Reviewing evidence of morphine poisoning and the remarkable recovery of Child M
2025.01.24 21:03 Pauloxxxx Reviewing evidence of morphine poisoning and the remarkable recovery of Child M
The evidence appears to indicate that some babies may have been poisoned with morphine.
However, prosecution witnesses believed instead that babies were deliberately harmed by injection of air into the bloodstream, for instance Child M.
Could the prosecution witnesses be right? Or could the collapses all be down to natural causes? It is important to look again at the evidence.
Let’s first consider some of the evidence that may suggest the possibility of morphine:
1) Symptoms
There are a number of cases of collapses and deaths which all have the same symptoms as morphine poisoning*:
1. Apnoea;
2. Desaturation;
3. Bradycardia;
4. Excess air or gas in the stomach or bowels;
5. Unusual purpuric rash / discolouration;
6. Abdominal distension;
7. Swelling all over the body;
8. Projectile vomiting;
9. Swelling of the throat / vocal cords;
10. Gasping for air
(A number of other morphine symptoms are also indicated including myoclonus / involuntary jerking movement of the limbs.)
Morphine poisoning fits with all of these symptoms.
(Note morphine poisoning would not appear to explain the injury caused to Child O’s liver, which suggests Child O’s liver injury has a different cause.)
2) Availability
Morphine was available on the unit. (As a controlled drug, it appears that a nurse would have to obtain the keys to access the morphine.)
3) Post mortem
The toxicology results for Child D identified a low concentration of free morphine present at the time of the post-mortem. It mentions that this is consistent with medical treatment, but the detailed review by Dr Hawdon that listed out the drugs that Child D had been given did not include morphine.
https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0002045_04_07-08_831-834.pdf
https://thirlwall.public-inquiry.uk/wp-content/uploads/thirlwall-evidence/INQ0003172_5-6_17_19_22_24_44-45.pdf
Dr Hawdon may have identified it in her analysis if she had seen the toxicology results, but her analysis for Child D noted no PM report in records.
[*Note: some examples of morphine symptoms may be found at the following links:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31813-0/fulltext31813-0/fulltext)
“The predefined safety stopping boundary was passed, because three (20%) of 15 infants assigned morphine had apnoeic episodes requiring resuscitation...
Infants assigned morphine had significantly more episodes of oxygen desaturation in the 6 h and 24 h periods after the clinical procedure, and significantly more episodes of bradycardia in the 24 h period after the clinical procedure, compared with those allocated placebo”
https://www.mayoclinic.org/drugs-supplements/morphine-and-naltrexone-oral-route/description/drg-20073309
“More common
· Excess air or gas in the stomach or bowels
· Trembling or shaking of the hands or feet
· Bloating or swelling of the face, arms, hands, lower legs, or feet
· Vomiting“
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.12111
“Upon visiting the patient the next day her unusual rash was noted to have almost entirely disappeared”
https://pmc.ncbi.nlm.nih.gov/articles/pmid/3133042/
“Purpuric rash associated with slow release morphine”
https://pmc.ncbi.nlm.nih.gov/articles/PMC2077632/#:~:text=Myoclonus%20has%20been%20described%20as,to%20cause%20opioid%E2%80%90induced%20myoclonus.
“The myoclonus occurred in all four limbs”]
The fact that the symptoms across a number of cases are all consistent with morphine poisoning as well as the availability of morphine on the unit and the detection of morphine in Child D’s toxicology, suggests the need to carefully consider if babies were poisoned with morphine. This may include carefully re-examining the toxicology results e.g. for Child D and double checking the medication administered.
It may be that other symptoms and evidence could also help to conclude on the cause of the collapses. The mother of Child A and B did really well taking a photo the following day for Child B, and maybe future advancements could even use that to help understand the cause.
Is there any other evidence that can strongly point to morphine poisoning?
If not, there may still be some doubts about whether or not babies were poisoned with morphine.
Despite the symptoms suggesting morphine poisoning, could it be that actually the babies collapsed / died because of some other reason such as a) injection of air or b) natural causes?
To understand this, it is worthwhile to look again at the case of Child M.
Child M - recap
https://www.reddit.com/lucyletbyevidence/comments/1hu5nfo/child_m_and_the_noxious_substance/
It was seen that Child M was previously stable and suddenly collapsed and that Child M went apnoeic and had a profound bradycardia and desaturation. The evidence by Belinda Williamson was that there was a mottling appearance and the evidence by Dr Jayaram was that he had seen these blotches on another baby in this case, Child A.
Injection of air:
It was noted that air embolus is fast acting. The defence argued that if air has been administered at that time … it would not take 15-16 minutes to have effect [as] air embolus is fast acting.
The evidence suggested that four people were in the room at the time of collapse: Mary Griffith, Lucy Letby, an unnamed nurse, and Belinda Simcock and none of them appear to have seen anyone administering air at a time sufficiently close to the time of the collapse.
Therefore the evidence suggests it is unlikely for Child M’s collapse to have been caused by the injection of air into Child M’s bloodstream.
Natural causes:
Dr Gibbs mentioned that NEC and sepsis were excluded by following evidence.
Also, as reported by Dan O’Donoghue from the BBC:
https://x.com/MrDanDonoghue/status/1628706561332838401?t=sa8gndhcguU5uNLZ60C3Aw&s=19
“Dr Gibbs said subsequent X-rays and heart scans offered no explanation for the child's collapse…
Consultant paediatric cardiologist Dr Arjamand Shauq … reviewed an ultrasound of Child M's heart … Dr Shaq said having reviewed the images the structure 'is not a thombos' but a eustachian valve, which is 'perfectly normal in infants' …
Dr Evans said he ruled out infection (like pneumonia) as the cause of Child M's collapse as he would not 'have made such a prompt respiratory recovery' in the hours after. “
Therefore the evidence of the sudden collapse and exclusion of likely natural causes appears to suggest that the collapse may not have been down to natural causes.
However, there may still be doubt about the cause of the collapse. It is therefore useful to consider what happened to Child M after the collapse.
The remarkable recovery of Child M
https://x.com/MrDanDonoghue/status/1628341661787979776?t=y2yuppy1fQ9WwXmKFdI74g&s=19
“Dr Jayaram recalls receiving a crash call… When he arrived on the unit, Child M was receiving CPR… His notes from 9 April … show he arrived at 16:15.
Child M had already received three doses of adrenaline and had been intubated.
Dr Jayaram recalls having a conversation with Child M's family after 20mins of resus about whether they should stop.
'Generally the longer it goes on for, the less likely it is to have a good outcome. These decisions are very, very difficult', he tells the court.”
After 20 minutes of resus, Child M’s fate seemed inevitable.
However, Child M survived!
https://x.com/MrDanDonoghue/status/1628341661787979776?t=y2yuppy1fQ9WwXmKFdI74g&s=19
“[Dr Jayaram] said after 25mins, Child M 'suddenly recovered' - he said it wasn't due to a 'any specific intervention' by medics.
'I couldn’t really explain what had caused it and why he suddenly got better', he added.”
If Child M’s collapse was caused by natural causes, then it would appear extremely unlikely for Child M to have been so close to dying and to have then suddenly recovered.
Similarly, if Child M’s collapse was caused by an injection of air into the bloodstream then it would also appear extremely unlikely for Child M to have suddenly recovered.
https://x.com/MrDanDonoghue/status/1628706561332838401?t=sa8gndhcguU5uNLZ60C3Aw&s=19
“Dr Evans says most likely the cardiac compressions resulted in air moving from one side of heart into lung.”
As reported in the Chester Standard:
https://www.chesterstandard.co.uk/news/23636819.recap-lucy-letby-trial-july-6---judges-summing/
In cross-examination, Dr Bohin accepted most babies die in the case of air embolus.
https://www.chesterstandard.co.uk/news/23621368.recap-lucy-letby-trial-june-29---defence-closing-speech/
The defence stated that “the theory of air embolus is "utterly unrealistic" for Child M.”
So if natural causes and injection of air into the bloodstream are not realistic explanations for Child M’s collapse and sudden recovery after being on the brink of death, then what could have happened to explain this?
The evidence suggests that they were following the Resuscitation Council newborn life support algorithm for Child M.
https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ne.pdf
This involves administering certain drugs (see page 300 and 301 at the above link).
The drugs used during active resuscitation are noted as:
· Adrenaline
· Glucose
· Sodium bicarbonate
And in situations of persistent apnoea:
· Naloxone
Suddenly the reason for Child M’s recovery from the brink of death appears clear.
Is there any other evidence that can strongly point to morphine poisoning?
The answer is yes!
The effects of morphine (or similar opioid) poisoning rapidly reverse when the antidote is given.
And the antidote to morphine poisoning is … Naloxone!
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I'm upgrading from the S22 small version with the Exynos.
Battery life is horrid, cameras are ok-ish, speed is fine, nothing amazing but I'm not a gamer and not looking for insane performance I just want a decent battery that lasts more than the S22's 3 hours SoT and good cameras.
The Pixel seems right up my alley but I've got a nagging voice in my head telling me to grin and bear it until the 10 series comes out and the new TSMC chip drops.
What do you guys think? Buy the 9 Pro now or wait?
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I've found a few designs that really caught my eye:
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Any ideas where I could find something similar in design without the high price? ±100+ EUR is too high for me as I'm not sure whether I will pull it off.
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When trying open any app that doesnt work while playing music, the audio plays through for half a second and then stops completely. The only way to get music back is to close everything and open it again.
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I guess I just need support/somewhere to vent.
I live with my boyfriend of 1.5 years and we're two months out from match and things are TENSE over here. He had 3 interviews and will be ranking those 3 places. Of those three, all of the interviews went really well and he had letters of recommendations directly from DR.'s at each hospital + they continuously put a good word in for him + text/email him. From the outside looking in - you're like, 'of course one will work out' and 'it just takes one' - but then you come on here and learn how many people are basically promised spots and don't match.
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How are you guys managing the stress of the unknown? And how are you navigating heavy 'what if' conversations without spiraling your partner into the worst-case-scenario?
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Hi everyone,
As the title says, Why do people praise so much for it? It's prone to cracking, and there are other affordable options in the market that are long-lasting and are not prone to break unless something strong causes a damage.
For me it feels like, "It looks nice, it'll probably crack, but I don't care, I'll buy it anyway".
For me, I'd prefer to buy a pen that people say, "Hey my father has had it since the fall of the USSR and it didn't break neither itself nor his wallet" than something that leads me to have fear that it won't keep its structural integrity for quite long.
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2025.01.24 21:03 Emperor_Vaibz Def from UMich, USC :) (yay)
Demographics: Asian male, upper class, CA Bay (sigh)
Intended major: Aerospace/aeronautical engineering/mechanical
SAT: 1550 (790 Math)
GPA: 4.0 UW, 4.62 W
College Courses: 5, including dif eqs and lin al
APs: 15 out of 25 by senior yr (most i could take since I decided to take French all 4 years)
ECs:
FYI: Idk if i should frame it as such, but my "passion project" is developing a new sustainable plane, which is what my papers and my research at Umich aid
My focus is very much on aerospace and sustainability. in my essays, I also talk about how I want to connect that with ethics
Conferences, Presentations, and Publications:
- All my research is independent without any programs. I did not pay to get research or publish with anyone. My umich work was thru my nasa competition, where I gained connections.
- Presented abstract on C-wings at AIAA's YPSE Conference
- Presented paper at AIAA student conference
- Published with the conference
- Biofuel review paper
- Drone Pilot and Engineer School Aug 2023 - Present Pilot and engineer for the school's drone soccer team, involved in hardware and software development.
- Aeronautics School Aug 2021 - Aug 2024 Lead coder and designer for a UAV project focused on medical supply delivery.
- Engineering Intern Jun 2024 - First intern, Contributing to ML and AI model development for aerospace applications.
- Write blog with thougsands of viewers on sustainable aviation, recommended by NASA employees
- Senior volunteer at an aviation museum, lead in many aspects. almost 200 hours teaching kids about aviation
- First ever High School Student Research Assistant at lab at University of Michigan May 2024 - Present Collaborating on the development of test cases for a sustainable aviation software
- President, Astronomy Club School May 2024 - Present Organizing astronomy events, leading a team in designing and launching a rocket powered by gummy bears. Led effort to add rocketry
- Assistant Head Delegate (Vice President), Model United Nations School May 2024 - Present Training and mentoring members of the Model UN team, assisting in leadership roles.
- Lawrence Livermore Labs Work July 2024
- I lead PM everything I do, all are related to sustainability and aerospace
- AP Statistics Visualized Associated with School May 2024 - Present Created a tool to aid AP Statistics students, involving practical applications like building and testing a plane.
- Gummy Bear Rocket Project Associated with Astronomy Club Nov 2023 - Present Designed and built a solid-fuel rocket using gummy bears as propulsion.
- PilotPredict App Sep 2023 - Nov 2023 Developed an app to measure pilot performance using data analysis and machine learning.
- Medicine Delivery Drone Project Associated with School Sep 2022 - May 2023 Contributed to the development of a drone for accurate medicine delivery.
- CarbonWise App Aug 2020 - Feb 2021 Created an app to track household carbon footprints, receiving second prize for the project.
- AND MORE RANDOM OTHER PROJECTS
- 15th Internationally in the International Aerospace Olympiad Senior Div out of 28k ppl (thru all divisions, idk for my division how many ppl where there)
- NASA Dream With Us Challenge 3rd Place Winner (High School Division) Team Lead, NASA, Jun 2023 Led team in designing a sustainable Boeing 737 MAX 8 utilizing biofuels and innovative aircraft design concepts.
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- Citywide Recognition and Certificate in Science and Engineering, Recognized for creative innovation and academic excellence in the sciences.
- Model United Nations Awards:
- Outstanding at 28th Stanford MUN
- Outstanding Delegate, 8th South Bay Model United Nations
- Honorable Mention, 27th Stanford Model United Nations
- Outstanding Delegate, 2023 Fall Mock Conference
- Honorable Mention, 2023 Spring Mock Conference
Embry-Riddle: 60K Scholarship
USC: Deferred :(
Mich: Def :(
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My dad's girlfriend recently moved in and has decided that the way we have lived in the house for the past 8+ years is completely wrong and everything needs to be reorganized.
To be fair, some stuff was helpful. The pantry is neater. Most of what's she's done, however, is nonsensical.
For example, the cups which were in the top cabinet which can be easily accessed are now moved to a bottom cabinet that you have to bend down to grab. Common medicines (DayQuil, pepto, Tylenol, bandaids, etc.) are now in the hall closet with the towels.
There's some other minor stuff like switching what was on the right side of the stove to the left or insisting the vacuum be kept in the garage.
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I did try moving some stuff back but the next day I discovered that she had just moved it again. I don't want to have to go on a scavenger hunt every time I eat.
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