Thread by @UR_Ninja

Day 21 of our Derek Chauvin Trial coverage is starting shortly in Minneapolis - tune in now
twitter.com/i/broadcasts/1…

First to testify today is Martin Tobin, a phsyician in pulmonary critical care medicine at Hines hospital in Chicago (one of the largest in the country) as well as Loyola State University .

Questioning is being done by Jerry Blackwell from the Minnesota AG prosecution team.

Tobin defines pulmonology as "the study of the lungs...of all diseases that effect the respiratory system..." describes the anatomy of the pulmonary system faster than we can take it down.

"Critical care is where you take the very sickest people" - Dr. Tobin

Tobin often works with patients who require respirators and/or people with severe lung issues. Also people with overdoses, alcohol withdrawal, diabetic coma, sepsis. "Once they come into the ICU, they're our patients, I'm the primary physician for everyone who comes into the ICU"

Has been working for 46 years. He's from a small village called Freshford (sp?) in County Kenny (sp?) in Ireland.

Tobin is licensed in the state of Illinois and in the past was licensed in Ireland, england, and many US states but "let those lapse bc the only state in which im practicing is Illinois". Is board certified in various forms of medicine

He's held his positions at Loyola and Hines "for 32 years almost." before those places he was at UT Houston for 7 years. He set up a sleep clinic in Houston in early 80s - "I set up one of the very first sleep labs in the United States..for patients with obstructive sleep apnea"

Tobin describes how sleep issues such as snoring interact with breathing, blood oxygen levels. "The basic problem in sleep apnea is become the soft palette....the roof of your mouth is the hard palette...the piece thats hanging down is the soft palette..."

Tobin is engaged in medical research "since the early 80s, since about 1981." "All of my research is related basically to breathing, so it is kind of looking at breathing in patients with lung disease"

Tobin authored "a large textbook on mechanical ventilation thats called The Principles and Practices of Mechanical Ventilation". Blackwell shows the court the cover of the textbook. Its 1500 pages

Tobin's textboon was praised as a "bible" by the Lancet medical journal, one of the top medical journals in the world. Tobin has also authored other books about respiratory failure and the lungs, as well as numerous articles and abstracts

"i've lost count but i've published more than 750 or something like that" Tobin was editor-in-chief of a premiere medical journal regarding lung disease and intensive care - the offiical journal of the American Throracic (sp?) Society

He's lectured to the Mayo Clinic several times; the clinic has given him an award that's only "given to one doctor every ten years." He was recognized "for my work as a researcher in clinical medicine".

He's also published in The Journal of Applied Physiology. "a lot of work on basic science that's not directly related to medicine"

"physiology is really a study of how the body works...you want to understand the deeper mechanisms"

Tobin is interested in understanding breathing and how breath effects muscles, how breath fills the chest and can overcome resistance in the chest.

Tobin has been working in respiratory physiology "since 1981...40 years)

"I just wanted to know how you breathe...i wanted to come up with new knowledge...everybody thought they knew everything about breathing...so i thought it would be fun to come up with new stuff..."

Tobin says that after his 46 years working, it now seems rarer "to see people doing physiology at the bedside"

Tobin has been an expert witness on both sides of civil cases before, has testified in court "about 50 times" but never part of a criminal case.

He says he is not getting paid for his testimony in the #DerekChauvinTrial

"I thought i had some knowledge that would be helpful to explain how Mr. Floyd died. Since i've never been involved in this kind of work i didn't want to be paid for it"

The state reached out to Tobin to be a witness - he read all the Hennepin County medical reports

Asked to share his opinion on the cause of George Floyd's death. "Mr. Floyd died from a low level of oxygen. This caused damage to his brain that we see and it also caused a PEA [pulseless electrical activity] arrhythmia that caused his heart to stop"

Tobin says he doesn't like the term asphyxia...says "these are other words for a phenomena that is a low level of oxygen"

"the cause of the low level of oxygen was shallow breathing. Small breaths, small tidal volumes, shallow breaths that weren't able to carry the air down his lungs into the essential areas that get the oxygen into the lungs and carry away the carbon dioxide..." - Dr. Tobin

The state is about to play a video composite made by Dr. Tobin to explain how lungs work. He made the video as part of preparing for his expert testimony in the #DererkChauvinTrial

(tune in to our stream now to catch the video - see top of this thread)

"there are a number of forces that led to the size of his breath became so small. There are a series of forces...leading to that...the main forces leading to the shallow breath are that he's prone on the street, has handcuffs in place combined w the street...

...as well as a knee in his neck, a knee in his back, a knee in his side..."

Dr. Tobin created a 3D model recreating the scene of George Floyd’s death which allows a better view of how @MinneapolisPD worked to obstruct his airways on May 25, 2020

"Whether you're making a decision of whether the knee is on the knee or the back... from the point of view of breathing, the effects are very similar" - Dr. Tobin

Asked to discuss "how handcuffs, prone position, knee on the neck, back, arm and side, ow do those mechanisms fall into your work? " - Blackwell

"They don't have a lot to do w clinical medicine but they are directly related to pulmonary physiology" - Dr. Tobin

"The handcuffs are extremely important...but not on their own...it must be the handcuffs combined with the street...and how he's manipulated both by Officer Chauvin and Officer Kueng...they're pushing the handcuffs into his back and pushing them high...

he's against a hard asphalt street...the way they're pushing him w handcuffs down to the street...the left side is in a vice... being pushed in, squeezed in, at each side, from the bottom...

it's not the handcuffs, it's how the handcuffs are being held, pushed, that totally interfere w central features of [breathing]".

Dr. Tobin describes how such a "bucket handle movement" can "contract the diaphragm"

Dr. Tobin is guiding jurors through a "pump handle" metaphor for breathing, has them take deep breaths while he describes aspect of how the diaphragm works

Blackwell was going to show another exhibit Dr. Tobin had prepared to exhibit his medical models - Nelson (Chauvin's lawyer) objects, asks judge for a sidebar which is underway now w the public audio feed muted

Judge Cahill sustains Nelson's objection.

Dr. Tobin has selected segments of the involved MPD officer's body camera videos which shows portions where he believes George Floyd was clearly struggling to breathe.

Tobin describes seeing "that his left hand is being grabbed by the police officers, so that's a handcuffed left hand thats being pushed into his chest so he's not able to expand that..."

"Officer Chauvin's knee is coming in as well...also you're seeing that the size of the chain between the right side and the left side [of the cuffs] is very short, so his left arm is being pulled over, it's also preventing him from breathing on his right side..." - Dr. Tobin

Portions of Dr. Tobin’s testimony may feel very familiar to people, such as this observer, who have been arrested before

Tobin says it's "extraordinarily significant" that George Floyd can be seen pressing his knuckles into the MPD squad car tire as he's being crushed into the pavement.

Dr. Tobin describes in fast medical terms we didn't entirely catch how that while a layperson wouldn't see it, this shows that Floyd was actually "trying to breathe w his fingers...to crank up the right side of his chest...this is the only way to try to get air into the lung..."

Tobin selected images showing the physiology of how George Floyd was trying to breathe through his shoulder. Says it’s not “an effective way” to breathe but it’s what people do when they “have to call on the shoulder to try to be able to breathe”

Dr. Tobin says the knee on the neck is significant because “it occludes the airflow in the passageway”

Dr. Tobin is walking the jury through feeling the anatomy of their necks to understand some of the physiology involved in his testimony

"the hypotharanx is important for understanding this case because its very vulnerable...its very small..."

"the hypotharanx is going to be the area thats vulnerable from the knee on the neck...the hypotharanx is also controlled by the size of the lungs... you influence the hypotharanx w every breath"... Tobin says "varying from time to time" Chauvin was applying weight to hypotharanx

"If [the hypotharanx] became totally occluded... you're going to drop to a level of oxygen that will produce oxygen deprivation in the body that will lead to a seizure or a heart attack, one or the other" - Dr. Tobin

“On the first slide you see that Mr. Floyd’s nose, his face, is directly face down on the street, it’s not at any angle...”

Nelson interrupts during this exhibit portion of testimony to ask for a sidebar

Oops, we broke this thread. The rest of it picks up here; thanks for following:

https://twitter.com/UR_Ninja/status/1380178138123079687