Medical Information, Questions and Answer thread

In my mind a mental addiction is still an addiction, however murray would not need to wean him off if there is no physical addiction. I guess that article throws out the therory that you can't inject yourself with it either.
 
Could someone please explain what ion trapping is? the defense seems to find this important and I can't understand what it is. Does it relate to bleeding into the stomach and how propopofol was found in mj's stomach?

Thanks in advance
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Could someone please explain what ion trapping is? the defense seems to find this important and I can't understand what it is. Does it relate to bleeding into the stomach and how propopofol was found in mj's stomach?

Thanks in advance
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from wiki:

http://en.wikipedia.org/wiki/Ion_trapping
The term ion trapping is used to describe the build-up of a higher concentration of a chemical across a cell membrane due to the pKa value of the chemical and difference of pH across the cell membrane. Generally speaking, this results in basic chemicals accumulating in acidic bodily fluids such as the cytosol, and acidic chemicals accumulating in basic fluids such as mastitic milk.

the pKa of lorazepam in an acid environment(?) is reported as 11.5 -13:

http://web.squ.edu.om/med-Lib/MED_C...temporary Pharmacy Practice/pdf/pKa-table.pdf
http://www.drugbank.ca/drugs/DB00186

This implies lorazepam concentrations would build up in the stomach (because it's acidic). The lorazepam concentration there could get higher than of the surrounding tissue.

- could someone confirm this please. lorazepam has actually two different pKas. From what i get, the 11.5 -13 value is the one referring to an acidic environment. its pKa value for bases is 1.3.


the autopsy report says there was transmural bleeding of the stomach. this is how the blood (with the lorazepam) would get into the stomach in the first place.
 
In my mind a mental addiction is still an addiction, however murray would not need to wean him off if there is no physical addiction. I guess that article throws out the therory that you can't inject yourself with it either.

But what is mental addiction? People who are mentally addicted to propofol don't get it via a drip, always injections and reinjection, always awaking and falling asleep again. MJ's case is really unique!!!



Murray proof of the psychological addiction in that interview was MJ complaining about the sypmptoms associated with sedation using benozs , he "reluctantly" agreed to his treatment with benzos the last three days which frankly I don't buy, I don't believe mj was aware. He said although he was aware propofol was not physically addictive still MJ was mentally addicted to it believing nothing but propofol worked for him while Murray's benzos were working.

Was Kenny a liar too? people saw what benzos were doing to MJ on June 19 , why if true should not MJ complain? can you blame him for complaining, and call it an evidence of his mental addiction to propofol?

You have to ask yourself WHY MJ WAS ASKING FOR PROPOFOL IN THE FIRST PLACE?


He wanted to sleep, nothing worked for him, and obviously the VERY HIGH DOSES of lorazepam were working BUT AT WHAT COST? He was a hot mess mentally and physically on some days and it was going to get even worse.

I don't believe that was a mental addiction, that was a NEED, A NEED NOT WANT big difference, he needed to sleep to perform if chocolate made him sleep he would have taken chocolate and called it a day but NOTHING WORKED.
 
from wiki:

http://en.wikipedia.org/wiki/Ion_trapping


the pKa of lorazepam in an acid environment(?) is reported as 11.5 -13:

http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/A Practical Guide to Contemporary Pharmacy Practice/pdf/pKa-table.pdf
http://www.drugbank.ca/drugs/DB00186

This implies lorazepam concentrations would build up in the stomach (because it's acidic). The lorazepam concentration there could get higher than of the surrounding tissue.

- could someone confirm this please. lorazepam has actually two different pKas. From what i get, the 11.5 -13 value is the one referring to an acidic environment. its pKa value for bases is 1.3.


the autopsy report says there was transmural bleeding of the stomach. this is how the blood (with the lorazepam) would get into the stomach in the first place.

Thanks :flowers:
 
@soundmind, I don't disagree, my comment about mental addiction was referring to a comment that propofol was non-addictive but that you can become mentally addictive. As for Michael, I can't say whether he was 'mentally addicted' or not, all we do know was, as you quite rightly said, that nothing else worked. Regardless the blame still lies directly at murray feet, and him making these heroic statements about weaning him off but at the same time ordering shed loads shows what a liar he is.
 
With propofol, it isn't proper 'sleep' which is why most medics are appalled that Murray was using it for this purpose let alone all the risks involved. I'm not sure exactly what kind of sleep it is, but I doubt it would be REM sleep.

He shouldn't snore. I found that quite alarming when he said that. It means that Michael's airway was being partially obstructed. He would still be able to breathe but because of the sedation, his airway was not being well protected. In that instance something should be done to rectify it but Murray took it to mean that it was reassuring cos he was in deep sleep

Yeah, snoring while in deep sleep could mean sleep apnea. NOT a good thing to have. It needs to be diagnosed and treated. Any *good* doctor knows that. Seriously, every. single. word. out of Murray's mouth makes me go "WTF?!"
 
WOW it took me ages to have the courage to pop in here but gosh what an interesting thread is this :clapping:
Thanks guys for the 'right to the point' questions and 'clear' answers...
DO I have a question?
Well, just WHY is CM an :evil: Now, I've read two 'medical' questions thread... I'm sure he got his license FREE with his fave box of Cheerios :doh:
How could you make so many stupid mistakes and be such a creep to HIDE all his mistakes...
Putting the blame on Michael :no: How dare he? :mat:
 
Is it Illegal for c.murrary to treat a patient or patients without keeping Medical Records? Can any one find out if he filed income tax, he worked for Michael from 2007 to 2009. Thank you.
 
Could someone please explain what is femoral blood? I was sure of my translation but now I'm starting to think I didn't tranlsate it correctly. where is it in the body? blood from where?

Thanks in advance
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There are 2 femoral arteries, one each in the rt and lt groin areas between the aorta and upper portion of the lower extremities. They are usually very readily palpated when the heart is beating, and I would assume one of the largest targets one could blindly access even if there is no heart beat. Hope that helps, and Google has many vasculature anatomy links that can visually show the femoral arteries and their location/relationship to other human vasculature.
 
Could someone please explain what is femoral blood? I was sure of my translation but now I'm starting to think I didn't tranlsate it correctly. where is it in the body? blood from where?

Thanks in advance
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Definition of FEMORAL is of or relating to the femur or thigh. So blood taken from the upper leg, the thigh.
The blood is preferably taken from the femoral veins.

I hope that this helps and makes sense now x
 
Can you please explain what long term or short term durg use have on the organs. thank you
 
There are 2 femoral arteries, one each in the rt and lt groin areas between the aorta and upper portion of the lower extremities. They are usually very readily palpated when the heart is beating, and I would assume one of the largest targets one could blindly access even if there is no heart beat. Hope that helps, and Google has many vasculature anatomy links that can visually show the femoral arteries and their location/relationship to other human vasculature.

Definition of FEMORAL is of or relating to the femur or thigh. So blood taken from the upper leg, the thigh.
The blood is preferably taken from the femoral veins.

I hope that this helps and makes sense now x

Thank you very much :)
 
The paramedic report states that at 12.33 MJ's heart was in PEA (pulseless electrical activity). It is written on the form as 'Pea'.

http://lady-medic.blogspot.com/2010/...reportpcr.html

So, how long does a patient have to be down, for PEA to appear?

It's not so much the time the patient has been 'down' but the cause that made them go into cardiorespiratory arrest. Not everyone will go into PEA and what kind of electrical activity one will see depends a lot on the cause.
 
Something I find odd. The witness yesterday (toxicologist Anderson) testified that 3x 400ml containers of urine were drained from MJ's bladder (so a total of 1200 mls) at time of autopsy.

1. If MJ was being treated for "dehydration", he surely was well hydrated on the day of his death for if someone was dehydrated, no way they'd produce that much urine.

2. When someone dies, my understanding is that the muscles in the body relax and their bladder would spontaneously empty. How was it that his bladder remained full of SO much urine?

Didn't they autopsy report state that the prostrate was indeed enlarged? It's speculative, but if a coroner's report states that the prostate was enlarged- if it acts like a clamp, it would explain that the bladder didn't empty spontaneously.

I do agree that that seems like a lot of urine- especially for someone who was supposedly dehydrated every day??? Does that make sense??

Secondly- didn't Murray even claim he "had him urinate"?? It strikes me as almost cruel torture to pump saline bag after saline bag into a man with an enlarged prostate- and then wonder why he couldn't fall asleep? I'd bee peeing every 15 minutes!

I also found it a very strange claim to 'have him urinate' when the supposed plan of the night did not involve Propofol that night- you cath a patient on VALIUM? Wut? That catheter makes me wonder about a number of things, actually!
 
I looked at the autopsy report, anesthesiology consult, Dr Calmes talks about the risks of propofol, she mentionned "respiratory depression" and "cardiovascular depression" and it sounded like 2 different things sometimes, not necesarily linked, and she mentions that a bolus injection should not be too fast.

So my question is : what is a cardiovascular depression, how fast can it be, can propofol send you directly into cardiac arrest , without a respiratory depression first ??

Why shouldn't the bolus injection be too fast ?

thanks
 
I looked at the autopsy report, anesthesiology consult, Dr Calmes talks about the risks of propofol, she mentionned "respiratory depression" and "cardiovascular depression" and it sounded like 2 different things sometimes, not necesarily linked, and she mentions that a bolus injection should not be too fast.

So my question is : what is a cardiovascular depression, how fast can it be, can propofol send you directly into cardiac arrest , without a respiratory depression first ??

Why shouldn't the bolus injection be too fast ?

thanks

i just posted a partial answer in the day 15 thread, sorry i didnt see it here :( i could move it here if you'd like? am i allowed to answer a question in here, i don't really think i'm a medical "expert"? i am a 2nd year medical student, but the info i got was from an anesthesiology textbook...
 
i just posted a partial answer in the day 15 thread, sorry i didnt see it here :( i could move it here if you'd like? am i allowed to answer a question in here, i don't really think i'm a medical "expert"? i am a 2nd year medical student, but the info i got was from an anesthesiology textbook...

of course you can answer a question here

+ in addition to information from text book can you also simplify it for us - that can't understand medical terminology?
 
of course you can answer a question here

+ in addition to information from text book can you also simplify it for us - that can't understand medical terminology?

yes, i kind of summarized it in my post: basically, drop in blood pressure is the main cardiovascular effect, in addition a decrease in the force of the heart muscle can happen. these effects can indirectly lead to an increase in heart rate to compensate (but it also said or maybe a decrease in heart rate sometimes can happen too, although the evidence is not clear it seems). i am not sure how this could lead to a sudden arrest in someone who does not have a pre-existing cardiac condition, but perhaps one of the real experts :p can presume how the defense is going to play that. i still can't understand how they are going to explain the thready pulse of 122 though.
 
Propofol attenuates the heart rate response to atropine in a dose-dependent manner.

This being the case, had the EMTS known about the propofol, would this have made any difference in the amount of atropine they used during the resus. attempt? Does the ACLS algorithm take something like this into account?
 
thanks for all your answers. I have this:

1. which one is better to use ambu bag or mouth-to-mouth ?

2. please clear is it possible to be addicted to propofol or not ?

3. is it possible to self inject propofol ? from what i read and watched it should be given slowly not at one shot. So could it works as a one shot ?

4. How it's possible the pipe (not sure how it's called) that connect the IV system with needle is without propofol tracks ? (at least the detective said so , after testing the is no signs of propofol on it, but full propofol bottle was into the bag) please clear this testimony.

THANK YOU!
 
thanks for all your answers. I have this:

1. which one is better to use ambu bag or mouth-to-mouth ?

2. please clear is it possible to be addicted to propofol or not ?

3. is it possible to self inject propofol ? from what i read and watched it should be given slowly not at one shot. So could it works as a one shot ?

4. How it's possible the pipe (not sure how it's called) that connect the IV system with needle is without propofol tracks ? (at least the detective said so , after testing the is no signs of propofol on it, but full propofol bottle was into the bag) please clear this testimony.

THANK YOU!


1. An ambu is better than mouth-to-mouth. Shaffer actually got on Murray for using mouth-to-mouth since it's only something you do if you don't have the right equipment. He said you're only given a down patient 30% of the oxygen they need to survive.

2. Propofol is not physically like benzos or opiates. You can, however, form a mental addiction because it feels good to wake up from propofol's effects. An addict usually ends up self-injecting 50 to 100 times a day.

3. You can self-inject propofol if you know how to do it, hence the 50 to 100 times addict can inject themselves.

4.Murray had a separate tubing that connected from the propofol bottle to the long tubing that went into Michael's legs. It's a special tube because Murray took the propofol straight from the bottle using a spike and the bottle needs to have air in it in order to get the propofol out. This is the tubing that was missing from the room and the polices never found.
 
thank you once again!

one more question - after using propofol do you feel well, rested like you slept 8 - 10 h. ? OR you are feeling dizzy , weak, like what you feel usually after anaesthetic ?
or if i tell it other way - could Michael just jumps out of the bed after some sleep thanks to propofol and feels ready for active day. Or he would need other medication to wake him ?
 
People react extremely different to Propofol. Generally it's used because the side effects are so much less severe than older style anesthesia. I for example was extremely lucid, awake and slightly euphoric. I was not dizzy, disoriented etc.

My neighbor (shared hospital room) on the other hand was extremely sleepy for the rest of the day- and we had almost the same type of surgery.

Hard to tell. You can be 'everything'. Stands to reason that Michael would not have gotten involved with Propofol if he would have felt nauseous, dizzy and weak. I don't think Michael would have needed something to wake him up because of the Propofol itself- but because anesthesia is not sleep and hence you're not sleeping, not resting etc- you're being anesthetized.
(I don't even understand that medical professional even say "putting someone to sleep" when talking about general anesthesia - you're anesthetizing them. Also, Flanagan does an 'awesome' job blubbering on and on as if mild sedation and general anesthesia were the same thing!)

The exhaustion must have been incredible for Michael.

So the "Red Bulls" that Nurse Lee supposedly saw and criticized wouldn't be some bad, naive habit of Michael- but a simple attempt to just.get.through the day.
I recall that the autopsy report stated anemia- so just imagine the lack of energy he must have felt. No sleep, high demands troughout the day, 3 children, anemia- and no energy. Ugh.
 
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