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

3. 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

5. Making 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.” 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.”

6. Clinical 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

8. Ethchlorvynol 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

9. Ethchlorvynol 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

10. Ethchlorvynol 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

11. Elvis Presley’s Autopsy Report

12. 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

13. “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

14. 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.

15. Elvis Alive and Well in Indiana