Sedation Deaths

[CCCSD]

Burn ointment on your list..?

 

[Akulahawk]

Messing about with Ketamine outside of RSI is how malpractice lawyers make money and how entire hospitals go broke.

Correct me if I'm wrong, but isn't it still considered an off label use?

Using Ketamine in RSI is an off label use.

Simply because a medication is used "off label" does not necessarily mean that medication is not generally accepted for that off-label use. In the case of Ketamine, it is widely accepted for use in the setting of procedural sedation. It is also quite useful for pain relief. An isomer of Ketamine, known as esketamine, is FDA approved in the treatment of resistant depression.

The FDA does not regulate medicine. That is not the function of the FDA.

Being ACLS certified doesn't mean you're an expert in ACLS. It simply means you're ACLS certified. It also doesn't mean you're actually capable.

 

[proctorologist]

Using Ketamine in RSI is an off label use.

Simply because a medication is used "off label" does not necessarily mean that medication is not generally accepted for that off-label use. In the case of Ketamine, it is widely accepted for use in the setting of procedural sedation. It is also quite useful for pain relief. An isomer of Ketamine, known as esketamine, is FDA approved in the treatment of resistant depression.

The FDA does not regulate medicine. That is not the function of the FDA.

Being ACLS certified doesn't mean you're an expert in ACLS. It simply means you're ACLS certified. It also doesn't mean you're actually capable.

Using a medication off label might be generally accepted but where it goes wrong there is strict liability merely because the FDAs failure to approve the medication for that purpose is considered to put a reasonable practitioner on notice that the medication might not be safe and effective for that particular purpose such that when it goes wrong it becomes res Ipsa loquitur liability.

Also, an investigator of any kind isn't an expert - in that we don't testify as to issues of opinion, but rather we testify only to facts able to be determined based upon the way the book says it is to be done.

 

[CCCSD]

Using a medication off label might be generally accepted but where it goes wrong there is strict liability merely because the FDAs failure to approve the medication for that purpose is considered to put a reasonable practitioner on notice that the medication might not be safe and effective for that particular purpose such that when it goes wrong it becomes res Ipsa loquitur liability.

Also, an investigator of any kind isn't an expert - in that we don't testify as to issues of opinion, but rather we testify only to facts able to be determined based upon the way the book says it is to be done.

So you DON’T know anything about EMS et al except what you’ve read.
Got it.

 

[Akulahawk]

It is

Using a medication off label might be generally accepted but where it goes wrong there is strict liability merely because the FDAs failure to approve the medication for that purpose is considered to put a reasonable practitioner on notice that the medication might not be safe and effective for that particular purpose such that when it goes wrong it becomes res Ipsa loquitur liability.

Also, an investigator of any kind isn't an expert - in that we don't testify as to issues of opinion, but rather we testify only to facts able to be determined based upon the way the book says it is to be done.

It is when a medication is used in an off-label manner that isn't in any accepted use that a medical practitioner becomes a test pilot, so to speak, for that medication. In that instance a more strict liability case can be made. Since the FDA doesn't regulate medicine, failure of the FDA to accept a medication for a given purpose doesn't mean that med cannot be used for an off label reason. Zofran is a great example. Use in non-chemo patients is off label, yet it's is a first line medication in nausea/vomiting cases in many emergency departments. Using a medication in an FDA on-label manner also doesn't guarantee safety nor absolves the practitioner from ensuring the medication is appropriate in that instance. It's entirely possible for FDA approved meds used for their on-label indications to have very adverse interactions, even when each med is otherwise appropriately prescribed.

When a med is used off label, yes it does make the defendant have a slightly increased burden as they have to show that the med is accepted for a given purpose and that it was given according to generally accepted practice for that med. At that point the burden of proof shifts back to the plaintiff to show where the harm came from.

 

[Carlos Danger]

Using a medication off label might be generally accepted but where it goes wrong there is strict liability merely because the FDAs failure to approve the medication for that purpose is considered to put a reasonable practitioner on notice that the medication might not be safe and effective for that particular purpose such that when it goes wrong it becomes res Ipsa loquitur liability.

Once again, this is completely untrue.

Every time you repeat the same lie, you reinforce the fact that you really have no idea what you are talking about.

 

[ffemt8978]

Once again, this is completely untrue.

Every time you repeat the same lie, you reinforce the fact that you really have no idea what you are talking about.

But he's an "ACLS certified medicolegal investigator - Tragos, Sartes, and Tragos at clearwater FL.". Apparently injury law firms are now teaching ACLS and other medical courses

 

[CCCSD]

But he's an "ACLS certified medicolegal investigator - Tragos, Sartes, and Tragos at clearwater FL.". Apparently injury law firms are now teaching ACLS and other medical courses

You forgot Fan of the Windward Passage, per his username.

 

[DrParasite]

In any event - adminstration of an antipsychotic (or any other drug used for a psych reason) is out of scope for the paramedic. We are not trained in psychiatric services. Therefore, I wouldn't be surprised to see second degree murder charges (e g. Negligence) filed on this.

We? how many years of prehospital EMS do you have?

For the record, it appears that Wake County (NC) EMS's protocols have been directing their paramedics to operate outside of scope for a paramedic...

Since you are such an expert in this topic, I would reach out to them from your work email, because I'm sure their county attorney would want to know about this huge potential for criminal liability.

Having looked it up Ketamine is in fact not FDA approved for use for sedation, but rather is approved for use as a surgical anesthetic agent and just gained approval this year for surgical Pain control. This in turn makes it an off label use which in turn creates a legal presumption of negligence liability where there is injury or death resulting from said off label use.

is that a real presumption of negligence liability? can you please share where you got your law degree, and cite any cases where this happened for prehospital personnel?

ACLS certified medicolegal investigator - Tragos, Sartes, and Tragos at clearwater FL.

Anyone wanting to see certs can send me an email addy or else can STFU about credentialing, which I am not - I might add - obliged to provide anyone here.

Well, my ACLS expired years ago... and my county EMS system doesn't even require paramedics to hold a current ACLS card... So you might be more qualified than me... but you work for a personal injury attorney group, which is kinda weird, because certified medicolegal investigators tend to work for the local medical examiner or coroner, as least as per the American Board of Medicolegal Death Investigators. Maybe you don't specialize in death, but rather the living, which is why you work for a law firm.

I'll be honest, I don't want to see your certs, but ACLS doesn't impress me as much as you seem to think it should. Many of post have had... questionably accurate claims?

You disrespect me I disrespect you. That's how this is going to work, so I suggest you adjust your attitude before making my block list, because, frankly, I dont put up with peoples **** unless they're a member of the Bar.

I have yet to disrespect you, but simply passing the bar doesn't really impressive me much. My little brother did it. And if you think only people who pass the bar know stuff about medicine, well, I think you are in the wrong place...

 

[CCCSD]

Burn ointment, Isle Two!

I can get my ACLS card online within minutes. Using that as a claim to fame is asinine. But then again…we ARE talking about Attorneys.