Well, it isn't quite that clear. In this case, it means before the official time of death was recorded. And the reason it matters is that blood levels of fentanyl often increase after death. So, people argue that he was dead on the pavement at 8:30 (ish) and that the fentanyl levels in the tox report are inaccurate - essentially that he didn't die of a self-inflicted overdose.
But the medical literature involves comparisons of blood drawn perimortem (at the time of death) with blood drawn postmortem (typically several days later). I haven't seen anything to suggest that PMR (post-mortem redistribution) of opiods can happen so fast that testing of blood drawn while the doctors are still actively attempting a rescue would be seriously misleading.
So, bottom line, words like antemortem, perimortem and postmortem are not sharply defined objective facts. For that matter, neither is "time of death" - George died somewhere 8:25 and 9:25, was it when his heart stopped beating by itself? Was it when the doctors gave up? Was it some instant in between? Or was it the whole interval?
Basically, if you use it medically, a patch releases it slowly into your blood over the course of about 24 hours, and it reaches something like an equilibrium and stays there.
But, if you take it recreationally, you get a big pulse. The first organs to see it will take in a lot of it. As is spreads through the body, the blood concentration reduces, and the organs that took up that big pulse give some back. This is a pretty passive process, so it continues even after you die.
What the ME should have done (and maybe did do) is draw blood from several different points in his body, along with tissue samples from several organs, then send them all off for testing. All of that data together could be used to basically reconstruct the fatal dose.
Ante-mortem means before death. So he was still alive when they got to the hospital.
Well, it isn't quite that clear. In this case, it means before the official time of death was recorded. And the reason it matters is that blood levels of fentanyl often increase after death. So, people argue that he was dead on the pavement at 8:30 (ish) and that the fentanyl levels in the tox report are inaccurate - essentially that he didn't die of a self-inflicted overdose.
But the medical literature involves comparisons of blood drawn perimortem (at the time of death) with blood drawn postmortem (typically several days later). I haven't seen anything to suggest that PMR (post-mortem redistribution) of opiods can happen so fast that testing of blood drawn while the doctors are still actively attempting a rescue would be seriously misleading.
So, bottom line, words like antemortem, perimortem and postmortem are not sharply defined objective facts. For that matter, neither is "time of death" - George died somewhere 8:25 and 9:25, was it when his heart stopped beating by itself? Was it when the doctors gave up? Was it some instant in between? Or was it the whole interval?
How does fentanyl concentration go up after death? Doesn't it break down into metabolites like norfentanyl (which shows up in his tox report)
It diffuses out of organs.
Basically, if you use it medically, a patch releases it slowly into your blood over the course of about 24 hours, and it reaches something like an equilibrium and stays there.
But, if you take it recreationally, you get a big pulse. The first organs to see it will take in a lot of it. As is spreads through the body, the blood concentration reduces, and the organs that took up that big pulse give some back. This is a pretty passive process, so it continues even after you die.
What the ME should have done (and maybe did do) is draw blood from several different points in his body, along with tissue samples from several organs, then send them all off for testing. All of that data together could be used to basically reconstruct the fatal dose.
Ohh, thank you!