return if worse
return if worse
This 9 minute video demonstrates the strengths and weaknesses of an intubation strategy that relies on dissociation with ketamine. The essential strength, compared to RSI, is that a breathing technique keeps the patient breathing during laryngoscopy, which transforms the procedure from high-adrenaline to highly controlled. You see in this video that my (fabulous) resident was …
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 …
You’re cardioverting an otherwise healthy 100 kg 48 year old man with lone afib. Since cardioversion is a brief procedure, you decide on a smaller than usual dose of ketamine, 50 mg. You push the ketamine and prepare the defibrillator. The patient develops a far off stare, seems like a good time to shock, and …
Rapid-onset antidepressant? Hot damn. I would prefer an ethanol antidote, or a cure for secondary gain, but this is a start. Abstract: We examined the preliminary feasibility, tolerability and efficacy of single-dose, intravenous (i.v.) ketamine in depressed emergency department (ED) patients with suicide ideation (SI). Fourteen depressed ED patients with SI received a single …
In this month’s Annals of Emergency Medicine, Sener et al report on their nicely blinded study where 182 adult subjects were randomized to one of four groups – IV or IM ketamine (at dissociative doses), with or without IV midazolam (.03 mg/kg). They conclude that midazolam reduces the incidence of recovery agitation based on their …
In this month’s Canadian Journal of Emergency Medicine, Filanovsky et al describe how studies in the 70s associate rises in ICP to ketamine, and review more recent, higher quality evidence to the contrary. They do not mention that several of the early studies examined the influence of ketamine on ICP in non-intubated patients. Ketamine is …
Needle-less procedural sedation / sedation for imaging: “After extensive discussion with the patient’s parents and NICU staff, the PPM service recommended oral administration of intravenous ketamine (10 mg?mL, Monarch Pharmaceuticals) at a starting dose of 0.5 mg (0.125 mg?kg?dose). Over 4 days, the dose was titrated to 3 mg (0.75 mg ? kg ? dose) …
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, …
Ups J Med Sci. 2008;113(1):39-46. In vitro investigation of the antibacterial effect of ketamine. Gocmen S, Buyukkocak U, Caglayan O. Department of Microbiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey. jsedef@yahoo.com BACKGROUND: Antibacterial activity of local anesthetics especially lidocaine has been shown previously. In this study, the antibacterial effect of ketamine, a general anesthetic agent …
Continue reading “Another reason to use ketamine for RSI in sepsis”
ketamine dose comes from Denmark, Crane, Brown. Ketamine to avoid mechanical ventilation in severe pediatric asthma. J Emerg Med 2006;30:2 163-166