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Rod Brouhard, EMT  P

Could Dr. Conrad Murray Have Prevented Michael Jackson's Death?

By June 29, 2009

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Is having a doctor at the bedside a guarantee of proper emergency care?

Nope.

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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Comments
June 29, 2009 at 9:50 am
(1) Elizabeth says:

Wow. You provide a very strong argument for the specialist expertise of paramedics. If paramedics can outperform fully trained physicians in life-or-death situations like this, why on earth are they having to go on strike in BC? As far as I can see, the only reason this situation hasn’t been resolved is because the paramedics are too committed and responsible to actually stay off work. What a shameful state of affairs!

http://www.workingtv.com/cupe-condition-critical.html

June 30, 2009 at 12:37 am
(2) nightstalker says:

Chest compressions with a pulse? He’s a cardiologist? Unbelievable!

June 30, 2009 at 10:11 pm
(3) SHEL Canadi says:

I feel ill even thinking that this could be prevented.

This video gives a good explanation about Naloxone and how it’s used.

http://www.anypositivechange.org/NALOXONE/

July 1, 2009 at 10:51 pm
(4) beverly says:

First of all, the term cpr stands for cardiopulmonary resuscitation. This includes rescue breathing and OR compressions. So when someone says cpr they may indeed mean rescue breathing, alone or in combination with compressions.A word about naxolone (narcan).. this does reverse the opiates but it can also cause ventricular fibrillation and in fact is usually not given without placing the pt on a cardiac monitor. As far as one handed cpr.. if MJ really weighed about 105 – 112 lbs it is conceivable that the heel of one hand is in fact correct. As to the absence of a defibrillator, that only works if the heart is actually in Vfib. in the case of cardiac standstill it would do nothing and you would need to use drugs such as epinephrine or atropine to be successful. It is simply too soon to rush to judgement about Dr. Murray or MJ.

July 4, 2009 at 2:43 am
(5) justice shall b served says:

SOUNDS LIKE DID SOME1 TRY 2 KILL MJ?

July 6, 2009 at 12:25 am
(6) Joy says:

So is the protocol to do CPR on an anorexic brittle man to drag him off to the ground swiftly and go on with the process ? Do all MD’s know how to lift a limp 120 pound body from a 3.5 feet hight without breaking the neck ? If you break his neck or vertebrae and he does not make it, how does that news play out in this crisis-hungry society ?

Some who are Monday morning quarterbacks will be sh****** in their pants if they were in this situation. Sure, when you take a CPR class and start by saying “Annie, are you OK” at the community center it all looks clear. Annie is always on a hard surface, the mouth is cleaned up and the mask is somehow always next to Annie etc. When you are a medic and you know you have an immediate support via radio with your emergency room physicians and your buddy next to you, now it is all clear. When CNN telly you that narcotics may have been an issue, sure Narcan looks like the clear choice. As for the AED, no use if this is a primary respiratory arrest and there is already a pulse.

When you are faced with an already sick looking pale anorexic guy who is not breathing and the prospect of going on the history book as he who let the King of Pop die, then CPR may not appear that clear after all. Let’s not judge too much.

July 11, 2009 at 10:20 pm
(7) Howard says:

As a former ambulance crew chief, there is no question that had 911 been called immediately, paramedics could have started advanced life support procedures, giving MJ a good chance at survival. Dr. Murray robbed MJ of that opportunity. It just goes to show, in a medical emergency, you want a trained paramedic who is able to do what needs to be done. Dr. Murray had no business making a deadly decision to NOT call 911 for such an extended period of time.

July 12, 2009 at 11:40 pm
(8) Bryan Brouhard says:

The discussion here forgets that propyfol was found at the scene. This strong aneasthetic, and MJ’s desire to use it, suggest that MJ may have in fact succumb to respiratory distress with subsequent cardiac arrest. Beverly correctly reminds us that CPR includes some form of rescue breathing, this if performed adequately by the doctor should have bought the time for paramedics to arrive and perform advanced life support.

July 21, 2009 at 5:14 pm
(9) JUSTICE says:

I HATE DR.CONRAD MURRAY. HE SHOULD OF DONE THE CPR ON THE FLOOR. WHY THE HECK WOULD YOU DO IT ON THE BED. I HATE HIM. HE COULD OF DONE BETTER.

October 1, 2011 at 12:01 am
(10) DN3 says:

Only Murray would know if Jackson had pinpoint pupils before he died, but if MJ really was suffering from opiate (Demerol) withdrawl, then the pupils would be dilated not pinpoint (parasympathetic drive). Therefore, MJ’s pupils would be dilated. If MJ was taking opiates that day well then Murray is even more stupid than I thought possible. First of all, anyone giving IV Ativan and propofol without cardiac monitoring is an idiot.

Here is a scenario that I think is likely. Murray gives numerous doses of lorazepam in an attempt to put Jackson to sleep. Doesn’t work. Finally gives in and gives propofol. MJ falls asleep. Murray goes to bed. MJ goes into respiratory arrest some time after that. Murray awakens and finds MJ dead and panics…..then acts like a bumbling idiot in front of paramedics. The end.

August 3, 2013 at 9:53 am
(11) aplikacje mobilne says:

When I initially commented I clicked the “Notify me when new comments are added” checkbox and
now each time a comment is added I get three
e-mails with the same comment. Is there any way you can
remove people from that service? Many thanks!

January 23, 2014 at 3:57 am
(12) Darrel says:

This is exactly the 2nd article, of your blog I
read. However , I enjoy this one, _Could Dr. Conrad Murray Have Prevented Michael Jackson’s Death?_
the best. All the best -Timmy

Here is my website: <a href=”http://Abc.com/”>Darrel</a>

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