Is having a doctor at the bedside a guarantee of proper emergency care?
It seems to reason that a physician would be the best person to react to just about any medical emergency. It may just be that in Michael Jackson's case, we could learn why that belief is a myth.
CPR? With a Pulse
Dr. Conrad Murray, MJ's personal physician, has said through his attorney, Edward Chernoff, that he found Jackson not breathing. Chernoff was quoted by Rolling Stones saying, "There was a weak pulse in [Jackson's] femoral artery. [Dr. Murray] started administering CPR."
For the layperson, doing CPR on a victim with a pulse is appropriate, but a healthcare provider (with proper equipment -- we'll go there in a minute) would administer positive pressure ventilation. Jumping to chest compressions when the heart is still beating calls into question this doctor's competence -- or at least his attorney's ability to accurately portray what really happened.
Describing Jackson as "not breathing" but "with a pulse" is consistent with an overdose of opiates. It's also a blow to the idea that MJ died as a result of sudden cardiac arrest, which is most often caused by a lethal, sudden heart rhythm change like ventricular fibrillation (hence the reason we use defibrillators to treat sudden cardiac arrest).
What Dr. Murray's lawyer is describing is known as respiratory arrest instead of cardiac arrest.
What About Naloxone?
If indeed Michael Jackson had a pulse but was not breathing when the doc found him, he would most likely have benefitted from naloxone, the antidote for opiate overdose. Even if Dr. Murray didn't know MJ was doing Demerol and oxycontin, as Chernoff the lawyer claimed on Dateline, a quick look at the pupils would confirm opiate use. Oxycontin, fentanyl, morphine, heroin, vicodin, percocet, Demerol and other opioid medications cause the pupils to constrict. Emergency medical providers call this sign pinpoint pupils.
The reason chest compressions won't work for an opiate overdose is because the opiates only stop the heart after it runs out of oxygen. If Jackson (or anyone else) died of an opiate overdose, chest compressions won't help once the heart stops. Instead, he needs a fresh supply of oxygen before the heart stops, and mouth-to-mouth (rescue breathing ) would likely be enough.
Not all doctors understand these subtleties. Based on the things the lawyer, Chernoff, has been quoted saying, I believe Dr. Murray is the kind of doctor who didn't quite understand opiate overdoses. If indeed he didn't give Jackson any opiates, he probably didn't know how to recognize (or didn't think to consider) an overdose.
The Right Tools for the Job
Even had Dr. Murray recognized that Michael Jackson's respiratory depression was a result of opiate overdose, his treatment needed to be different. He needed to at least give mouth-to-mouth. If his role as Jackson's private physician included treating MJ during an emergency (Chernoff said Jackson wanted Dr. Murray to watch over him as he slept, presumably to respond in an emergency). To do this correctly, Dr. Murray would need some basic emergency equipment. At a minimum, that would include a bag-valve-mask (manual ventilator) and an automated external defibrillator (AED).
There've been no reports that the doc had any emergency equipment, and his attorney's statements suggest that if the doc did have equipment, he didn't use it.
Even the choice to do CPR on a mattress with only one hand, as the lawyer claimed on Dateline, shows poor emergency medical judgment.
Skip the Private Doc, Call a Paramedic
Having a doctor sitting at your bedside will only help if the doc is familiar with emergency medicine, capable of using specialized emergency medical equipment and has that equipment available. It sure doesn't sound to me like any of that existed in this case.
Having the right doc at the bedside might help, but based on all the things I've started to hear about Dr. Murray, I'm not sure he's the right doc for anything. Patrick Malone, author of The Life You Save, in a blog post shows how some relatively easy snooping into Dr. Murray's past would lead to serious doubts about his competence.
Was the doc at fault? I don't think so, but I think a paramedic at the scene quicker (I've heard reports that the doc worked on MJ for 30 minutes before calling 911) would have been much more effective. Los Angeles paramedics carry naloxone, and if they'd gotten there earlier, they may have been able to use it.
Maybe -- just maybe -- Michael Jackson didn't have to die.
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