In North Carolina, you're considered legally impaired if your blood-alcohol level is .08 or above. Judge Osmond Smith heard the testimony while the jury was out of his courtroom, and ruled the jury could hear it.
When Cook was first indicted in 2009, authorities reported his blood-alcohol level was .19 in a separate blood test performed for police.
According to experts, police crime labs test whole blood, and produce a blood-alcohol content figure on that basis. Most hospitals and clinics test only the blood serum, which can result in a blood-alcohol content figure that can be 25 - 33 percent higher than a "whole blood" test result.
Cook's lawyers argued the tests done for medical reasons weren't admissible.
Also Thursday, an off-duty paramedic continued his testimony.
Simon Capell has been to many wrecks including fatal ones, but he said Thursday that the circumstances surrounding the crash and the death of Elena Shapiro were so unusual he has had psychological issues.
Cook, a Raleigh plastic surgeon, is charged with second-degree murder, felony death by motor vehicle, and driving while impaired in the death of Shapiro. Police say Cook was intoxicated and driving more than 80 miles an hour in a 45 mph zone just before he crashed into Shapiro's car on Strickland Road in Raleigh on September 11, 2009.
Capell had just left work and was heading home when he came upon the crash in his personal car. It was just seconds after the accident, and Capell immediately tried to help. He said he checked Shapiro's vital signs, realized she was dying and pulled her from the wreckage so he could start chest compressions.
Capell said Dr. Cook was also there.
"He joined me immediately as I began compressions," Capell testified.
Capell said Cook attempted to perform mouth-to-mouth resuscitation on Shapiro. Capell also said, initially, he didn't realize Cook was the driver of the car that hit her.
"It came across to me that this was probably lay person that was doing it simply because he was blowing on her mouth, but the air wasn't going in," he said.
Capell says he tried to stop Cook to clear Shapiro's throat, but Cook kept going. Minutes later, when other paramedics arrived, he heard Cook bark an order to "resume compressions."
"I had been a little bit annoyed from before and I'm thinking, 'Who is this guy?'" Capell testified.
It was about that time that Capell said he realized Cook was the other driver.
"He turned to me and said, 'I'm a physician,'" Capell testified.
Capell says he immediately noticed the strong smell of alcohol and started getting angry.
"I actually asked him directly and said, 'Brother, have you been drinking?'" Capell testified. "And he paused, turned, looked at me and said, 'No.'"
Capell said he was so angry at Cook and frustrated that he didn't have more medical equipment in his personal car that might have helped Shapiro that he's experienced post-traumatic stress disorder.
Cook's attorneys admit he had been drinking before the crash and was speeding. They're challenging the second-degree murder charge saying the prosecution can't prove malice - a requirement under North Carolina law.
Following the crash, Cook gave up his medical license and left positions he once held at WakeMed and the UNC School of Medicine. According to WakeMed hospital's website, Cook was a facial reconstructive expert.
ABC11 has confirmed that this was not the first time Cook had been charged with going well over the speed limit while intoxicated.
In 1989 in Camden County, Georgia, he was stopped for doing 110 in 65 miles-per-hour zone. He was also charged with DWI.
Court records in North Carolina show that same year he was charged with DWI in this state, but the charges were dropped.
Three years earlier, he was charged with driving too fast for conditions.