Annals of emergency medicine
December 1, 2024
Mark W Simon, Heather A Olsen, Christopher O Hoyte et al.
12 citations
Over half of psychedelic exposures reported to US poison centers resulted in symptoms that required treatment, severe residual or prolonged symptoms, or death. From 2012 to 2022, 54,605 cases were recorded, with hallucinogenic mushroom exposures rising most sharply from 593 to 1,440. Cardiovascular effects were common, especially with hallucinogenic amphetamines (31.1%). Among patients managed in healthcare facilities, 62.4% received medical therapies, including sedation (32.9%) and respiratory interventions (10.3%). Concomitant exposures occurred in 41.1% of cases. Increasing psychedelic use may lead to more adverse events and healthcare utilization.
Annals of emergency medicine
September 1, 2020
Johanna J Nugteren-Van Lonkhuyzen, Dylan W de Lange, Antoinette J H P van Riel et al.
12 citations
Most poisonings from the psychedelic drug 2C-B result in moderate toxicity, even at high doses up to 192 mg. Among 59 patients for whom a poison center was consulted, 32 were followed up; 53% reported high doses (over 20 mg). Moderate poisoning occurred in the majority of both low-to-moderate and high-dose groups. Common symptoms included dilated pupils, agitation or aggression, hallucinations, confusion, anxiety, high blood pressure, and rapid heart rate. No severe cases were observed. The clinical course was usually short-lived (up to 24 hours) and typically involved hallucinations along with mild physical effects.
Annals of emergency medicine
October 1, 2024
Tommy Nguyen, Mo Mai, Amulya Choudhary et al.
11 citations
In emergency department patients with acute pain, intravenous and nebulized ketamine provide similar short-term pain relief. A randomized trial compared a single dose of 0.3 mg/kg intravenous ketamine to 0.75 mg/kg nebulized ketamine in 150 adults with pain scores of 5 or higher on a 0–10 scale. At 30 minutes, mean pain scores fell from 8.2 to 3.6 (intravenous) and 3.8 (nebulized), a difference of 0.23 points that is neither clinically nor statistically significant. No serious adverse events occurred. Both routes offer a meaningful reduction in moderate to severe acute pain without safety concerns.
Annals of emergency medicine
October 1, 2024
Jason T McMullan, Christopher A Droege, Kathleen M Chard et al.
5 citations
Adding 50 mg of intranasal ketamine to fentanyl for out-of-hospital treatment of acute traumatic pain did not improve pain control compared to fentanyl alone. In a randomized, placebo-controlled trial of 192 male trauma patients aged 18 to 65, there was no difference in the proportion who experienced at least a 2-point reduction in pain 30 minutes after treatment (44.7% with ketamine versus 36.0% with placebo) or at any time through 3 hours. Side effects and need for additional pain medications were also similar between groups. The results suggest no analgesic benefit from this dose of intranasal ketamine in this setting.
Annals of emergency medicine
June 30, 2025
Joshua C Black, Karilynn M Rockhill, Evelyn J Fox et al.
4 citations
About one-third of US adults who used psychedelics in the past year traveled out of state to do so, primarily to Colorado and Oregon, which have decriminalized natural psychedelics. Travelers were more likely than nontravelers to report anxiety or depression symptoms and to have visited an emergency department or urgent care for a psychedelic-related issue. They were also more likely to use psychedelics for medical symptoms, at healing centers, or at ceremonial sites. Emergency physicians in both legalized and nonlegal states should be aware that travel for psychedelic use is common and may carry risks of adverse outcomes.
Annals of emergency medicine
May 1, 2025
Maeve Muldowney, Catherine R Counts, Madison C Maider et al.
2 citations
For patients with acute behavioral disturbance treated by paramedics, the need for emergency airway support was similar whether they received midazolam or ketamine. In a retrospective study of 376 patients in an urban emergency medical service system from 2017 to 2021, 43% initially received midazolam and 57% ketamine. Advanced airway management occurred in 12% of the midazolam group and 11% of the ketamine group, a difference of 0.5%. After adjusting for confounders, the odds of receiving an airway did not differ between the drugs. Emergency department intubation rates and overall mortality were also similar.
Annals of emergency medicine
January 22, 2025
2 citations
In Israel, third-year pediatric residents are trained to administer deep and dissociative sedation in emergency departments when pediatric emergency physicians are unavailable. A retrospective review of 23,578 sedations across 10 pediatric EDs from 2018 to 2022 found only 6 critical sedation events (chest compressions, intubation, vasopressors, or unplanned admission). Residents performed 12,733 sedations and emergency physicians 10,845. The frequency of critical events was 0.024% for residents and 0.028% for emergency physicians, a statistically similar rate. The findings suggest that unsupervised sedation by trained pediatric residents is safe in this setting.
Annals of emergency medicine
April 22, 2025
Daniel S Tsze, Nick Barrowman, Maala Bhatt
1 citation
Children with upper respiratory infections (URIs) undergoing sedation in emergency departments (EDs) do not face a higher risk of respiratory complications or need for serious interventions compared to those without URIs. A secondary analysis of 6,292 children aged 17 years or younger who received parenteral sedation in six pediatric EDs found that the adjusted odds of any respiratory adverse event, serious adverse event, or serious intervention (such as bag-valve-mask ventilation or intubation) were not significantly elevated. The odds ratios were 1.00, 0.53, and 1.08, respectively, with confidence intervals crossing 1.0, indicating no detectable increase in risk.