Ketamin in head injury

Tal

Tal

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In my course Trauma weeks we argurd alot on this topic.
The main problem was the inconclusive fact that Ketamin cause rise in ICP, which can be problematic in closed head injuries.

So, as argues in medice are, when I got to my unit, I talk to the other paramedic with me abot this subject. So we argued, and what a better way to win an argue? Articles.

He showed me one about this pratcular subject. and it's a myth.
Ketamin cause a rise in MAP which cause rise in CPP. ICP rises was not noted in any pt. the went trough Rapid Sequence Intubation.

So feel Free to give it, and I'll try to find on the web (he broght a printed copy).
 
New Zealand is currently using ketamine for advanced analgesia and rapid sequence intubation.

I have had fantastic experience with it on patients it's just the best thing since sliced bread!

We can give it PO, IM or IV which means its very flexible and can be used in combination with morphine/fentanyl.
 
What kind of pain are you giving fentanyl, ketamine and morphine for?


In the hospital we typically rotate morphine and hydrocodone/acetaminophen... but that is for long term coverage.

Are you doing excessively long transports?
 
Ketamine works great actually and is used just about everywhere but the US.

Nursing doesn't like it because it requires a bit more close observation in patients, especially adults, but in EMS it is usually one/one care. In the EDs where the nurse to patient ratio is often stretched from what I have seen, as well as not conducive to intense monitoring, it seems like a legit concern to me, bt certainly not a reason to withold its use from EMS nor to deny using it on a patient that could benefit from it. Particularly peds.

There is also a big stigma about its abuse potential. (probably completely disproportionate to reality)
 
My questions is why give po ketamine, what is the onset of effect for that route?

I can understand that each drug has its own pros and cons, but I am curious why give a PO analgesic, if the drug has to make a first pass before it begins to take effect.
 
8jimi8 said:
My questions is why give po ketamine, what is the onset of effect for that route?

I can understand that each drug has its own pros and cons, but I am curious why give a PO analgesic, if the drug has to make a first pass before it begins to take effect.
Click to expand...

not all drugs are affected by first pass, some can be activated and not affected by multifunction oxidase. Others are activated by the same. But this link is very good for all there is to wonder:

http://www.metrohealthanesthesia.com/edu/ivanes/ketamine1.htm
 
I know Childrens in Dallas, a level 1 trauma, LOVES to give Ketamine in their ED for trauma. I saw 5 kids in one day get ketamine while procedures were done.


Man do I have a great story about my experience with a kid and ketamine too.
 
the quick technical look

It is inactivated by first pass, except for small amounts which can be beneficial in maintaining theraputic range in a less invasive manner.
 
Ketamine is used here for severe, unmanagable pain. It is often (but not always) used in combination with morphine. For RSI it is used in combination with fentanyl (although I hear fent is going to replace morph generally).

Three examples I've seen are multiple long bone fractures in an MVA, NOF fracture and burns. All have had really good results with ketamine.

We can give it IV/IO (preferred), IM or PO if we cannot get venous access.

Our IV/IO dose is 5-10mg q3-5 prn or 1mg/kg IM/PO for analesgia and 1.5mg/kg for RSI.

Ketamine for RSI is something I am quite interested in as my anaesthesologist friend said he'd much perfer we carried etomidate because ketamine is nut a true "sleep" inducing anaesthetic agent.
 
We use it to PAI our ped's and for bronchospasms in our adults. Wonderful drug, wish it was more widely accepted.
 
Ketamin (Ketanest-S or esketamine) is a standard drug in the dutch EMS.
It is only indicated to trauma patiënts and is used to repose an stabilize fractures an luxations. When used on a patiënt, midazolam is given to relax the patiënt and to avoid psychic side-effects...
Some patiënts realy freak out when given ketamin.B)
 
Dutch-EMT said:
Ketamin (Ketanest-S or esketamine) is a standard drug in the dutch EMS.
It is only indicated to trauma patiënts and is used to repose an stabilize fractures an luxations. When used on a patiënt, midazolam is given to relax the patiënt and to avoid psychic side-effects...
Some patiënts realy freak out when given ketamin.B)
Click to expand...

I have only seen adults have hallucinations and "dreams" afterword, have you or anyone else seen the side effect in a PED?
 
Most of our ketamine is given to traumaticly injured patients; e.g. NOFs/crushed femurs things like that.

Medically the only use I've seen it for is burns or induction of anaesthesia.

That said although we are giving very large induction-like doses (1.5mg/kg) for RSI we have changed the verbage to "intubation" and not "induction"; AO stands for Ambulance Officer and not Anaesthesiologist!

I am told for RSI etomidate is better but I don't forsee us getting that any time soon.
 
The two CRNAs I'm friends with love it, and they've told me that it's almost always their first choice. While shadowing one of them, I've seen it put to great use. However, we only carry fentanyl and morphine.
 
Linuss said:
I know Childrens in Dallas, a level 1 trauma, LOVES to give Ketamine in their ED for trauma. I saw 5 kids in one day get ketamine while procedures were done.


Man do I have a great story about my experience with a kid and ketamine too.
Click to expand...

Kids are funny while on the Special K. We were tx a kid for a lac, the PA gave him some Ketamine. Once it kicked it in, he said "mom, now I know why you love drugs so much". It was embarassing for the mother, but really funny for the er.
 
The N-methyl-D-aspartate antagonist effects of ketamine has been researched with regard to their effect as a Neuro-Protectant. However, results are still inconclusive. This is something I am watching carefully.

The following are for your reading pleasure if you want to look into this further:

http://journals.lww.com/anesthesiology/Abstract/2003/09000/Effects_of_Subanesthetic_Doses_of_Ketamine_on.16.aspx

http://www.ionchannels.org/showabstract.php?pmid=7840413 [NOT PEER REVIEWED]

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYR-4378WGN-C&_user=10&_coverDate=06/22/2001&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1327338438&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b907c74bed4d4caa1e310fb2725a1ae7
 
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