Crashing airway patient

TransportJockey

Forum Chief
8,623
1,675
113
It generally doesn't unless the patient has essentially run out of sympathetic compensation

Sent from my SM-N920P using Tapatalk
 

Handsome Robb

Youngin'
Premium Member
9,736
1,173
113
Assuming of course Ketamine isn't otherwise contraindicated is the real kicker. I could see Ketamine as an alternative to more orthodox RSI (and perhaps make things a bit smoother in some ways if your particularly adept with dropping an ET or a King) On the other hand, if your case involves the presence of barbs, major tranqs, benzos, alocohol, etc. The ketamine is probably going to end up potentiating CNS depressant effects which probably isn't the best situation in the world, but never the less probably the most manageable solution in the long haul.
This whole thing almost sounds like one of those mega-code scenarios where things are going to turn into a quite nasty situation regardless of how you really handle it - the question is really more of exactly how long its going to take for the crap to splatter off the fan blades.

Ketamine is probably one of the safer agents in those scenarios you described...


Sent from my iPhone using Tapatalk
 

bakertaylor28

Forum Lieutenant
198
20
18

VFlutter

Flight Nurse
3,728
1,264
113
It is a well known side effect of Ketamine that it will potentiate the effects of alcohol, barbs, Opiates, anticholinergics, Quinazolinones, and Phenothiazines. See the following links, among other research on the topic:
http://www.dovepress.com/to-use-or-...llicit-ketamine-use-peer-reviewed-article-SAR
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148758
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852477
http://www.palliativecareguidelines.scot.nhs.uk/documents/Ketaminefinal.pdf

The first article talks about Ketamine's use and side effects, the second article actually supports concurrent use with benzos to reduce issues with emergence, the third article just talks about how young adults are abusing ketamine, and the other link doesn't work. None of the articles talk about pharmacodynamics or Ketamine potentiating anything. Not sure what any of those were meant to prove? And I am not sure how "well known" it is since many of the practitioners here have never heard it.
 

bakertaylor28

Forum Lieutenant
198
20
18
The first article talks about Ketamine's use and side effects, the second article actually supports concurrent use with benzos to reduce issues with emergence, the third article just talks about how young adults are abusing ketamine, and the other link doesn't work. None of the articles talk about pharmacodynamics or Ketamine potentiating anything. Not sure what any of those were meant to prove? And I am not sure how "well known" it is since many of the practitioners here have never heard it.

I must have grabbed the wrong links. I'm going to double check the source, I'm working on it.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,510
3,234
113
It is a well known side effect of Ketamine that it will potentiate the effects of alcohol, barbs, Opiates, anticholinergics, Quinazolinones, and Phenothiazines.

You'll find the same warnings about giving opioids concomitantly with those drugs as well. Not really sure what point you are trying to make.

FWIW, ketamine isn't a CNS depressant. It increases CNS activity.
 

bakertaylor28

Forum Lieutenant
198
20
18
You'll find the same warnings about giving opioids concomitantly with those drugs as well. Not really sure what point you are trying to make.

FWIW, ketamine isn't a CNS depressant. It increases CNS activity.

The point I'm making is that there's a reason they saw fit to put the warnings there. Hence, something to be OTL for as a distinct possibility. NOT saying Its something I wouldn't do - because like I said, its the path to least resistance. Especially for those of us who hate having to deal with standard RSI in general and would rather avoid that approach to things. ( Considering the fact that most of us are not particularly adept with an ET and find ourselves using the King with these sorts of things.)
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,510
3,234
113
The point I'm making is that there's a reason they saw fit to put the warnings there. Hence, something to be OTL for as a distinct possibility. NOT saying Its something I wouldn't do - because like I said, its the path to least resistance. Especially for those of us who hate having to deal with standard RSI in general and would rather avoid that approach to things. ( Considering the fact that most of us are not particularly adept with an ET and find ourselves using the King with these sorts of things.)
When you gain both a better understanding of pharmacology and more practical experience with airway management, then we can have this talk.
 

ERDoc

Forum Asst. Chief
546
616
93
Every medication has several hundred warnings. With ketamine, when someone is having an emergence reaction, we use benzos.
 

VentMonkey

Family Guy
5,729
5,043
113
Every medication has several hundred warnings. With ketamine, when someone is having an emergence reaction, we use benzos.
Doc, how common are these emergence phenomena with Ketamine in your experience, and how big of an issue that needs to be addressed is it typically?
 
Last edited:

ERDoc

Forum Asst. Chief
546
616
93
Doc, how common are these emergence phenomena with Ketamine in your experience, and how big of an issue that needs to be addressed is it typically?

In 14 years, I've seen it twice. As for how big of an issue it is, it depends on how bad it is. If it is just a little agitation and restlessness, turning down the lights and minimizing stimuli usually works. The worst I've seen is someone screaming and thrashing. This is usually for procedural sedations. When you use it to intubate it's not a problem because they are going to be further medicated.
 

bakertaylor28

Forum Lieutenant
198
20
18
When you gain both a better understanding of pharmacology and more practical experience with airway management, then we can have this talk.

And exactly how many of us have ET Intubation down as a precise skill? Not like we're doing it every day. (at least MOST of us anyways- you might be the exception.) Think about it- Otherwise we would have absolutely zero need for a King in the first place-- EVER. And the last time I checked the first rule of pharmacology is take heed to the known warnings.
 

bakertaylor28

Forum Lieutenant
198
20
18
Of course, then again, I'm not so sure I'm exactly comfortable neither with the sheer idea of giving a drug designed to tranq large cats to a human. It just doesn't sound like a good idea. (Sarcasm intended). :-D
 

LaAranda

Forum Probie
13
6
3
I have seen a precordial thump work once. The theory is sound, just like commotio cordis. I also like the idea of percussion pacing from the old school anesthesia literature. When I was a floor nurse I had a patient that kept going asystole on me and every time I did a sternal rub/thump his rhythm would pick back up and he would wake up for a few seconds then slow back down. Pretty cool and worked until the crash cart got there.

Somehow I was picturing you rounding on the pt every 2 hours and finding him asystolic every time. Sternal rub, ask how his pain is, move on. :D
 
Top