Crashing airway patient

It generally doesn't unless the patient has essentially run out of sympathetic compensation

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bakertaylor28 said:
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.
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Ketamine is probably one of the safer agents in those scenarios you described...


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bakertaylor28 said:
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
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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.
 
Chase said:
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.
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I must have grabbed the wrong links. I'm going to double check the source, I'm working on it.
 
bakertaylor28 said:
It is a well known side effect of Ketamine that it will potentiate the effects of alcohol, barbs, Opiates, anticholinergics, Quinazolinones, and Phenothiazines.
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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.
 
Remi said:
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.
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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.)
 
bakertaylor28 said:
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.)
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When you gain both a better understanding of pharmacology and more practical experience with airway management, then we can have this talk.
 
Every medication has several hundred warnings. With ketamine, when someone is having an emergence reaction, we use benzos.
 
ERDoc said:
Every medication has several hundred warnings. With ketamine, when someone is having an emergence reaction, we use benzos.
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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?
 
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VentMonkey said:
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?
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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.
 
Remi said:
When you gain both a better understanding of pharmacology and more practical experience with airway management, then we can have this talk.
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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.
 
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
 
Chase said:
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.
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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
 
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