The American journal of emergency medicine
July 1, 2015
Charles W O'Connell, Roy R Gerona, Matthew W Friesen et al.
16 citations
Ibogaine, a psychotropic indole alkaloid used in some medical subcultures for its anti-addictive properties, can cause serious health risks including altered mental status, ataxia, gastrointestinal distress, ventricular arrhythmias, and sudden death. A 33-year-old man overdosed on ibogaine while attempting to quit heroin, experiencing altered consciousness, tremor, ataxia, nausea, vomiting, and transient QT interval prolongation, which resolved as the substance cleared. Ibogaine was confirmed in his urine and serum, with a peak serum concentration of 377 ng/mL. Nonlinear elimination kinetics and the presence of its active metabolite noribogaine were also observed. This case provides serial serum concentrations and product-confirmed ibogaine toxicity with transient QT interval prolongation.
The American journal of emergency medicine
November 1, 2014
Patil Armenian, Roy R Gerona
15 citations
NBOMe derivatives, which are modified versions of the 2C class of phenethylamines, have recently appeared as designer drugs in the US market. While cases of toxicity from one derivative, 2C-I-NBOMe, have been documented, no reports have yet described the clinical effects of another derivative, 2C-C-NBOMe, leaving its toxicity profile unknown.
The American journal of emergency medicine
December 1, 2024
Robert G Fuller, Evan M Kikla, Andrew P W Fawcett et al.
12 citations
Low-dose ketamine is a safe and effective option for treating acute pain in prehospital and emergency department settings. A review of 64 studies found that low-dose ketamine is non-inferior to opioids when used alone and provides an opioid-sparing effect when used as an adjunct. Doses below 0.5 mg/kg were not associated with significant side effects. Available in intramuscular, intravenous, and intranasal formulations, low-dose ketamine can serve as an alternative to opioids or be used alongside them to reduce opioid exposure.
The American journal of emergency medicine
July 1, 2024
Michael C O'Brien, Kyle J Kelleran, Susan J Burnett et al.
6 citations
A fixed 250 mg dose of ketamine effectively sedated 80% of patients with hyperactive delirium and severe agitation in a prehospital setting, with only 20% requiring a second dose. Among 60 cases, no patient was intubated by emergency medical services; three needed bag-valve-mask support and were later intubated in the emergency department, along with three others who received additional sedation. All six intubated patients survived hospitalization with good neurological outcomes. Weight-based dosing equivalents were not associated with intubation risk. Four patients had adverse events likely related to ketamine, but all 60 patients were discharged alive.
The American journal of emergency medicine
February 1, 2025
Skyler Kessler, Bernard Weigel, Ross Ellison et al.
5 citations
A 61-year-old man with open skin ulcers from pyoderma gangrenosum developed ketamine toxicity after applying a large amount of a compounded analgesic cream containing 10% ketamine, 5% lidocaine, and 5% amitriptyline to his perineal and sacral region. He was brought to the emergency department with agitation, altered mental status, and torsional nystagmus after erratic driving. Urine testing showed a ketamine concentration of 32,300 ng/mL. His symptoms resolved spontaneously within a few hours. This case demonstrates that dermal application of ketamine cream can cause systemic toxicity when skin barrier function is impaired.
The American journal of emergency medicine
February 1, 2025
Christopher W T Miller, Mario Rullo, Sarah Van Remmen et al.
4 citations
Guidelines for managing agitation in emergency and psychiatric emergency settings have been updated since the 2012 Project BETA recommendations. This paper synthesizes current guidelines, explains the neurobiology of agitation, and links brain mechanisms to the pharmacological profiles of recommended drugs, including ketamine and droperidol, which have seen increased use. Clinicians are given treatment strategies tailored to specific causes of agitation.
The American journal of emergency medicine
May 16, 2025
Praphaphorn Supatanakij, Thitipat Mungjadetanadee, Nitchakarn Boonyok et al.
2 citations
Among elderly patients in the emergency department requiring tracheal intubation, the incidence of peri-intubation hypotension (PIH) was 44.1% with etomidate and 53.2% with ketamine, a difference that was not statistically significant. 28-day mortality was 36.0% for etomidate and 25.2% for ketamine, also not statistically significant overall. However, in patients who developed PIH and required vasopressors, ketamine was associated with a lower risk of 28-day mortality. Among patients with a shock index of 0.9 or higher, higher doses of either induction agent increased the probability of PIH. The findings suggest no clear advantage of one agent over the other for preventing PIH or reducing mortality in this population.
The American journal of emergency medicine
November 1, 2024
Hayley T Gartner, Herbert Z Wan, Reeves E Simmons et al.
2 citations
Recreational use of psilocybin-containing mushroom chocolates is rising in the United States. A case series of 36 patients from three poison centers (2023–2024) found a median age of 17 years. Most exposures (64%) were intentional, including abuse or misuse. Common clinical effects included mental status changes (76%), paranoia or hallucinations (28%), dysrhythmias (19%), and gastrointestinal discomfort (17%); one seizure occurred. Effects typically lasted 3 to 24 hours. Treatments included intravenous fluids (50%) and benzodiazepines (19%). No fatalities were reported. While most cases were minor, some patients developed serious effects, highlighting the need for larger studies to identify factors influencing outcomes.
The American journal of emergency medicine
October 1, 2024
Yichen Zhang, Matthew Miller, Alexander Buttfield et al.
2 citations
In a pilot randomized controlled trial at three Australian emergency departments, alfentanil and fentanyl produced similar effects on blood pressure and heart rate when given with ketamine and rocuronium for rapid sequence induction. Among 61 patients, 58% in the alfentanil group and 50% in the fentanyl group had at least one post-induction systolic blood pressure outside 100–160 mmHg, a difference of 8% with a wide confidence interval (−17% to 33%). Rates of hypertension, hypotension, hypoxia, first-pass intubation success, and 30-day mortality were also similar between groups. The findings suggest both opioids are comparable adjuncts for hemodynamic control during emergency intubation.