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Ketamine makes you go night night and forget to breathe. Probably not a good idea to inject someone with it without a way to protect their airway.
Not to mention they never did an evaluation, they never checked vital signs, they didn't do any attempt at administering this medication safely. They fucked up utterly and completely. So did the cops. So did the fucker that called 911. Society let this young man down every step of the way.
I'm out of the loop -- what did the 911 caller do?
Called the cops bc he was wearing a ski mask and therefore looked suspicious
Damn. Especially if it was cold out at the time, then that's inexcusable. But even if it wasn't, there are reasons to wear a ski mask that don't involve breaking the law, so calling the cops for that seems stupid if that was their only reason for making the call.
*outside walking while it was cold.
Made a phone call that got a completely innocent person killed.
Wouldn't there be other more appropriate medications to calm someone without the possibility respitory arrest? Something like Xanax or Ativan for example? Not a pharmacist but Ketamine seems kinda hardcore.
Paramedic here, we don’t have access to a fully stocked pharmacy in our ambulance. Ketamine is pretty much the industry standard for situations like this. Its efficacy, safety profile, wide dose range, and rapid onset make it the ideal drug for managing violent behavior and sedation in a prehospital setting. I am not saying the medics made an appropriate decision in this situation but that is the appropriate mediation to use in situations like this. Versed would be a good runner up but is less effective in some situations with low doses and higher doses have a higher risk of respiratory compromise. Ativan is an option, if they carry it, I wouldn’t personally use Ativan in this situation because it has a longer onset/duration and higher chance of adverse reactions.
Ketamine might seem a bit excessive but it’s a very good medication for prehospital use. This is a situation that a lot of stuff went wrong and someone died. The cause of the death is more likely an adverse reaction that was not appropriate addressed by the paramedic, but that’s probably why they just got a conviction. But ketamine is used every day across the US without situations like this happening.
And this is why I love Lemmy. An informative well reasoned answer.
I’m now smarter because of you. Thank you!!
Thank you for your kind words! I love that there is finally a topic that I can contribute to!
Benzos have their issues, but I'd probably go there in case of something like a postictal psychosis, with Haldol being a second line. Ketamine and PCP have a similar mechanism of action, so it doesn't feel like a great med for someone with psychosis, but I'm also not a doctor or nurse, I just play one on ~~TV~~ the Internet.
This may be completely wrong but I'm guessing ketamine so they can inject it rather than waiting on non injection medication. I'm not sure if the other two can be injected or if available but it was a thought I had for reasoning. Not that any of this situation was handled with reasoning, it's another tragedy in a long list of them. I have enough anxiety myself I can't imagine what that poor guy went through in his final moments.
Ketamine, as I currently understand it, is not known for depressing the respiratory system. Usually when people asphyxia during ketamine use it's because they've gone unconscious and then vomit and choke on that, which is one reason why mixing ketamine and alcohol is generally a very bad idea.
"Respiratory: apnea, increased laryngeal, and tracheal secretions, laryngospasm, airway obstruction in infants (may not be drug-related), respiratory depression " see the adverse effects here: https://www.ncbi.nlm.nih.gov/books/NBK470357/
Your reference, at least in this particular quote mentioned in infants so I'm not sure how that translates to teenagers or adults. But, yeah, looks like you're right in at least high doses or very fast IV infusions, which I think this case covers both a high dose and a very rapid IV infusion. But I believe at what would be considered a normal dose there seems to be very little risk of respiratory depression.
"Consequently, ketamine-induced apnea or respiratory depression are transient and rare in case of occurrence, and result frequently from rapid IV infusion."
https://journals.sagepub.com/doi/10.1177/2045125320981498
"Ketamine generally maintains normal pharyngeal and laryngeal reflexes and, therefore, permits spontaneous respiration. It slightly enhances or maintains normal skeletal muscle tone and is associated with cardiovascular and respiratory stimulation. These characteristics make it particularly useful in the emergency department setting for short-term procedures, especially as is often the case when a patient has not been "prepped" for an emergency procedure. Since there is no guarantee of maintenance of the pharyngeal and laryngeal reflexes, there can be no assumption that they will "protect" the airway. Additionally, there may be transient minimal respiratory depression if the medication is administered too rapidly or in too high a dose. Therefore, the physician must be ready to perform emergency intubation." From the same article I linked earlier.
We can go back and forth all day, but ultimately they gave a medication that demanded a higher level of care than was provided and it was an appropriate sentence.
Well, I learned a bit more about ketamine today, so thanks for that. I wasn't attempting to defend what the paramedics did to this person, it was more a slight attempt at defending ketamine against the generalized "ketamine makes you forget to breathe" statement as I felt it made it sound like it's a very common thing.
The dose makes the poison.