful, was there a realistic chance of saving the patient ? No
If ER doctors had known about propofol, there would have been no change in the treatment, it wouldn't have changed the outcome in this case.
25 mg propofol bolus over 3 to 5 mn, the effects would be apparent by the end of the bolus. There would have been no resaon to suspect anything at a later time.
About the IV tube with the broken cap : did you do that to confuse Dr Shafer ? No, it deosn't make sense to remove it. It wouldn't change anything about how the tube works. An IV tube easier to conceal than an IV bag, if the IV tube was in your pocket, there would be liquid in your pocket.
About the preliminary hearing : 2 witnesses indicated the possibilty of oral consumption of propofol
Mr Walgren contacted Dr White , they talked on the phone, dr White told Walgren that had been conctacted by the defense, Walgren asked if he was paid, Dr White said he was, it's his only source of income.
Recess until tomorrow 9.30
