Michael Jackson's Final Medical Moments

As soon as the world learned about pop star Michael Jackson’s untimely death in 2009, there was even more shocking news: reports of inadequate emergency medical care.

I worked for several years in emergency room at the Bellevue Hospital in New York City. I was dismayed by the reported delays and ineffective medical interventions by Dr. Conrad Murray as Jackson died.

It was also clear to me at the time that propofol, a rapid onset anesthetic best used by anesthesiologists with advanced monitoring equipment in Operating Rooms and surgical suites, had no place in Jackson’s home nor should it have been administered for sleep by Murray, a cardiologist.

I was also quite critical at the time of CPR being conducted on a soft bed rather than on a hard floor, a delay in calling 911, along with the inadequate medical equipment on hand in the home.

The ongoing trial of Dr. Murray and the current testimony of paramedic Richard Senneff, the first EMT to arrive on the scene, are now confirming the initial disturbing reports.

A finger device to measure oxygen (known as a pulse oximeter) was hardly adequate to monitor the effects of propofol, a powerful anesthetic that can suppress breathing and blood pressure.

But what of Senneff’s claim that Murray’s decision to withhold information revealing that Jackson was on more medication (propofol and other sedatives) -- beyond the dose of lorazepam he admitted to administering -- interfered with the paramedic’s ability to save the star? Is this medically fair or just courtroom theatrics?

No matter what the cause, the paramedics would generally put a patient with low blood pressure and difficulty breathing on a respirator, at the same time administering intravenous and fluids and pressors. They would also have attempted to stabilize him and bring him to the hospital as soon as possible.

While it is true that chronic high doses of propofol can rarely lead to multiple organ failure with acidosis, high potassium, muscle breakdown, and kidney failure (something as "propofol infusion syndrome"), at the same time, most of the life saving interventions performed by trained personnel, whether the cause is propofol or some other drug, would have been the same.

And, of course, a drug overdose would clearly be on any paramedic’s mind who was rushing in to try and save Michael Jackson.

Here's one other thing: the dilated eye pupils and dry eyes that Senneff reported are in fact NOT suggestive of a propofol overdose. Just the opposite. Propofol use leads to a release of the powerful neurotransmitter acetylcholine which constricts the pupils and moistens the eyes.

In fact there are studies which suggest that atropine, an anti-cholinergic agent which BLOCKS acetylcholine may work as a partial antidote for the effects of propofol on the heart.

Nevertheless, Seneff is right to have insisted on full information about what drugs Jackson was taking.

Murray was obstructing these lifesaving attempts to save Jackson if he withheld the truth.

No matter what the specifics, knowledge of medication use is always helpful in guiding a paramedic. Sometimes this information is lifesaving and sometimes it isn’t. In Jackson’s case, it is difficult to know whether he was beyond saving by the time the paramedics came.

Marc Siegel, M.D. is an associate professor of medicine and Medical Director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and is the author of several books. His latest is: "The Inner Pulse; Unlocking the Secret Code of Sickness and Health."