Description of Adverse Events in a Cohort of Dance Festival Attendees with Stimulant-Induced Severe Agitation Treated with Dissociative-Dose Ketamine
Emergency clinicians often treat severe agitation resulting from intoxicants, psychiatric illness, and other CNS or systemic diseases. Recreational drugs-especially stimulants-are frequently used by attendees of electronic dance music festivals (EDMFs), and festivalgoers may become dangerously agita...
Saved in:
Published in | Prehospital emergency care Vol. 25; no. 6; p. 761 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
England
02.11.2021
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | Emergency clinicians often treat severe agitation resulting from intoxicants, psychiatric illness, and other CNS or systemic diseases. Recreational drugs-especially stimulants-are frequently used by attendees of electronic dance music festivals (EDMFs), and festivalgoers may become dangerously agitated and pose an immediate threat to themselves and others. Although benzodiazepines and antipsychotics are classically used to treat severe agitation, these medications are burdened by safety concerns including respiratory depression and cardiac arrhythmias. The effects of ketamine when used to treat severe agitation in an exclusive cohort of patients with psychostimulant drug-induced toxicity (PDIT) has not previously been reported, and existing literature describes a widely variant safety profile when ketamine is used for sedation of the agitated patient.
To describe ketamine's adverse event profile when used to treat patients with severe agitation resulting from PDIT.
This is a retrospective, observational study enrolling consecutive patients who presented for medical attention at a large outdoor EDMF over a period of eight days on two consecutive weekends in the summer of 2017. The EDMF had an estimated attendance of 40,000 per weekend. A medical tent was set up on-site; patients were managed by a team of EMS providers, nurses and emergency physicians. Medications used, adverse events and the need for repeat dosing were abstracted from prehospital care reports.
Over the course of eight days, 1081 of 1186 patients who were evaluated in the medical tent had a recorded chief complaint. 274 of these patients (25.3%) had a chief complaint of altered mental status. In patients presenting with AMS, 68 patients (24.8%) had severe agitation that was treated with dissociative-dose (≥4 mg/kg) intramuscular ketamine. The mean initial dose of ketamine was 308 mg. There were four serious adverse events (5.9%): Two patients (2.9%) had copious hypersalivation treated with atropine, one patient (1.5%) had transient apnea requiring assisted ventilation, and one patient (1.5%) was intubated and transported to the hospital. 42 patients (61.8%) required redosing of calming medications. All patients who received ketamine except the single patient who was intubated and transported were observed in the medical tent until resolution of symptoms and discharged back to the festival.
In this cohort of festival attendees who developed stimulant-induced severe agitation and were treated with dissociative-dose ketamine, serious adverse events occurred in 5.9% of patients including one patient who was intubated. |
---|---|
AbstractList | Emergency clinicians often treat severe agitation resulting from intoxicants, psychiatric illness, and other CNS or systemic diseases. Recreational drugs-especially stimulants-are frequently used by attendees of electronic dance music festivals (EDMFs), and festivalgoers may become dangerously agitated and pose an immediate threat to themselves and others. Although benzodiazepines and antipsychotics are classically used to treat severe agitation, these medications are burdened by safety concerns including respiratory depression and cardiac arrhythmias. The effects of ketamine when used to treat severe agitation in an exclusive cohort of patients with psychostimulant drug-induced toxicity (PDIT) has not previously been reported, and existing literature describes a widely variant safety profile when ketamine is used for sedation of the agitated patient.
To describe ketamine's adverse event profile when used to treat patients with severe agitation resulting from PDIT.
This is a retrospective, observational study enrolling consecutive patients who presented for medical attention at a large outdoor EDMF over a period of eight days on two consecutive weekends in the summer of 2017. The EDMF had an estimated attendance of 40,000 per weekend. A medical tent was set up on-site; patients were managed by a team of EMS providers, nurses and emergency physicians. Medications used, adverse events and the need for repeat dosing were abstracted from prehospital care reports.
Over the course of eight days, 1081 of 1186 patients who were evaluated in the medical tent had a recorded chief complaint. 274 of these patients (25.3%) had a chief complaint of altered mental status. In patients presenting with AMS, 68 patients (24.8%) had severe agitation that was treated with dissociative-dose (≥4 mg/kg) intramuscular ketamine. The mean initial dose of ketamine was 308 mg. There were four serious adverse events (5.9%): Two patients (2.9%) had copious hypersalivation treated with atropine, one patient (1.5%) had transient apnea requiring assisted ventilation, and one patient (1.5%) was intubated and transported to the hospital. 42 patients (61.8%) required redosing of calming medications. All patients who received ketamine except the single patient who was intubated and transported were observed in the medical tent until resolution of symptoms and discharged back to the festival.
In this cohort of festival attendees who developed stimulant-induced severe agitation and were treated with dissociative-dose ketamine, serious adverse events occurred in 5.9% of patients including one patient who was intubated. |
Author | Saloum, David Likourezos, Antonios Strayer, Reuben J Haaland, Astrid Drapkin, Jefferson Friedman, Matt S |
Author_xml | – sequence: 1 givenname: Matt S orcidid: 0000-0003-4634-1612 surname: Friedman fullname: Friedman, Matt S – sequence: 2 givenname: David surname: Saloum fullname: Saloum, David – sequence: 3 givenname: Astrid surname: Haaland fullname: Haaland, Astrid – sequence: 4 givenname: Jefferson surname: Drapkin fullname: Drapkin, Jefferson – sequence: 5 givenname: Antonios surname: Likourezos fullname: Likourezos, Antonios – sequence: 6 givenname: Reuben J surname: Strayer fullname: Strayer, Reuben J |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33054495$$D View this record in MEDLINE/PubMed |
BookMark | eNo1kEtOwzAYhC0Eog84AsgXSPltx3azjJoWKiqxaPeVk_ymRo1TxW4QB-G-hNdqpPlGM9JMyKVvPRJyx2DGYA4PDDIQjOsZBz5Yc6EFYxdkzGQqEwClRmQSwhsAU1yoazISAmSaZnJMPgsMVedO0bWetpbmdY9dQLrs0cdAnaeGLtpD28VvWhhfIV1hiK43R5rHiL5GDPTdxQPdRtecj8bHZO3rc4U13eLQhjR_ddH8LOw6NHEAP_nChdBWbiA9JkU7rD5jNI3zeEOurDkGvP3TKdmtlrvFU7J5eVwv8k1SCaVigiqzysoSMmtLpTUyXYOZSxAqM0LqNDM8VaKsK2a1kMwoyyvkmpXAbIZ8Su5_a0_nssF6f-pcY7qP_f89_Avzg2pf |
CitedBy_id | crossref_primary_10_1016_j_annemergmed_2021_03_039 crossref_primary_10_1007_s12024_023_00589_3 crossref_primary_10_1080_10826084_2021_1892144 crossref_primary_10_1016_j_ajem_2024_04_011 crossref_primary_10_1080_10903127_2022_2108178 crossref_primary_10_1016_j_ajem_2022_08_046 crossref_primary_10_1007_s40278_022_18855_7 |
ContentType | Journal Article |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.1080/10903127.2020.1837311 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1545-0066 |
ExternalDocumentID | 33054495 |
Genre | Journal Article Observational Study |
GroupedDBID | --- .GJ 00X 03L 0B8 0BK 0R~ 123 1HT 29O 34G 36B 39C 3V. 4.4 53G 5VS 6PF 7RQ 7RV 7X7 88E 88I 8AF 8AO 8FI 8FJ 8FW AAEDT AALIY AALRI AALUX AAMIU AAPUL AAQFI AAQQT AAQRR AAQXK AATTQ AAWTL AAXUO ABBKH ABEIZ ABJNI ABLCE ABLIJ ABLKL ABUPF ABUWG ABXYU ACENM ACGEJ ACGFO ACGFS ACGOD ACIEZ ACKZS ACVOX ADBBV ADCVX ADFOM ADFZZ ADMUD ADRBQ ADXPE AECIN AEGXH AEIIZ AENEX AEOZL AFKRA AFKVX AGDLA AGFJD AGRBW AGYJP AHMBA AIAGR AIJEM AIRBT AJWEG AKBVH ALIPV ALMA_UNASSIGNED_HOLDINGS ALQZU ALYBC AMDAE ASPBG AVWKF AWYRJ AZFZN AZQEC BABNJ BENPR BKEYQ BLEHA BOHLJ BPHCQ BVXVI CAG CCCUG CCPQU CGR COF CS3 CUY CVF CZDIS DKSSO DRXRE DU5 DWQXO DWTOO EBS ECM EIF EJD EMOBN EX3 F5P F8P FDB FEDTE FGOYB FYUFA GNUQQ H13 HCIFZ HMCUK HVGLF HZ~ KRBQP KSSTO KWAYT KYCEM LJTGL M1P M2P M2Q M44 M4Z NAPCQ NPM O9- P2P PCD PQQKQ PROAC PSQYO R2- RNANH RVRKI RWL S0X SJN TAE TBQAZ TDBHL TERGH TFDNU TFL TFW TUROJ U5U UEQFS UKHRP V1S WOW YJK ZGI ~1N |
ID | FETCH-LOGICAL-c366t-e69f6f5b09ffb677e17d0a850369a35749a2463bdc1f7351a6f2ce271b01f9e2 |
IngestDate | Wed Oct 16 00:40:30 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 6 |
Keywords | toxicology EMS pharmacology |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c366t-e69f6f5b09ffb677e17d0a850369a35749a2463bdc1f7351a6f2ce271b01f9e2 |
ORCID | 0000-0003-4634-1612 |
PMID | 33054495 |
ParticipantIDs | pubmed_primary_33054495 |
PublicationCentury | 2000 |
PublicationDate | 2021-11-02 |
PublicationDateYYYYMMDD | 2021-11-02 |
PublicationDate_xml | – month: 11 year: 2021 text: 2021-11-02 day: 02 |
PublicationDecade | 2020 |
PublicationPlace | England |
PublicationPlace_xml | – name: England |
PublicationTitle | Prehospital emergency care |
PublicationTitleAlternate | Prehosp Emerg Care |
PublicationYear | 2021 |
SSID | ssj0016236 |
Score | 2.3706112 |
Snippet | Emergency clinicians often treat severe agitation resulting from intoxicants, psychiatric illness, and other CNS or systemic diseases. Recreational... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 761 |
SubjectTerms | Anesthetics, Dissociative - therapeutic use Dancing Emergency Medical Services Emergency Service, Hospital Holidays Humans Ketamine - therapeutic use Psychomotor Agitation - drug therapy Psychomotor Agitation - etiology |
Title | Description of Adverse Events in a Cohort of Dance Festival Attendees with Stimulant-Induced Severe Agitation Treated with Dissociative-Dose Ketamine |
URI | https://www.ncbi.nlm.nih.gov/pubmed/33054495 |
Volume | 25 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9wwEBabFkIupe_0iQ69Gae2Jcv2MXQTQktCYbeQW5DlUbOQfZA6e-j_6P_tjCV53Wxa2l6M0djaRd_n8Yw8D8beSdMkdSZ0XIIV6KBUOq6sbWJ8uTWyNsJkXcn80zN18kV-PM_PR6NhheCbtj4w3-_MK_kfVHEMcaUs2X9Atp8UB_Ac8cUjIozHv8IYncb-oSeLkporf4PoaN2lrc0Wkcbn_RINbJJ2-EbHVFVjTbi03e43-PS2STub31zhMsfUzIOCAiaAs0F0-NVX8Y6mZF-GaPXxLOC6hnhMQe-foNXz8JXem7ufr-HSNyaJoE_0pGiznjfoqjd-F5Z6j2-2Yif6aumaMA_i7klVboIxqedILxhf61XoLUZRKuRJDPc0srRL7nNKGbwelnlM5tBQUbsMaU_IodYtXD33rbeBC5-k0FORZsUB_hIOokcu0l-uR1BX844iArWflK7r55-lt4p0B9EO2ylKUrRntGnkP2ahhalC8liZvL_z_-yx3TDHLQenM3SmD9kD76HwQ0e3R2wEi8ds99THYDxhPwas40vLPeu4Yx2fLbjmjnUk7VjHA-t4zzpOLOJbrOOOdbxnHfesc9dvsY4H1j1l0-Oj6YeT2Df3iI1Qqo1BVVbZvE5QNdSqKCAtmkSXOVpUlRZ5ISudSSXqxqS2EHmqlc0MZEVaJ6mtIHvG7i2WC9hn3DQ2N-h1aFOWstZ4eyqUtDqpDMgEshfsuVvPi5Ur4HIRVvrlbyWv2N6Gl6_ZfYsaA96g-dnWbztwfwI0qYjI |
link.rule.ids | 786 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Description+of+Adverse+Events+in+a+Cohort+of+Dance+Festival+Attendees+with+Stimulant-Induced+Severe+Agitation+Treated+with+Dissociative-Dose+Ketamine&rft.jtitle=Prehospital+emergency+care&rft.au=Friedman%2C+Matt+S&rft.au=Saloum%2C+David&rft.au=Haaland%2C+Astrid&rft.au=Drapkin%2C+Jefferson&rft.date=2021-11-02&rft.eissn=1545-0066&rft.volume=25&rft.issue=6&rft.spage=761&rft_id=info:doi/10.1080%2F10903127.2020.1837311&rft_id=info%3Apmid%2F33054495&rft_id=info%3Apmid%2F33054495&rft.externalDocID=33054495 |