Read on Twitter
KETAMINE, KIDS, AND DOSING
While legal authorities looked on, two white men injected a young brown-skinned child with a big dose of ketamine.
They then handcuffed him and deliberately shoved his face underwater.
The child lived.
While legal authorities looked on, two white men injected a young brown-skinned child with a big dose of ketamine.
They then handcuffed him and deliberately shoved his face underwater.
The child lived.
Actually, this happened to *12 children*, all of whom lived.
And the two men, an anesthesiologist and a veterinarian, are the closest thing to a Neil Armstrong/Bruce Wayne hero mashup you could imagine.
https://en.wikipedia.org/wiki/Tham_Luang_cave_rescue
And the two men, an anesthesiologist and a veterinarian, are the closest thing to a Neil Armstrong/Bruce Wayne hero mashup you could imagine.
https://en.wikipedia.org/wiki/Tham_Luang_cave_rescue
Let’s talk about the #ketamine dosing
Ketamine is taking some of the heat for deaths in police ± EMS custody.
The heartbreaking case of Elijah McClain is only *one* of the most well-known cases.
https://en.wikipedia.org/wiki/Death_of_Elijah_McClain
Ketamine is taking some of the heat for deaths in police ± EMS custody.
The heartbreaking case of Elijah McClain is only *one* of the most well-known cases.
https://en.wikipedia.org/wiki/Death_of_Elijah_McClain
Was McClain killed by too high a dose of ketamine?
McClain weighed 65 kilos, so the dose was 7.7 mg per kilogram.
Standard IM dosing can be up to 5 mg/kg, so about 50% higher than recommended. https://www.thedenverchannel.com/news/investigations/aurora-paramedics-gave-maximum-dose-of-ketamine-even-when-patients-weight-was-unknown
McClain weighed 65 kilos, so the dose was 7.7 mg per kilogram.
Standard IM dosing can be up to 5 mg/kg, so about 50% higher than recommended. https://www.thedenverchannel.com/news/investigations/aurora-paramedics-gave-maximum-dose-of-ketamine-even-when-patients-weight-was-unknown
OTOH, kids who have received 5-100 - fold overdoses (no type) have done just fine, no deaths.
Pretty safe drug even when you give a funk-ton of it! https://www.sciencedirect.com/science/article/abs/pii/S0196064499800511
Pretty safe drug even when you give a funk-ton of it! https://www.sciencedirect.com/science/article/abs/pii/S0196064499800511
Back to Thailand.
How did the docs calculate the right ketamine dose for each kid?
A scale?
Broselow tape?
Nah.
Sorta sounds like they held up a thumb and squinted
(From Against All Odds: The Inside Story of the Amazing Thai Cave Rescue)
How did the docs calculate the right ketamine dose for each kid?
A scale?
Broselow tape?
Nah.
Sorta sounds like they held up a thumb and squinted
(From Against All Odds: The Inside Story of the Amazing Thai Cave Rescue)
Let's try to back-calculate their mg/kg ketamine doses
The Thai kids were 11-16 years old, from a rural background, definitely lower socio-economic context, probably means they were overall lower weight...
https://en.wikipedia.org/wiki/Tham_Luang_cave_rescue
The Thai kids were 11-16 years old, from a rural background, definitely lower socio-economic context, probably means they were overall lower weight...
https://en.wikipedia.org/wiki/Tham_Luang_cave_rescue
Look at these kids.
Not the heaviest youths I've seen.
Not the heaviest youths I've seen.
So ballparking their range of weights.
At 18 years of age, the average weight of an urban, *higher* socio-economic-status Thai boy is 58 kg... https://pubmed.ncbi.nlm.nih.gov/2738501/
At 18 years of age, the average weight of an urban, *higher* socio-economic-status Thai boy is 58 kg... https://pubmed.ncbi.nlm.nih.gov/2738501/
… while 10-11 y.o. Thai boys are are about 30-36 kg. https://content.sciendo.com/view/journals/abm/8/6/article-p799.xml?language=en
So roughly:
The loading dose could range from 125/58 = 2.2 mg/kg for the biggest kid, to 100/30 = 3.3 mg/kg for the smallest.
If they choose a 125 mg syringe for a 30 kid, could be up to 4.2 mg/kg!
The loading dose could range from 125/58 = 2.2 mg/kg for the biggest kid, to 100/30 = 3.3 mg/kg for the smallest.
If they choose a 125 mg syringe for a 30 kid, could be up to 4.2 mg/kg!
And that’s just the loading dose!
Each kid was supposed to get maintenance half-dose injections on their way out of the cave.
So the total dose could have gone from 4.4 mg/kg, maybe all the way up to 8.25 mg/kg.
Hard to say. They weren't doing a lot of charting.
Each kid was supposed to get maintenance half-dose injections on their way out of the cave.
So the total dose could have gone from 4.4 mg/kg, maybe all the way up to 8.25 mg/kg.
Hard to say. They weren't doing a lot of charting.
Feel free to check my math
Oh BTW
These kids didn’t swim out of the cave, they were *dragged*
The doctors handcuffed their arms, shackled their feet, slapped on a full-face Scuba mask, and pulled them through the cave as an inert bundle.
https://www.businessinsider.com/thai-cave-rescue-timeline-how-it-unfolded-2018-7
These kids didn’t swim out of the cave, they were *dragged*
The doctors handcuffed their arms, shackled their feet, slapped on a full-face Scuba mask, and pulled them through the cave as an inert bundle.
https://www.businessinsider.com/thai-cave-rescue-timeline-how-it-unfolded-2018-7
What about monitoring the sedated patients?
Ha.
They didn’t have cardiac monitoring, end-tidal CO2, or even an oxygen saturation.
They monitored for “physically moving to the point of being a problem”
Ha.
They didn’t have cardiac monitoring, end-tidal CO2, or even an oxygen saturation.
They monitored for “physically moving to the point of being a problem”
So these kids got stout doses of ketamine, while handcuffed underwater, with basically no cardiovascular monitoring.
And they all lived.
And they all lived.
Elijah was in a modern mobile ICU, with sophisticated monitoring equipment and oxygenation/ventilation devices.
He died.
He died.
I messed up the thread
Continues https://twitter.com/BrooksWalsh/status/1341772124239896578?s=20
Continues https://twitter.com/BrooksWalsh/status/1341772124239896578?s=20
