 So how exactly did George Floyd die? Could he have been saved? And what exactly does this preliminary autopsy report tell us, if anything? This is what I want to talk about in today's video. Now full disclosure, I'm a cardiologist, not a forensic pathologist, but I deal with patients with cardiopulmonary issues, cardiac arrest, respiratory problems pretty much on a daily basis. And we of course have this video that is very telling and gives us a lot of information. So the following is going to be my assessment and my opinion, which I think is shared by a lot of health care professionals. And I want to give you a doctor's perspective of what we know and what we can kind of infer based on the information that's out there. Not relaxed, not to breathe my face, not to breathe. So again, a lot of you have seen that video, very disturbing to watch, but also very important that it was captured. So what do we know based on this? Well, we know a lot. What we can see is George is in a prone position, meaning he's flat on his stomach, on the ground with his face flat against the pavement and a knee into his neck, applying pressure and force. What's exactly going on physiologically here? Well, there are two things that are compromised in this position. Breathing and circulation. First, let's talk about breathing. Now breathing involves filling our lungs with air, all right? And our lungs are obviously in our thorax. So in order for that to happen, the rib cage in the thorax has to be able to expand and that's accomplished because the diaphragm muscle contracts. It pulls down and as that happens, the chest wall will expand, allowing the lungs to fill with air. Similarly, our abdomen sort of gets pushed down a little bit in order for that to happen. Additionally, we have to be able to bring air through our mouth, our throat and down our trachea without much resistance to get that air into the lungs. Now when you're lying prone flat on the ground and you have resistance or a weight or a force pushing down on you, now you have to be able to lift your body up off the ground as you take in a breath. Now that can be more difficult for someone like George, who of course they call Big George because he was a big guy. So there's a lot more weight for him to be able to push up if he wants to take an adequate breath. Additionally, he has a knee on his neck. So that is applying force and pressure down. So not only has he pushed up against his own weight, he has to push up against the force of the officer, which can make things very difficult. Now additionally, when he has that knee on his neck, this could further compromise breathing by applying pressure against his trachea, which could compromise airflow coming in. Also, if you have other conditions like sleep apnea, this could further close up the airway in the back of the throat. Now we could potentially recreate a similar scenario by breathing through a straw. Take a straw and try to take some deep breath through it really fast. Again, it's very difficult, right? Now imagine breathing through a straw while you're down flat on the ground with your face against the pavement and a resistant force on your neck and try to do that for nine minutes. Now let's talk about what's going on physiologically in the body in a situation like this. First, let's talk about breathing. Breathing accomplishes two things. One is oxygenation. Two is ventilation. Now oxygenation is obviously the process of breathing air into our lungs to get oxygen into our blood in order for us to live. Ventilation is just as important. Ventilation is being able to get rid of CO2 or carbon dioxide that gets built up in the blood once the body consumes that oxygen during metabolism. Without ventilation, we cannot get rid of that carbon dioxide. And what happens is it causes the pH of the blood to go down. This causes a state of acidosis. So the body needs a balanced pH to function. If the body gets acidotic because it cannot get rid of all that carbon dioxide, then you're going to get an organ dysfunction. The heart is eventually not going to be able to function and electrical signals will fail and it'll cause cardiopulmonary arrest. Now let's talk about circulation. We talked about the breathing component of it, but there were also probably a circulation component. Now, as you saw in the video, the police officer's knee was against the neck forcefully for a long period of time. What can happen in this situation? Well, your carotid artery runs right along your neck. So compression to that air, the neck could compromise blood flow of the carotid artery up to the brain. Now another important fact is stimulation of the carotid body. The carotid body sits where the common carotid artery bifurcates into the internal carotid artery. Carotid body contains baroreceptors. Now these baroreceptors when stimulated can send impulses up to the brain, which in turn will send impulses down to the heart and the blood vessels to cause the heart rate to go really slow and the blood pressure to get really low. This can create a situation of further reduction in cardiac output in addition to the oxygenation and the ventilation issues we talked about. This is the same mechanism that sleeper holes or choke holes work on. Now add to all of this underlying conditions such as high blood pressure or coronary disease that we think George may have had. Obviously that creates a bad situation where his reserves to be able to tolerate something like that are worse than people without those health conditions. So it was the perfect storm of badness. So the other question is could George have been saved? We obviously watched this unfold sort of in real time and people were there when he passed out, police were there, EMS was there, no CPR was done. We all saw that but could have something have been done that could have potentially saved them. Well let's look at the timeline. From what we know by the videos about 825 is when he's thought to have lost consciousness, okay? Again the knee was on him for an additional almost three minutes after that. 827 is when EMS arrived and it wasn't until 830 he actually got on the ambulance. Now no CPR was done on the scene by the police officers which I think again is a big mistake. Which I think goes to show a deficiency in training of these officers. There were four officers there, clearly he had no pulse, he was not breathing. Immediate cardiopulmonary resuscitation should have been started, CPR should have been started, again that was not done. Now by the time the EMS arrives, it's unclear. Now at first I sort of criticized them for not getting on him immediately and starting CPR but one could argue either the police were instructing them not to do that at the scene or if they wanted to get him on the bus immediately and start resuscitation measures there. May not be unreasonable because when you started on the road you're eventually gonna have to get him up and get him into the bus. If that's what they were thinking they probably should have gotten them up under the gurney into the ambulance as fast as possible rather than the three minutes that it actually took because when you have a cardiac arrest patient every second counts. This is why we put so much into bystander CPR and as a cardiologist seeing patients come in without a hospital cardiac arrest the difference between those who live or die or have permanent brain damage are really the ones who get immediate CPR by bystander. In this situation it's unfortunate that there were trained police officers that did not start CPR immediately. Again it's hard to know if immediate CPR would really have changed the outcome for George but it at least would have given him a fighting chance. So in the end we have a witness cardiac arrest where the patient was out for at least six minutes. Again it was unclear at what point CPR was started in the ambulance but you know minimum six minutes which is a long time especially for somebody with underlying heart and other medical problems. Finally let's talk about this autopsy report. Now I know this was a preliminary report but these were still words in a statement put out by the medical examiner and these are words they're gonna have to stand by. Now first of all big picture the report doesn't really give a cause of death. Additionally it's very vague and it actually even makes assumptions to facts that we may not even know exist. The full report is pending but the statement they released reads the autopsy revealed no physical findings that support a diagnosis of traumatic asphyxia or strangulation. Mr. Floyd had underlying health conditions including coronary artery disease and hypertensive heart disease. The combined effects of Mr. Floyd being restrained by the police, his underlying health conditions and any potential intoxicants in the system likely contributed to his death. Now let's break this down line by line because this is important. First of all this was not traumatic asphyxiation nor was it strangulation, right? So strangulation when they're looking for signs of strangulation you're basically looking for signs of someone getting choked. So you're looking for ligature marks, you're looking for bruises and markings to show that someone's neck was forcefully compressed, fracture of the hyoid bone and other things you see like contractile and particular hemorrhages and signs of kind of acute obstruction of the airway. But we all looked at a video. He wasn't strangled, we know this. So that seems silly. Secondly traumatic asphyxiation. Again this was not traumatic asphyxiation. Traumatic asphyxiation refers to in a situation of trauma like a motor vehicle accident or machinery accident where there's trauma to the chest or there's some sort of situation where the patient literally cannot take a breath at all. What it causes is an acute increase in intratheurastic pressure which basically limits the backflow to the right side of the heart causing a spike in the right atrial pressure which transmits back up to the supervena cava which in turn causes an acute rise in venous pressure of the head and the face which will cause facial swelling. This will call a rupture of various veins and capillaries and other similar phenomenon that we see. But again we know in a situation this was not an acute trauma induced chest restriction situation. This was a slow asphyxiation process. What he had is something called positional asphyxiation. Positional asphyxiation is a situation where someone is not able to adequately breathe mechanically because of a certain position. You know in his case being prone on the ground and with a weight on the back of his head kind of like what we talked about before. And this process again can sometimes be a little drawn out and slower than your traumatic asphyxiation. But again, we don't need an autopsy to make that diagnosis. It was clear in the video. The last line which really bothered me reads the combined effects of Mr. Floyd being restrained by the police his underlying health conditions and any potential intoxicants in the system likely contributed to his death. Now, you can't get much more vague than that. Likely and contributed. Already two words that sort of expressed uncertainty and any potential intoxicants like they didn't even do a tox report. They're just assuming that he may have been intoxicated or under the influence of something. I mean that line alone to me really compromises the integrity of this report combined with all this uncertainty and really it's a poor statement to put out and all it does is fuel the fire and I don't think they did anybody any good by releasing that paragraph. So again, a lot of holes in that in the terminology. I can't help to think that there is some bias involved in that preliminary report. What they should have just said is full report is pending. I'm really looking forward to the full autopsy. Hopefully there's details and I fully support an independent non-miniapolis associated medical examiner or pathologist doing an autopsy on him as well given the intensity of the situation and hopefully we can get some more answers soon. In the end, I think it's pretty clear we all know how he died. We don't need an autopsy to tell us that. It's semantics if you ask me. It's clear as day and something to be done about.