Archive for the ‘agitation’ Category

Intubation Dissociation Agitation

November 16th, 2017
by reuben in agitation

The Fourteen Year Old and Her Red Tablet

Jon Cole on Ketamine for Agitation

November 2nd, 2017
by reuben in agitation

NEJM Journal Watch recently reviewed Jon Cole’s study on intramuscular ketamine for severe agitation; the title of their review is IM Ketamine Is Not a Good First-Line Option for Severely Agitated Patients. From their comment: …An intubation rate of 57% is not acceptable, and there are many alternatives for sedation of the agitated patient. These findings cast a shadow on the otherwise excellent safety profile of ketamine, and reinforce our prior conclusion that IM ketamine is not a good first-line agent for sedation of agitated patients. Dr. Cole and I discussed his data when it became available, about 2 years ago. Here are some of his comments, at that time: There is no question dealing with a dissociated patient is a challenge for some EM docs. It is my personal practice to observe them for a short period and reassess them (ideally letting them emerge), however there are times when the shift gets busy enough that I intubate them too because I simply don’t have time to watch their airway. We did see the intubation rate fall over time as the physicians got used to ketamine. The intubation rate for the ultra-violent group was 57% – similarly high to the less violent group in the comparative study, suggesting the physicians were “treating the treatment” and not the underlying condition. As with the study population, the intubation rate in this group (AMSS +4) also fell over time as everyone’s comfort level rose. Also, not surprisingly, these patients used more drugs, were more likely to be male, and…

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