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MaduroBU wrote: ↑Thu Aug 01, 2019 10:02 pm Benzodiazepines sensitize GABA-ergic receptors, but cannot directly activate them. Imagine hosing a lock down with WD40: a key will turn easily, but there must be a key. Ethanol is the most common "key" that people introduce into their bodies, but even that requires a fair amount before it can induce anything resembling the respiratory depression seen with opioids. Benzos and opioids can induce respiratory depression, but they're actually quite safe if you know what you're doing.

The point being, Versed/Ativan have limited respiratory effects by themselves, which is probably why the fireman felt comfortable giving just Versed. Narcan (an irreversible opioid antagonist) is given very often empirically on cases of respiratory depression, even by cops in Chicago now. Flumazenil, which reverses the effects of benzos, is rarely used because 1) you generally don'thave any real need to reverse the effect of a benzo and 2) it WILL uncover seizure disorders and concurrently render the best treatment for status epilepticus (IV benzos) useless.

I'm not saying that administering sedatives and then leaving is reasonable or that it meets any standard of care, but there were pharmacologic reasons for his (unforgivable) complacency. That's also part of my wild speculation that the deceased had another underlying medical energency: while benzos have a tough time causing respiratory depression alone, hypoxia and hypercarbia both can.

I don't understand how the ECMO thing could've happened....it's a circuit. I have a hard time believing that the return to the filter was just run into the trash. Bypass and ECMO machines look complex, but fundamentally they're just sone tubes, a reservoir, an oxygenator and a pair of peristaltic pumps.

Regardlessn I doubt it's wise to post info about that event, much less on a public forum.