Sunday, June 28, 2009

Like Mike

You have probably heard by now that Michael Jackson has died. I have a few words to say about it. What, you may ask, could a one man judge and jury like Texino possibly add to the wave of feedback generated by the passing of the self styled King of Pop? There are, after all, hundreds of writers covering every inch of the story in search of horrid detail. Well, as it turns out, I am uniquely qualified for this assignment. Why? On the one hand, I have studied emergency cardiac care for nearly 30 years both as an instructor and care giver in the field and on the other I suffer from chronic pain due to a series of lower back injuries going back to Vietnam and culminating with my work with the fire/rescue service. Unlike Jackson, however, I control the pain with RX Methadone tablets which, while relieving the pain, do not give any sort or euphoric feeling such as produced by other narcotic analgesics i.e.
Demerol, Morphine or Oxycontin. I have tried the other drugs and found that I quickly became addicted to Oxycontin and Codeine. It was hard to stop using those pills because not only was I getting them from my doctor, but found that I needed to get them on the street as well which was very expensive. My situation is much better now and though I am sure that my use of the methadone has become an addiction it controls the pain without making me high. So from a drug users standpoint, I would say that MJ was hooked up with a tame Doc who would keep him feeling up by injecting Demerol as needed.

Now the heart attack scenario. Sudden cardiac death is not uncommon in seemingly healthy males over 50 yrs. I went to the hospital in 2000 because I had a funny feeling in my neck which went away after I took a nitroglycerin tablet. I was admitted and a test showed my coronary arteries to be extremely occluded with the most important one about 93%. What that meant was I was very close to having a severe and most likely fatal coronary event. This type of myocardial infarction can be fatal even if it happens with a room full of doctors. Bypass surgery is the life saver there. So MJ could have something like that, but it would have been obvious in the autopsy. Since no one has mentioned that, it now becomes possible that Jackson went into cardiac arrest as a result of an overdose of Demerol. Demerol is usually given as a IM injection as an IV shot can cause abrupt CNS depression with the patient becoming unable to breathe for himself. Two scenarios present themselves here. One: The shot was given as an IM and accidentally hit a vein or Two it was given by an IV route too quickly causing respiratory depression leading to cardiac arrest. Now whether it was #1 #2 or a combination of both there is an easy way to reverse the problem and that is with the narcotic antagonist "Narcan" (Naloxone™) This drug given IVP (fast) will completely reverse the effects of the narcotic immediately putting the patient into withdrawal and possible seizures. Never the less, it works and anyone who is treating a patient by injecting narcotics should have a good supply on hand as the half-life on the Narcan is shorter than the narcotic meaning the Narcan may wear off and put the patient back in respiratory arrest. In general the patient can be handled by maintaining respiration until the effects of the drug moderate. When I was on the job, we often did not wake the OD patients up because the reaction to the withdrawal could be dangerous. We just inserted a breathing tube and kept IV access and monitored the heart rate and oxygen saturation.

So here in my opinion is the issue with Mike. He had a Doc with him 24/7 Supposedly a cardiologist and the guy does not seem to have had the necessary
drugs and equipment to manage a cardiac event. If this was the case, then it is an awful over site, but it should be remembered or made clear to the public in general that doctors in private practice are seldom aware of the latest advanced cardiac life support protocol. I have a feeling that the fact Jackson's MD went missing for a while is to figure a way to cover himself for not having the proper set up which may have easily saved Jackson's life.
We will see. It's all cheers and sorrows, Texino

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