Ketamine

[DesertMedic66]

0.5 for cardiac arrests is an interesting one. Where did that come/what is the rationale?

That is a good question. Unfortunately my ground agency does not provide us with any of the studies or really the reasoning why they are changing things. In some cases we use 1mg of epi, in others we use 0.5mg. For example our V-Fib/V-Tach protocol only includes a single dose of 1mg of epi during the entire arrest. If we witness the patient go into V-Fib/V-Tach we do 3 stacked shocks.

 

[AusPara]

I think the rationale is that weve been dosing based on a study in dogs from the 1960's if you google, but if you dig deeper the first documented study was 1906. Nobody knows what the optimal dose is and how often to give it, or when in the scenario to give it. Nobody will ever know those answers until someone goes away from the norm.

There are a few systems that have move to 0.5 q3-5 minutes, and i expect several more will move in different directions.

I actually expect AHA to go this route too.

Thanks for your reply.

As mgr22 noted, I was under the impression there wasn’t much to the idea in terms of evidence.

I agree nobody really knows, but I’m surprised people are deviating from the peak body recommendations in the absence of compelling evidence to contrary. Must be passionate medical director there somewhere I would reckon. Interesting stuff.

 

[Alan L Serve]

Subdissociative ketamine

0.1-0.3 mg/kg IV

 

[Akulahawk]

I'm a fan of ketamine for pain control too. 0.1-0.3 mg/kg IV works pretty well for most. It doesn't last that long (one down side), but if you accidentally give too much, you won't shut down the respiratory drive. So, it's reasonably safe.

For epi, I've heard of some places going to what's basically an EtCO2-driven dosing system. You give 0.5 or 1mg IV, and watch the EtCO2. If it and the compressions are effective, you should see an increase in EtCO2. You don't give it again unless/until you see the EtCO2 drop off. Vasopressin is good stuff too but I haven't seen it used in the field and I haven't seen it used often in the in-hospital codes I've been a part of.

 

[silver]

I'm a fan of ketamine for pain control too. 0.1-0.3 mg/kg IV works pretty well for most. It doesn't last that long (one down side)

and there we come back to the 100mg/100ml.

Can give 0.1-0.3mg/kg IV bolus followed by continuous infusion 0.1-0.3mg/kg/hr or 2-5mcg/kg/min.