A protocolised approach to sedation for aeromedical transfer of acutely unwell mental health patients, including the use of ketamine, was associated with fewer complications overall and fewer severe complications compared to off-protocol care. Among 85 transfers by the Royal Flying Doctor Service in New South Wales from 2011 to 2022, complications occurred in 25.6% of on-protocol cases versus 54.3% of off-protocol cases. Severe complications were 5.1% on-protocol compared to 37.0% off-protocol. Intubated patients and those receiving midazolam, all off-protocol, had the highest rates of severe complications. No on-protocol patient required intubation or experienced treatment failure.
Intranasal ketamine provides pain relief comparable to intravenous morphine for adults with acute severe pain in the emergency department, with a similar side effect profile. This conclusion comes from a systematic review of four studies. However, the generalizability of these findings is limited due to inconsistent study methods, short follow-up, broad exclusion criteria, and small sample sizes. Further research is needed.
Between April 2010 and August 2012, the UK National Poisons Information Service received 47 telephone enquiries and 298 online database sessions about methoxetamine, a dissociative drug. After the UK placed methoxetamine under a Temporary Class Drug Order in April 2012, online sessions fell by 79% (from 151 to 32) and telephone enquiries by 80% (from 15 to 3). Clinical features reported included stimulant effects (36%), reduced consciousness (17%), dissociative effects (11%), cerebellar signs (6.4%), and acute mental health disturbances (43%). The pattern suggests reduced presentations to healthcare services, though whether the legal order caused the decline is unclear.
Between 2000 and 2007, 505 patients (mean age 24.7 years, 68% men) were treated for GHB (liquid ecstasy) poisoning at a Barcelona emergency department. Most cases occurred on weekends (89%) and in the early morning (75%), with reduced consciousness as the primary symptom: 72% had a Glasgow Coma Score of 12 or below. 76% had also consumed other drugs, most commonly ethanol (64%). Patients who combined GHB with other substances took longer to recover consciousness (71 vs 59 minutes) and were more likely to need treatment (29% vs 16%) or mechanical ventilation (3% vs 0%) compared with those who took GHB alone. No deaths occurred.