Update 6/29/09 @ 12:36 This may all be a hoax.
NOPE. APPARENTLY THIS IS REAL.
British Media and News Reporting may actually not be related.
The shock findings of the Michael Jackson autopsy | The Sun |News
8st 1oz, no food just pills in his stomach, bald, bruised, his ribs broken by CPR, 4 needle wounds near his heart…
I don’t know if this is real or not, but it sounds … like I have some questions …(1 stone is 14 pounds)
There’s this:
SUFFERED several broken ribs as frantic rescuers pumped his chest after he collapsed in cardiac arrest.
That’s unfortunately normal. No problems there.
And the (Emergency Medical) weirdness:
Four injection sites were found above or near to Jacko’s heart.
All appeared to result from attempts to pump adrenaline directly into the organ in a failed bit to restart it.
Three of the injections had penetrated the heart wall — causing damage — but a fourth missed and hit one of the 50-year-old star’s ribs.
What? Intracardiac injections of epinephrine? I thought that went out in the very early 80’s. As for ‘causing damage’, needles do that, but the major problems with intracardiac epi are coronary artery lacerations (bad, but not the end of the earth, as the recipient was dead to start with and getting a return of circulation allows time to fix them) and intracardiac muscle injection, which causes intractable ventricular fibrillation, which is Bad. Capital B Bad. Usually Unrecoverable Bad.
Where does one even get epi with and intracardiac needle? I’ve been in the business for a good while and haven’t seen one since Paramedic school (82-83) and was then taught it was out of favor.
Nowadays if you don’t have an IV line during a code (it happens) you can squirt it down the endotracheal tube, or, failing that, an intraosseous IV line (shorter needle, not in the heart, works very well) through which all the resuscitation meds can be given.
Interesting. Nothing to make of it now, but, who’s a) been watching too many Tarantino movies and b) did this?
(I doubt an emergency pericardiocentesis was the reason for the described wounds, as those if done without sonographic guidance are done from the top of the abdomen up, and with sono guidance would be through the chest wall, but with sono guidance you’d know if they needed it or not, and if there was a big pericardial effusion it’d have been in the report).
So he was only 112 lbs??? Holy crap! And bald? WTF?
Haha I was just thinking about Pulp Fiction as I read through it.
Is his physician still on the run?
Yes, all round weirdness.
The only other explanation for the needle wounds near the heart that I think could be reasonably entertained might be if an USS was performed during CPR but misinterpreted as indicating the presence of a pericardial effusion. Unlikely though.
If they attempted intracardiac injection of adrenaline… bizarre.
If true, it’s a good thing California has tort reform so quality physicians like this don’t have to worry!
This was a fake autopsy story by the Sun. The real one isn’t published yet. (Per an investigator in the case that was on CNN.)
If true, Thank Goodness, Matt has solved the case. No further investigation is needed. It was the tort reformed physician’s fault. Matt, you shine out with your objectivity and ethical principles….and of course the relevance of fact…if true.
I expect a doc (or docs) will get in trouble. I doubt a “personal physician” would meet standards of care for record keeping. MJ would not be ideal patient to have walking into your clinic, even in LA. I would guess he has a pool of physician that have come to treat him at home for several years. Documentation will be the key to keeping out of jail.
Crystal Ball gazing says drugs found will be associated with weight loss more than pain killers. In prior returns to the stage, MJ wanted to return to his measurements/weight he enjoyed in his early 20s. That is not easy at 50-for MJ or Elvis.
The best thing I have heard so far is the “I can’t sleep, I need…propofol”. WTF? That is serious insomnia right there. Oddly enough, he was found apneic. Who would have thought?
As long as we’re all speculating I think the question is whether this was a true cardiac arrest or a respiratory arrest leading to a cardiac arrest. The media is using the term “cardiac arrest” but I’m not sure they know or care about the difference. It sounds like most of the meds at Jackson’s home were more likely to cause respiratory depression than arrhythmias.
The picture I get is that there were a lot of people around at Jackson’s home, including a physician. A respiratory arrest would be pretty straightforward to manage even without equipment assuming it was recognized quickly. Either he had a respiratory arrest that was unrecognized or mishandled, or had a cardiac arrest as a rare side effect of the reported meds, or had a cardiac arrest as a result of something else (underlying disease or drugs not yet reported).
While I haven’t seen one in two or three years, the intracardiac epinephrine preloads are still available and not even expired. One of the nice things about the Luer adapters is that nobody is going to pull a John Travolta move with it. What would be the point?
The really scary thing is that there are still people in EMS who do not realize that the AHA had removed intracardiac injections several revisions ago. There isn’t even a good reason to be squirting a bunch of water into the lungs of patients with essentially zero ability to clear it out of the lungs, but with IOs, there is not as much desire for iatrogenic CHF.
Even though this was not the true autopsy result, would it really be that surprising if IC Epi were given? This is just one weird story.