UKH

Interesting night out.

https://www.climbing.com/news/climber-stuck-for-12-hours-in-crack-the-docto...

I think this should serve as a reminder to all of us to keep a gram or two in our chalkbags just in case the worst should happen.

under the photo, third paragraph..... Whats an "Alpine Knee"? Sounds like BS for for a dirty grovel / ungraceful mantel. 
I also wonder if the climber with the ketamine relived his crack experience by sliding into the K hole as he was rescued..
And finally, where Jim Perrin in all this? I realise hes not the only famous ascensionist on substance...

Gripped.com has a piece describing 5 times when climbers got knees stuck. The one in here which I knew about was Martin Boysen on Trango Towers (apologies and sympathy if you're reading this, Martin):

https://gripped.com/profiles/five-times-a-climber-got-a-knee-seriously-stuc...

Someone got stuck in Crewcut (VS 4c) a few years ago. They were about to get the jackhammer out when a trusty vanwanker brought the crisp n dry, I think. 

I'm reminded of this funny little episode from Cedar Wright:

youtube.com/watch?v=1dJLN43G6KA&

If it's the one I was around for, and hopefully it hasn't happened twice recently, you haven't quite got the details right. Someone did try cooking oil from their van, but that was before Mountain Rescue arrived and it wasn't successful. I left them to it once MR got there but I heard afterwards that the solution was better lube provided by MR and a proper hauling system. I gather MR have occasionally had to resort to chiseling away rock but it didn't sound like they came anywhere near it on that occasion.

"Avery Olsen, the San Juan County Search and Rescue commander, spoke with Climbing via email, saying that he believes soap would have sufficed in this case as well, had the climber been wearing shorts."

Surely with the judicious use of scissors and some tension, the offending pants could have been removed?

Ketamine was how they got the guy who was stuck in the artificial cave system in Keswick out. Unfortunately due to all the delays it was to no avail

I hope they up the grade a bit with all that soap, motor oil and lubricants lining the crack, its gonna be one slippery crack for a while! 

What dosage of ketamine was used? Did it contribute to his demise? It is not a drug which can be used without careful thought and consideration of the circumstances.

I can't speak for NWAS but up here in Scotland Ketamine (Or any drug.....) is certainly not used without "careful thought and consideration of the circumstances" and I don't think English services would be any different. 

Internationally Ketamine seems to be used far more widely by ambulance services especially in countries regularly dealing with major trauma in remote areas.

2 seconds of googling this case reveals that injuries were significant with a prolonged extrication.

Anyway. Not helping the thread. 

I'm sure the experienced doctors and paramedics on the scene exercised careful thought and consideration. Suggesting that they didn't is pretty offensive tbh.

I was getting the impression that it was being given by non-medical staff. That is why I asked the question. Ketamine is also a drug which, although it has some small degree of pain relief, has no muscle relaxing properties. Perhaps muscle relaxation was not wanted in the circumstances, or possibly it would help(?).

Ketamine is a controlled drug, there is absolutely no way that it would be used during a rescue by someone unqualified to administer it.

You say that as if the suggestion that "non-medical staff" would be recklessly administering a drug like that is somehow less offensive than the suggestion that paramedics would do so without due care.

Firefighters, police and Keswick MRT were also on the scene - if not paramedics, which group in particular were you accusing of criminal negligence?

I know that it is a controlled drug: I have to keep records of it. The feeling for me, at least, was that the way that this subject was being written about, there was a less serious nature to things. So that was why I was querying things. I was wondering what the circumstances of its supply and use was. If doctors were the ones using it, then that explains things. 

The sub-headline is literally 'Doctor prescribed Ketamine'. Did you read the article?

The climber in Indian Creek in the article the OP links to was eventually freed with no significant injuries, so it isn't beyond the bounds of good taste that it takes a fairly light hearted view of things.

The post you were replying to was about a person in Keswick who tragically did not survive, which you clearly understood since you were wanting to know whether someone involved in his rescue recklessly administering an inappropriate dosage might have lead to his demise.  (There's no way for any of us posting here to know of course - except that if a member of "non-medical staff" had done that, we'd probably have seen them on the news being charged with manslaughter by now.)

You should probably stop digging.

The article also said it had been administered for it’s entirely nonexistent muscle relaxant properties. I wouldn’t get hung up too much on the accuracy of the article.

But at the end of the day I'm no wiser about "throwing an alpine knee"? Unless it's the old and trusted technique of using knees in desperate situations, as in I'm about to fall off! 

Personally I prefer the  Gusando method.

Culpa mea: Yet that was only one article, and I was not sure who administered ketamine in the circumstances that obtain in rescues. All I know is that we are finely scrutinized with the use of ketamine, and I wasn't sure if this is the case with rescue situations. Additionally in tense situations, dosages can be difficult to decide upon. Yet let us just leave it that we assume that in all cases there is a doctor determining administration and dosage of ketamine.

I had, if you read what I said in latter messages.

Ketamine regularly gets used in ED for the reduction of fractures, especially in paediatrics as they tolerate the emergence better, but I think also being used more and more in adults and especially pre-hospital trauma.

Also, I believe used extensively in low income countries for anaesthetics as its stable to transport and very safe (if a bit trippy). 
Having held people’s arms and legs whilst a burly orthopaedic surgeon hanks them back into place I would say it’s muscle relaxing properties were pretty good…..

Also used by my own service for analgesia and procedural sedation.

Seems reasonable but I can’t claim any first hand knowledge.

I’ve also treated patients administered ket on major trauma jobs. I can confirm it’s a great analgesic and sedative. But it’s still not used as a muscle relaxant, we’ve got other stuff for that. In fact ket tends to slightly increase muscle tone. You can google it if you like….

Sounds like this (the original story, climber with his knee stuck) might be procedural sedation? If someone has been stuck there for twelve hours I suspect knocking them out with something might help make them go a bit floppy and stop resisting being dragged out by a hauling system. I've been on scene when it's been administered but it's well above my (voluntary) pay grade, so I wouldn't know whether it's the appropriate drug, but maybe that was the only option they had that didn't involve intubation?

I’ve no experience of how things work in the states and I’m very leery about commenting on individual cases I’ve got no real knowledge of.

What I do know is ket is highly regulated in my own service and is only administered by named paramedics, employed in specialist roles and individually signed off by a consultant paramedic. 
 

It also comes with a list inclusion criteria indicating when it’s use should be considered. From that list:

“Extrication of the traumatically injured patient.”

Isn't a lot of that control due to illegal use.

Yes, street value, abuse etc.

Same as with any controlled drug carried on an ambulance (eg Morphine, Midazolam- these will depend on the Ambulance service) only the appropriate staff member will be able to access it and administer it-Basically registered paramedics or more senior such as a CCP or Doctor (Who may also have access to Ketamine, Fentanyl, Methoxyfluorane and other drugs depending on the service)

In addition other drugs that are not controlled may be "Paramedic only drugs" or "General drugs" that can be administered but non-Paramedic but suitably trained staff like Technicians and EMTs.

Morphine and midazolam can also be administered by MRT cas carers with no other medical background or qualifications. Ketamine isn't on the formulary though and isn't part of the standard toolkit. Interestingly entonox is and as of today is now a controlled drug too.

Ah yes you are correct-I'd forgotten special circumstances such as MRT (Sorry!) etc. I'd imagine that it's a similar scenario though with tight constraints on who can access controlled drugs etc?

In one of my previous lives we used to sell it for this indication - typically for extracting casualties from RTAs.  It preserves the gag reflexes so that casualties who can't be intubated can be anaesthetised for emergency amputations etc.

The Thai cave rescue used ket to subdue the casualties, as they swam them through the cave system.

I just googled it and one of the headlines started 'Handcuffed, drugged with ketamine ...'.

To many people that's a good Friday night. Handcuffed, underwater, in the dark, is probably less fun.

Yup absolutely, and with strict licensing conditions for each team that carries those drugs. I haven't heard anything about how the change in status of entonox will affect us though, if at all.