Archive for the ‘PSA & analgesia’ Category

Ketamine Drip for Analgesia

November 26th, 2009
by reuben in PSA & analgesia

20 mg over 10 minutes then 20 mg/hour, titrated to effect. ketamine 50 mg/mL add 5 cc ketamine to 250 cc NS = 1 mg/mL Bolus: 20 cc @ 120 cc/hour (10 minutes) then Drip: 20 cc / hour weight-based dosing is .3 mg/kg over 10 minutes and .3 mg/kg/hr   Patients are awake, calm, and appropriately responsive to questions while benefiting from excellent analgesia using this protocol. For larger patients or patients in more severe pain, augment the dose, e.g. 30 mg over 10 minutes then 30 mg/hour. Titrate the drip up or down every 10-15 minutes as needed; analgesic effect is progressive. At higher doses, patients will enter into the recreational phase of the ketamine brain continuum, but this is generally not a problem and most patients will do well in the recreational range – be sure to tell your patients that the medicine you’re giving them will make them feel trippy. ABCs are not a concern at sub-dissociative doses of ketamine; this is not PSA, monitoring is not required. Dissociation will not occur at < 100 mg/hour in a normal sized adult.    MSSM PCA and Opioid Recs

Fasting prior to PSA guidelines

November 23rd, 2009
by reuben in PSA & analgesia

Annals of EM 2007;49:4 p457