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Further HistoryFurther History• “Yeah, the shit that killed Elvis. I

knew it had to be a good trip if it killed Elvis!”

• “Yeah, the shit that killed Elvis. I knew it had to be a good trip if it killed Elvis!”

Suspicious Minds?Suspicious Minds?

• “We can’t go on together with suspicious minds. . . So if an old friend I know stops by to say hello. . .” – Elvis Presley, 1969

• “We can’t go on together with suspicious minds. . . So if an old friend I know stops by to say hello. . .” – Elvis Presley, 1969

Making The DiagnosisMaking The Diagnosis

•“Yeah doc, the dealer that sold it to me said it was the shit that killed Elvis. I knew it had to be a good trip if it killed Elvis, but it never said on the pill that it would make me short of breath.”

•“Yeah doc, the dealer that sold it to me said it was the shit that killed Elvis. I knew it had to be a good trip if it killed Elvis, but it never said on the pill that it would make me short of breath.”•The patient also confirmed that the capsules from which he aspirated their contents were red in color and had a vinyl-like odor.

•The patient also confirmed that the capsules from which he aspirated their contents were red in color and had a vinyl-like odor.

•“By sucking out the liquid from the pill with a syringe and shooting it into my veins.”

•“By sucking out the liquid from the pill with a syringe and shooting it into my veins.”

Clinical CourseClinical Course• Admitted to ICU

– Intravenous furosemide– Supplemental oxygen

• 36 hours after admission– Dyspnea resolved– Lungs clear on exam– Chest x-ray improved– O2 saturation – 96% on room air– Patient offered substance

counseling but declined and was discharged home

• Admitted to ICU– Intravenous furosemide– Supplemental oxygen

• 36 hours after admission– Dyspnea resolved– Lungs clear on exam– Chest x-ray improved– O2 saturation – 96% on room air– Patient offered substance

counseling but declined and was discharged home

EthchlorvynolEthchlorvynol• Sedative-hypnotic• Placidyl discontinued in the

United States in 1999• 22 exposures reported in the

2001 Annual Report of the AAPCC TESS

• Sedative-hypnotic• Placidyl discontinued in the

United States in 1999• 22 exposures reported in the

2001 Annual Report of the AAPCC TESS

EthchlorvynolEthchlorvynol

• Dimorphic clinical picture– Oral overdose

•Hypothermia, hypotension, bradycardia, respiratory depression, pulmonary edema, coma

– Intravenous abuse•Noncardiogenic pulmonary edema,

CNS depression

• Dimorphic clinical picture– Oral overdose

•Hypothermia, hypotension, bradycardia, respiratory depression, pulmonary edema, coma

– Intravenous abuse•Noncardiogenic pulmonary edema,

CNS depression

EthchlorvynolEthchlorvynol

• Postulated mechanisms for ethchlorvynol-induced NCPE– Hemodynamic changes– Increased alveolar capillary

permeability– Arachidonic acid metabolites

• Disproved mechanisms– Polyethylene glycol– Sequestration of leukocytes

• Postulated mechanisms for ethchlorvynol-induced NCPE– Hemodynamic changes– Increased alveolar capillary

permeability– Arachidonic acid metabolites

• Disproved mechanisms– Polyethylene glycol– Sequestration of leukocytes

Elvis Presley’s Autopsy Report

Elvis Presley’s Autopsy Report

So How Did The King Really Die?

So How Did The King Really Die?

• Toxicologic analyses?– Codeine, morphine– Ethinamate– Methaqualone– Barbiturates– Ethychlorvynol– Diazepam– Meperidine– Chlorpheniramine

• Toxicologic analyses?– Codeine, morphine– Ethinamate– Methaqualone– Barbiturates– Ethychlorvynol– Diazepam– Meperidine– Chlorpheniramine

“Dr. Nick”“Dr. Nick”

• Dr. George Nichopoulos– Elvis Presley’s physician– Charged with prescribing Elvis

thousands of pills during the last two years of his life

– Medical license revoked in 1995

• Dr. George Nichopoulos– Elvis Presley’s physician– Charged with prescribing Elvis

thousands of pills during the last two years of his life

– Medical license revoked in 1995

Peanut Butter and Nana’ Sandwich Embolism

Peanut Butter and Nana’ Sandwich Embolism

• Ingredients– 2 slices of white or wheat bread– 2 to 3 tablespoons smooth peanut butter– 1/2 large, well-ripened banana, mashed– 1 to 2 tablespoons of Mazola Canola Oil

• Directions– Spread peanut butter on one side of both pieces of bread. – Spread mashed banana on top of the peanut butter on

one of the bread slices. – Put the two slices together to make a sandwich. – In a skillet over medium heat, pour the oil. – When the oil is hot, fry the sandwich, browning both

sides.

• Ingredients– 2 slices of white or wheat bread– 2 to 3 tablespoons smooth peanut butter– 1/2 large, well-ripened banana, mashed– 1 to 2 tablespoons of Mazola Canola Oil

• Directions– Spread peanut butter on one side of both pieces of bread. – Spread mashed banana on top of the peanut butter on

one of the bread slices. – Put the two slices together to make a sandwich. – In a skillet over medium heat, pour the oil. – When the oil is hot, fry the sandwich, browning both

sides.

Elvis Alive and Well in Indiana

Elvis Alive and Well in Indiana