Friday, October 7, 2011

Justice For Michael Jackson Trial- AUUUGH! HELP!

Much of today's testimony in LA for the Michael Jackson murder trial involved a taped interview that Conrad Murray had with the LAPD. I nearly had a nervous breakdown listening to this shady guy describing and justifying his medical interventions.

First of all, considering Michael was on VERSED and ATIVAN, as well as a cocktail of other narcotics, the administration of Diprivan on top of the other potent respiratory depressants, would require for him to be mechanically ventilated.

In the OR, the patient is induced, put on a ventilator after intubation. They have a dynamic ECG, Pulse oximetry reading for PaO2, a sensor for CO2, in some monitors, Blood Pressure, respiratory efforts and rate, and heart rate.
In Michael's makeshift clinic, in his bedroom, he had a pulse oximeter, which only monitors his oxygen saturation levels, by having a lighted probe which determines by how red the blood is underneath, on the fingertip, how much oxygen is present. It's no indicator of CO2, how well the patient is breathing.\

This is a guy who had a frikkin' amusement park in his backyard. Why couldn't he have a proper cardiac monitor and effective ventilating equipment, which would cost less than a cotton candy concession at Neverland?

This guy Murray's standard of care was beneath appalling and criminal. My dad and I discussed whether he is an actual medical doctor at all. He may have some credentials, but, I have to assume that he retained no substance from Medical School. He's shady enough to wonder if someone else stood in for him at school and to sit at boards. Who knows the standards in the islands for certifying doctors.

The heart and lungs may seem like two separate organs, but, they are part of a single system. In fact, that's what my title was, "Cardio-Pulmonary Care Specialist" and this is why I am as offended by what I hear. I take it personally, not merely because I've loved Michael all my life, but, I am proud of participating in the care of such ill patients, and helping many of them, to the very best of my ability. It didn't matter if I didn't sleep for a week. They always came first. It was like a holy pledge and an honor to be one of the healthcare team who could help to heal. I can't fathom a man like Murray, beneath contempt, whose only agenda seemed to be for his own self-aggrandizement and profit and glory.

Ventilation requires effective movement of air in and out of the lungs. This effects the PCo2, and pH of the arterial blood. When you under breathe, or experience hypoventilation, especially due to heavy sedation, the CO2 levels rise and the pH of the blood decreases.

You can receive oxygen via nasal cannula, like MJ was, and not have any idea how well, or effectively, he's breathing, until his CO2 levels are so high that they take up the space in the blood, so to speak, and replace O2, so the O2 goes down, and that will be noticed on the pulse oximeter as a lower reading and an alarm will go off.

By that point, the patient is in deep trouble.

Murray claims he did "mouth to mouth" which the ACLS protocols don't even care about anymore, nor does it make sense! There should have been bag--mask ventilation. This is ABCs. The A is for AIRWAY management. EFFECTIVE airway management. This is the imperative in the rescue of a patient that is down.

. It's like he had no connection with modern algorithms! Nowadays, they recommend single rescue CPR to achieve effective chest compressions. How come Murray didn't know this? How could he achieve it with one-handed compressions on a bed?

Second, he had a rescue AMBU bag clearly visible in the room. WHY would you do literal "mouth to mouth" when you had a rescue bag that you can hook up to oxygen, but, more importantly help blow off the accumulated CO2? He didn't need Murray's kiss of life. He needed something to help him to breathe out CO2 and receive 100 % O2 from an oxygen source, not the 20.9% or less from from Murray's exhaled kiss.

 Makes NO SENSE!

He tells the cops that Michael was never administered electrical shocks for asystole because he was in a process called PEA, or pulseless electrical activity. How did he KNOW this? Even a great god cardiologist cannot tell this rhythm anomaly without precise equipment.

 You cannot know if someone is in PEA unless they are on a cardio-monitor, and a pulse oximeter cannot determine if there is an electrical rhythm at all, let alone a toxic one.

PEA means that the electrical system in the heart is working, producing a rhythm, but, the heart is not beating, not circulating oxygen rich blood.

The PEA means there's an underlying reason, like hypercapnia, High CO2, amongst other things, so, it could be possible, but, Murray couldn't have known this until the EMTs put him on a monitor that could visualize a dynamic ECG .

PEA is very rare, as well, so you certainly couldn't assume it was happening. Why didn't he try to shock the heart? He had a dead patient by the time EMS came, UNLESS, he knew that MJ was already down for longer than 30 minutes. He'd be a total vegetable. I think he knew it, and wouldn't let them shock him. He knew it from the time he left off with his stripper girlfriends and tended to a cyanotic Michael.

He claimed that MJ had a HR in the 120s, but, pulse oximetry is unreliable for heart related monitoring, and if MJ had PEA, he had no pulse. Murray just contradicts himself again and again.  He claims he had a femoral pulse so how did he have PEA? The cops don't have the technical knowledge to question him on the aberrations, but, I am going nuts listening to this guy.

Michael's death was so unnecessary, and I think anyone with a medical background could have saved his life, or prevented this tragedy. What Murray did was take the money, easy money, and had not one particle of ethics in caring for this precious man's life. I have literally cried over this tragedy. How I wish I was the one to care for Michael.

I've had  patients that had to be under anaesthesia overnight, for things like unresponsive refractive Status Asthmaticus, and I've stayed with them, by their side, all night long. When I needed to go to the bathroom, I had someone like a nurse relieve me. And these are patients who were on a ventilator!

Murray claims when he came back from using the rest room MJ was unresponsive. WHAT? U gave him nearly fatal levels of narcotics, and anaesthesia. He wasn't supposed to respond. You Murray, DOCTOR MURRAY, had a condom catheter on him because he would be unresponsive. OF COURSE HE WAS UNRESPONSIVE!

I would have put MJ on an overnight system of ventilation, like a BiPAP machine, which many hundreds of thousands of people routinely use. I'd have him on a proper monitor. like in a hospital. I'd have intubation trays available. I'd have a portable ABG machine to check his blood, if he was distressed

 Murray claims to have witnessed the arrest. I have witnessed quite a few arrests and have NEVER lost a patient, not ONE, in a personally witnessed full arrest. That's not to say they survived longer than a day, but, I have never  been in a situation where we could not get a rhythm back when witnessed. Even without rescue equipment, I've done precordial thumps to start hearts, and got them back before the code teams arrived with crash carts.

  In MJ's case, he didn't have a cardiac incident, like a heart attack. He had respiratory failure which triggered a heart attack. It's outrageous that Murray couldn't bring him back from the tunnel.

Murray said that he could feel a femoral pulse when he did compressions. How in the world could he both compress effective depth and rate chest compressions, AND feel a pulse in his deep groin at the same time? I've done literally HUNDREDS of CPR resuscitations and cannot visualize how to do perfusion-effective compressions and feel for a femoral pulse at the same time. It's LAUGHABLE!

 In fact, why would you need to feel for the femoral pulse, when the standard and protocol is to feel for the carotids? The carotid is stronger. I'm not saying I wouldn't feel for a femoral, but, only once we're back in business with a carotid pulse first. I have only used the femoral pulses to take blood for ABG's or blood gases, and used them as a secondary standard to guess lateral perfusion, not central, which is your primary concern in CPR.

Next, he said he had them administer Bicarb HCO3 to reverse the acidosis that he could safely assume was happening. Yet, the ACLS algorithms of the 21st Century have pretty much abandoned that as well. There are many reasons for this, but, I would get too technical to explain. It can really mess you up... It's a ridiculous way to adjust the pH of the blood, when you need to be bagging the patient and getting the CO2 out of their lungs, which will restore the pH.  He was doing MOUTH TO MOUTH! I realize some laymen will think it's endearing, especially since this clown claims that he did "mouth to mouth
because MJ was "his friend."

With friends like that, huh?

I knew he was shady when he did CPR on the bed, in the first place! His explanations to cops were bizarre. He said that *Acidemia*  was when the oxygen level was low and that it made the pH low. WRONG. Acidosis is when the PCO2 is HIGH, and that brings the pH down. It's called Acute UNCOMPENSATED Respiratory Acidosis. He couldn't know that unless he did a blood gas, and he didn't do one until the hospital.

Here's my BIG problem. WHY DIDN'T he have a portable blood gas machine? I've used them for home monitoring, for my patients on home ventilators, and they are only a few thousand dollars. Every doctor knows how to do blood gases, a measurement of gas and chemical components in arterial blood, the best assessment of respiratory status.

 There's a bunch of possibilities in monitoring his breathing at home, even under these drugs, beside a blood gas, which were not available to MJ.

Why was he only on a nasal cannula? When you have surgery, you are INTUBATED, and externally ventilated, and it's afterwards when they pull the tube and have you wake up with nasal oxygen. That's because the effects of anaesthetic can last for a time, making breathing more shallow, but, MJ was left on stupefying drugs without a safety net.

He should have been hooked up, at the very LEAST, to a ventilating source, like BiPAP, which is a positive flow of air and oxygen, and  keeps the airway open, and can also be regulated to provide mechanical breaths, like a big ventilator, to assist in moving the chest to breathe when a patient cannot assist by himself..

I've put dozens and dozens of patients on home BIPAP with rates, because, some people stop breathing at night.

In that event, you also put them on apnea monitors, not just pulse oximetry, and there are also monitors which estimate the exhaled CO2 to assure adequate ventilation.

Ventilation is one thing and respiration is another thing entirely. Ventilation involves the movement of air with O2 and CO2, in and out of the lungs, and the mechanical action of the chest wall and thorax as well as airways and lung parenchema.

 Respiration is the gas exchange in the blood from the lungs. This is where oxygen passes into the blood to be used for energy and CO2 moves from the blood to lung to be exhaled. Ventilation is different than respiration. One's mechanical the other biochemical.

I trained in Sleep Management, and am well-versed in every aspect of the stages of sleep, abnormal breathing, and correcting the problem with adjunctive aids in ventilation and monitoring. One thing that boggled my mind is how any doctor would let this man not go through the stages of sleep, which is what our bodies need, not anaesthesia, which is NOT sleep, just unconsciousness. Sleep is a process that is vital to our homeostasis, our well being.
What these doctors did to Jackson is a crime.

He deserves to go to jail and never practice medicine again EVER EVER EVER!

Who cares if Michael was addicted. It was doctors like Murray who fixed him up with drugs and killed him, recklessly, heartlessly and negligently, to say the least.

Diprivan would not allow a normal sleep experience. In fact, whenever I've had surgery, I become a little psycho after anaesthesia. It's never a substitute for sleep.

It's a testament to how strong MJ was to endure this travesty of care. I wish I had been privileged with the opportunity to help Michael.

Shame on Dr. Adams, Dr. Klein and Dr. Murray. Y'all are
disgraceful. As far as I'm concerned, all these doctors deserve to go to prison.

I feel sick reviewing this gross incompetence and malfeasance of professionals who pledged to "do no HARM." They were worse than Charles Manson.

Heavenly Father, in Christ's NAME, I pray that there will be justice for dear Michael. May he rest in peace and finally have peace and rest.

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