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发表于 2011-10-13 03:10:39
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Dr Steinberg
Cross by Fanagan
are you trained in propfol : no , but did use it, in a practice for critical care in NY. Did not use it since he's been in Calif because it is not allowed in Cali. Felt confident in using it because he was trained in protecting airways.
Is there a difference in the equipment for moderate or deep sedation : no
Do you think CM's declaration was thorough and complete : i assumed it was.
Can the informed consent be oral : yes, but you need to do it in writing also. If it's not written it's not done. For everything that we do, there is a written document. It's important, because if MJ had been correctly informed , he certainly would not have agreed to this.
Can not know if MJ had been informed, but assumes he was not informed that a powerful dangerous drug would be used on him without proper monitoring. Assumes he would not have agreed to it.
Do you know anything about MJ's propensity towards drugs, mentions demerol and Klein. What if MJ was an addict , he would have agreed to it ? Answer : if he was an addict, I wouldn't give it to him in the first place.
Other doctors use prpofol : dentists, gastroentorologist, pulmonary doctors, ER doctors. But their societies advise on how to use it.
Concious sedation : there is no difference in equipment needed, same aquipment as in deep sedation.
Have you used it for conscious sedation : no, the propofol is too powerful, narrow margin between sedation and anesthesia.
What killed MJ ? : a respiratory depression. He still had a pulse.
How do you know the EMTs arrived 20mn after the arrest? How do you know it was around noon ? Heard it in the testimony. Can not be positive about 12 noon, but knows that there was a delay in calling 911, at least 12 mn based on on the 12 12 call to MAW.
What 2MG of lorazepam would do to a patient : I'm not expert on lorazepam; uses it for mild sedation; Gives it an hour before the procedure orally.
Further questions about lorazepam : objections, sustained, outside his area of expertise.
MJ and CM had been discussing propofol for the past 3 nights, and at 10 that morning. CM told MJ it was not good for him. Steinberg states that CM said he was trying to wean MJ off.
Steinberg states that CM said that he gave 25mg INITIALLY. Steinberg understood that after that initial 25mg dose, there was a drip, based on his police interview. Cites a lot of examples in CM interview, and says it makes sense, because 25mg would not keep MJ asleep.
Flanagan insists there was no drip on the 25th, Steinberg insists there was a drip, they both give examples in CM's LAPD interview. They agree it's not clear, but Steinberg says it makes no sense , it's logical CM gave a drip : MJ logically would have woken up, and there as no reason that CM changed his methods.
25 mg is a very small dose, it's mild sedation : yes it's a small , doesn't know if it's mild sedation.
25mg would make him sleep 4 to 7 mn. Steinberg agrees. So if he was still asleep he was sleeping for other reasons. Steinberg says that he would have worried that MJ was still asleep (if MJ was not on a drip) . Protocol says that after propofol, you should watch that the patient is fully awake. Just looking at MJ doesn't tell if he's asleep or in deep sedation. Would a a pulse oxymeter tell you ? No.
Dr Murray should have woken MJ up. The fact that MJ was still asleep after 10 mn, if there was no drip, is very alarming.
Flanagan : propofol was successfully used on refractery chronic primary insomnia in Taiwan Steinberg : yes, this article dates back to 2010, in 2009 there was no medical knowedge. CM was unthetical Article mentions propofol given for 2 hrs per night 5 night a week, not 8 hours per night for 2 months. The article says that this test was successul, but it's still not used as a sleep medication because it's still experiental, there is not enough data about this. CM is the first doctor he's heard of who used propofol for insomnia.
Is propofol used for other things than surgery ? Yes, in the icu on intubated patients. Steinberg has never heard of it given for moderate sedation because there's a narrow marrow margin beteen moderate an deep sedation. Steinberg says he's not an expert on propofol.
How do you know he didn't use the ambu bag : because he said he did mouth to mouth.
How do you know he did not se the blood pressure cuff : becaue it was not on MJ.
Was the pulse oximeter on MJ ? No
How do you know CM left MJ ? Do you know how long CM continued to watch MJ ? No.
Do you know what happened between 11 and 12 ? No.
Did he say what time it was when CM went to the bathroom ? No
Do you have an idea of the actual time death : was DOA at UCLA.
Steinberg says he based his report on CM's interview.
Was MJ savable when CM found him : yes. CM left for only 2mn. His oxygen was in the 90s, it takes some time before the oxygen lowers. Yes MJ was savable.
You don't think it was 2mn ? I'm assuming it was 2mn, because CM said it was 2mn.
Let's assume CM was gone longer than that : It's assuming too much.
Have you heard of the telephone calls : yes but i don't want to comment on the phone calls. Phone calls tell me that MJ was on a drip, why would you be on the phone and wake Mr Jackson up ?
Let's assume CM was gone more than 2mn, maybe 5, 10, 20 mn, was MJ savable ? Yes, because when CM came back MJ had pulse, according to CM. If CM had reacted properly with the proper equipment, MJ would have been saved.
Was MJ in PEA when CM came back ? No, he had a pulse.
How do you know MJ had a pulse ? Because CM said so.
What should CM have done ? Call 911 immediately.
How long does it take to call 911 ? 2 seconds
Are you aware of te time it took in this case to call 911 ? No, as a doctor in this case CM was allowed 2 minutes before calling 911.
CM went down at 1205 to call for help , was it a violation of standard of care ? Yes. He didn't have the right equipment, should have called 911 imediately.
The judge is pissed off, sidebar.
Flanagan talks about Kai Chase : CM went downstairs and asked for help. Objection from Walgren : CM didn't ask Kai Chase to call 911. Sustained.
Are you aware of the Medical quality assurance board ? No.
Did you talk to CM to review this case ? No.
Did you ask to : No.
What should he have done in these 2mn : call 911, protect the airway, make him breathe (intubation, ambu bag), give flumazenil.
Did he make a mistake in asking someone to call 911 ? he didn't ask anyone to call. The time it takes to call for security was the time it would have taken to call 911. He had a cell phone, could have put 911 on loudspeaker.
Are you aware that the EMTs said MJ was cool to the touch ? Yes, but CM said he was warm. The firemen got there 26 mns later. You get cold in 26 mn when you have no bood pressure.
You have no doubt that if 911 had been called immediately MJ would still be alive ? No, I have no doubt about that, they could have saved him. CM said that he lost the pulse after calling MAW at 1212. So if the paramedics had been there at 1205 or 1210, they could have saved him. There is clear evidence that there was a delay in calling 911 : CM went dowstairs and called MAW.
Based upon these facts do you think he's responsible of MJ's death ? Yes.
He should have anticipated a power shortage (back up battery) : yes.
He should have dropped MJ on the floor, in spite of the IV line ? He should stop the propofol drip first. And yes, he should be careful with the line.
You indicated there should be suction ? Wouldn't clearing his mouth with a finger be enough ? No, you need suction.
Have you ever seen propofol given without a defebrilator ? No
If you only have 1 patient do you need to document everything you do ? Obvioulsy he didn't recall what he had given when he talked to UCLA or with the paramedics. But that didn't cause MJ's death.
Lunch break .
I hope dr Steinberg has lunch with the defense. Anyone at the defense table might need a cardiologist soon. This testimony was probably the most devastating so far for CM. Dr Steinberg was great, simple, easy to understand.
He based his answers on CM's interview, which I thought was great. The defense has no way out. |
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狗仔卡
显身卡
发表于 2011-10-13 02:47:55
我觉得迈迈肯定不希望看我考试Fail掉- -于是我先去看书了……
发表于 2011-10-13 03:08:07