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Medical Information, Questions and Answer thread

ivy

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This is our dedicated thread about medical issues and information related to Conrad Murray Trial. Our medical volunteer team will post explanatory messages as well as will answer your questions.

Our volunteers consist of Cookie Monzter who is a practicing medical doctor, LMAT who is an ER experienced physician with paramedic experience, BGZ who is a registered surgical nurse with hands on experience about administrating Propofol and Arklove who is a registered nurse are going to be our medical team.
 
Medical team can you provide some basic information and explain some terms to us that we are likely to hear during testimony (anything regarded to paramedics, emergency room. autopsy and propofol).
 
is any of the drug Murray gave Michael (propofol, lorazepam, midazolam etc) can influence a person like Michael was on that recording? or none of it could do this to a person and it was some other drug?
 
Only going from things I've observed, I'd have to say slurred speech like that can be caused by any of those drugs if given in enough quantity; and/or also if given in conjunction with other meds, or the pt is particularly "sensitive" to any of those meds. Also take in the factor of a person being overly tired, their weight in r/t dosage, etc. And yes, there's many other meds besides those you listed that can cause similar symptoms, but I'd have to say they would likely be in similar categories.

Hope that helps?

After thinking about it a little more, I'd have to say that I haven't seen people receiving or awakening from Propofol slurring their speech to that extent that often, but definitely have frequently seen it when given in conjuction with other meds, especially narcotics like Demerol/Morphine, etc.
 
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Chernoff mentioned some data from the pulseoximeter by the time Murray had allegedly used it to administer those 25mg of propofol he declared to detectives. I understood Chernoff mentioning first levels around 90 and then he said "it was in its seventies", which he said that would be something "normal" for MJ. Could that be possible?

Edit: I think Chernoff was referring to pulse, then. Anyway, I will thank any clarification on this matter.
 
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how long does demerol stay in your system? Michael had no demerol at all so when do you think was the last time he took it (if the defense is right). Does it really cause an inability to sleep? wouldn't getting so much demerol would have showed up in the autopsy in some way- as some damage done?

Thanks in advance for answering :flowers:
 
I haven't had time to read everything. But I read somewhere that Murray's team was saying that Michael gave his self some kind of drug and they were trying to get him on lessor drug than Propofol. What drug did Michael allegedly give his self and what drug were they trying to give him instead of Propofol.
 
smoothlugar said:
Chernoff mentioned some data from the pulseoximeter by the time Murray had allegedly used it to administer those 25mg of propofol he declared to detectives. I understood Chernoff mentioning first levels around 90 and then he said "it was in its seventies", which he said that would be something "normal" for MJ. Could that be possible?

Edit: I think Chernoff was referring to pulse, then. Anyway, I will thank any clarification on this matter.
Click to expand...

Every pulse oximeter I've ever worked with showed both pulse rate and O2 sat. There are many types of oximeters from very basic to those more sophisticated. The one they showed yesterday that is supposedly the type CM used looks like one I have seen used for random monitoring (versus continuous monitoring), but most likely showed the pulse rate. Generally speaking, one can determine if the sat reading is picking up correctly by also noting that the pulse rate is consistent with palpable pulse rate.

With that said, I'd have to guess the "70's" reading was pulse rate, not sat. If the sat was really in the 70's, that would be a cause for concern to any physician, and steps taken to verify it and treat it/intervene by O2, awakening, using an ambu bag with O2, double checking positioning/contact of sat monitor, visually observing chest rise/fall, and auscultating the lungs for breath sounds.

Hope that helps.
 
Please forgive me if I didn't hear correctly, Chernoff said Michael died quickly somethin like "he didn't have time to close his mouth" that makes me believe Chernoff thinks Michael was conscious.

Now the medical question, have two:

Does this mean when a person is conscious before dying he/she closes the mouth or the open mouth is just because the muscles are not active anymore?

Can the open mouth also mean the person was grasping for air or was trying to talk?
 
Aquarius said:
Please forgive me if I didn't hear correctly, Chernoff said Michael died quickly somethin like "he didn't have time to close his mouth" that makes me believe Chernoff thinks Michael was conscious.

Now the medical question, have two:

Does this mean when a person is conscious before dying he/she closes the mouth or the open mouth is just because the muscles are not active anymore?

Can the open mouth also mean the person was grasping for air or was trying to talk?
Click to expand...

I've not personally heard what Chernoff said, just got off work. the mouth being open is mainly to do with the weight of the jaw and gravity acting on it if the person is laid on their back. Yes, the muscles are no longer acting against gravity to keep the mouth close. So even if the mouth was closed just before death, it is likely to open if the person is in a position that gravity will cause the jaw to open
 
abigaillovesmj said:
how long does demerol stay in your system? Michael had no demerol at all so when do you think was the last time he took it (if the defense is right). Does it really cause an inability to sleep? wouldn't getting so much demerol would have showed up in the autopsy in some way- as some damage done?

Thanks in advance for answering :flowers:
Click to expand...

Urine 7-12 days, saliva up to 10 days, hair 3 months...
 
But is it possible that if someone would give mouth-to-mouth resuscitation on a person who is already dead, the mouth would remain open? I have the same question about the eyes, would checking for pupillary response cause the eyes to remain open if the person has been gone for a reasonable amount of time?
Thank you!
 
Aquarius said:
Please forgive me if I didn't hear correctly, Chernoff said Michael died quickly somethin like "he didn't have time to close his mouth" that makes me believe Chernoff thinks Michael was conscious.
Click to expand...

Cookie Monzter said:
I've not personally heard what Chernoff said, just got off work. the mouth being open is mainly to do with the weight of the jaw and gravity acting on it if the person is laid on their back. Yes, the muscles are no longer acting against gravity to keep the mouth close. So even if the mouth was closed just before death, it is likely to open if the person is in a position that gravity will cause the jaw to open
Click to expand...

Actually chernoff said he died instantly and couldn't even close his eyes, that his eyes was wide open. "Eyes open" does it make any difference?

and what do you think of the defense theory of Michael swallowing 8 2mg Lorazepam and then administering himself Propofol and dying instantly theory from a medical stand point?
 
KZ over at Trials and Tribulations (http://sprocket-trials.blogspot.com/2011/09/guest-entry-by-kz-conrad-murray-case.html ) commented on the dying instantly part:

I can categorically state that a large bolus of propofol will not "kill"
instantly. A large bolus of propofol will render the recipient UNCONSCIOUS
within seconds. A large bolus of propofol can induce severe low blood pressure.
It DOES NOT stop the heart "instantaneously". The combination of respiratory
arrest, which deteriorates into asystolic cardiac arrest would occur over the
expected 3-7 minutes, or even a little longer, if no one intervened with
respiratory and cardiovascular support! That is NOT instantaneously, and is
ample opportunity for a practitioner WHO IS CLOSELY MONITORING THE PATIENT to
take action to save their life. I really hope that prosecutors correct that
misinformation with later expert testimony. Sheesh.
Click to expand...
 
Two questions:

1. What were the oxygen tanks for and how were they used (or could be used presumably)?

2. If Michael died in his sleep, why would his eyes be open? Is it posible to force the eyes to stay open if the person initially lost consciousness/died with closed eyes?

Thank you.
 
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ivy said:
Actually chernoff said he died instantly and couldn't even close his eyes, that his eyes was wide open. "Eyes open" does it make any difference?

and what do you think of the defense theory of Michael swallowing 8 2mg Lorazepam and then administering himself Propofol and dying instantly theory from a medical stand point?
Click to expand...

To my knowledge, it doesn't really have very much significance whether the eyes or mouth were open or closed. Yes, if someone opens the patient's eyes or mouth for some reason it will stay open if the patient is dead cos the muscles are not active anymore. In the same way, to then close the patient's eyes, it will have to be closed by someone else and held that way for a few moments for them to stay closed after death.

I concur with the excerpt about not dying 'instantly' with either lorazepam or propofol. Yes, propofol can kill you fast but we are talking death within minutes not seconds or instaneously. both would depress one's breathing so you start to breathe really slowly, oxygen levels drop. as this progresses, ie breathing slower and slower, oxygen levels continuously falling, one would eventually stop breathing. Even when one is not breathing at all, the brain does not die for several minutes without oxygen. If there is no intervention ie no intubation, ventilation or CPR, the brain will die without oxygen.
 
morinen said:
Two questions:

1. What were the oxygen tanks for and how were they used (or could be used presumably)?

2. If Michael died in his sleep, why would his eyes be open? Is it posible to force the eyes to stay open if the person initially lost consciousness/died with closed eyes?

Thank you.
Click to expand...

I presume any oxygen Murray had ordered was to be when Michael was 'under' to help him breathe cos he wouldn't be breathing so well due to the effects of propofol. This will help keep his oxygen levels up if they start to dip slightly.

I don't know how Murray would have administered it considering he didn't seem to have much equipment there at all. It can just be with tubing sitting just inside one's nose (nasal cannulae), or you can have various ventilation masks. Oxygen can also be used in a situation where this happens where one stops breathing to intubate and ventilate or in CPR when you have to 'bag and mask' as a part of CPR.

I can't remember exactly what equipment was found in terms of oxygen but I would think the nasal cannulae is what Murray would have been using. Maybe someone can help me with the equipment found there?
 
^^ I'm almost positive that the O2 tank was empty...No mention of any respiratory equipment that I know of...(cannula, sats monitor, O2 tubing etc..)...Not even a plain pocket mask....
 
Arklove said:
^^ I'm almost positive that the O2 tank was empty...No mention of any respiratory equipment that I know of...(cannula, sats monitor, O2 tubing etc..)...Not even a plain pocket mask....
Click to expand...

Thank you. I didn't recall any mention of anything either but thought I might have missed something
 
I can't remember exactly what equipment was found in terms of oxygen but I would think the nasal cannulae is what Murray would have been using. Maybe someone can help me with the equipment found there
Click to expand...
yes mj was wearing the tubing in his nose alberto said he saw that
 
There was also an ambu bag, but Alberto didn't recall seeing it.

The oxygen tank was found empty said Walgren on the opening statement.

There was also a pulseoximeter that Alberto said it was on the bed, not attached to MJ.
 
When a person is overdosed with propofol, the person is unconscious right?

Now, if the person is unconscious does he enters into any kind of awareness if he's unable to breath?
Thanks.
 
Aquarius said:
When a person is overdosed with propofol, the person is unconscious right?

Now, if the person is unconscious does he enters into any kind of awareness if he's unable to breath?
Thanks.
Click to expand...

no basically Michael passed in his sleep..:hug:
 
Cookie Monzter said:
To my knowledge, it doesn't really have very much significance whether the eyes or mouth were open or closed. Yes, if someone opens the patient's eyes or mouth for some reason it will stay open if the patient is dead cos the muscles are not active anymore. In the same way, to then close the patient's eyes, it will have to be closed by someone else and held that way for a few moments for them to stay closed after death.

I concur with the excerpt about not dying 'instantly' with either lorazepam or propofol. Yes, propofol can kill you fast but we are talking death within minutes not seconds or instaneously. both would depress one's breathing so you start to breathe really slowly, oxygen levels drop. as this progresses, ie breathing slower and slower, oxygen levels continuously falling, one would eventually stop breathing. Even when one is not breathing at all, the brain does not die for several minutes without oxygen. If there is no intervention ie no intubation, ventilation or CPR, the brain will die without oxygen.
Click to expand...



what Chernoff said was true. Blood concentration was 4.1ug/ml, this concentration is reached within one minute of bolus injection, the fact that it remained that high and did not drop is a strong medical evidence MJ's heart stopped within one minute, the heart stopped thus blood circulation stopped, the propofol did not have time to redistribute from his blood and its concentration remained very high. Dr. Rogers agreed with the defense that those levels would have been reached within one minute of being injected.


As for the open/closed eyes. I asked a doctor and he told me that it's not strange to have patients with open eyes during surgeries, so yes it may not be of great significance but in this case we have Murray's girl friend saying I heard someone other than Murray coughing. I believe that was MJ waking up from his lorazepam-induced sedation and I believe the rapidness of the last bolus injection did not give MJ the time to close his eyes , yes I do believe he was semi-awake when Murray gave him the last dose.
 
Remember Murray told one doctor he saw Michael go into cardiac arrest. But told another one he found him like that
 
Justthefacts said:
Remember Murray told one doctor he saw Michael go into cardiac arrest. But told another one he found him like that
Click to expand...

yep! Richelle Cooper testified today that Murray told her that he 'witnessed' the arrest. She is the ER doctor
 
Annie123 said:
KZ over at Trials and Tribulations (http://sprocket-trials.blogspot.com/2011/09/guest-entry-by-kz-conrad-murray-case.html ) commented on the dying instantly part:
Click to expand...

I can categorically state that a large bolus of propofol will not "kill"
instantly. A large bolus of propofol will render the recipient UNCONSCIOUS
within seconds. A large bolus of propofol can induce severe low blood pressure.
It DOES NOT stop the heart "instantaneously". The combination of respiratory
arrest, which deteriorates into asystolic cardiac arrest would occur over the
expected 3-7 minutes, or even a little longer, if no one intervened with
respiratory and cardiovascular support! That is NOT instantaneously, and is
ample opportunity for a practitioner WHO IS CLOSELY MONITORING THE PATIENT to
take action to save their life. I really hope that prosecutors correct that
misinformation with later expert testimony. Sheesh.
Click to expand...
Click to expand...

Thank you for this.
 
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