Prehospital use of Ketamine

We use ketamine as a second line analgesic for traumatic pain after fentanyl or methoxyflurane. It's an awesome drug that gives excellent relief.

We give 10mcg/kg IM, and 1mcg/kg IV/IO, repeat until effective at 10 and 3 minute intervals respectively.
 
Those of you who don't think there is a problem with ketamine and hallucinations are very badly mistaken. It doesn't happen all the time - but it most definitely occurs.
 
jwk said:
Those of you who don't think there is a problem with ketamine and hallucinations are very badly mistaken. It doesn't happen all the time - but it most definitely occurs.
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I dont belive anyone said that it did not. infact it was mention to use benzo's for the emergence reactions
So far very good info thanks everyone
 
A couple of quick opinions:

* Drugs are tools. Morphine is a great analgesic. It has some limitations in certain patient populations. I don't think it's going anywhere. It still has a very useful place in systems that use fentanyl.

* Same thing with benzodiazepines. Ketamine just provides a better option in some hypotensive patients, and intubating patients with reactive airway disease.

* I think in EMS we define ourselves based on scope of practice and the breadth of our protocols. If we see someone with a greater scope, more toys, and the newest medications, we assume their system is better. I think that it's often possible that a system with a more restrictive scope / protocols, but better QI / con-ed / medical director involvement may provide superior patient care.

* I think we need to move past a certain fascination with new medications and scope expansion, and focus on getting a decent base education if we want to professionalise EMS.

None of this is directed at anyone in particular. Just a couple of opinions.
 
systemet said:
A couple of quick opinions:

* I think in EMS we define ourselves based on scope of practice and the breadth of our protocols. If we see someone with a greater scope, more toys, and the newest medications, we assume their system is better. I think that it's often possible that a system with a more restrictive scope / protocols, but better QI / con-ed / medical director involvement may provide superior patient care.

* I think we need to move past a certain fascination with new medications and scope expansion, and focus on getting a decent base education if we want to professionalise EMS.
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Seriously. There is nothing "progressive" about blindly introducing (or maintaining) a skill or drug without evidence to support its use, or without studying it to produce data to determine its utility and safety. All EMS systems are guilty of this, but some more-so than others, for sure.
 
I don't disagree with the sentiments of the last two posts, but they are not apposite to the conversation about ketamine.

Also jwk: huh?
 
* Drugs are tools. Morphine is a great analgesic. It has some limitations in certain patient populations. I don't think it's going anywhere. It still has a very useful place in systems that use fentanyl.


Our county still carries Morphine, but we rarely use it. As said, it has its place, but mainly we have been using Dilaudid for pain management. It seems some of the seasoned medics still use Morphine over Dilaudid, and i'm not sure if this is because they are more comfortable with it, studies have shown that Dilaudid is 3-4x stronger then Morphine, and still has the same affect w/fentanyl as morphine does. Any of you guys have input on why to use either/or.
 
jwk said:
Those of you who don't think there is a problem with ketamine and hallucinations are very badly mistaken. It doesn't happen all the time - but it most definitely occurs.
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I know the hospitals in my area use Ketamine readily for pediatric sedation, but not for adults for that very reason. I do like the idea of using it with Benzos to prevent this, but I also don't like overdosing patients with psychoactive drugs...
 
Smash said:
I don't disagree with the sentiments of the last two posts, but they are not apposite to the conversation about ketamine.

Also jwk: huh?
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+1

Ketamine is not a "new" drug. It simply hasn't been popular in the US due to other factors.
 
systemet said:
A couple of quick opinions:

* Drugs are tools. Morphine is a great analgesic. It has some limitations in certain patient populations. I don't think it's going anywhere. It still has a very useful place in systems that use fentanyl.

* Same thing with benzodiazepines. Ketamine just provides a better option in some hypotensive patients, and intubating patients with reactive airway disease.

* I think in EMS we define ourselves based on scope of practice and the breadth of our protocols. If we see someone with a greater scope, more toys, and the newest medications, we assume their system is better. I think that it's often possible that a system with a more restrictive scope / protocols, but better QI / con-ed / medical director involvement may provide superior patient care.

* I think we need to move past a certain fascination with new medications and scope expansion, and focus on getting a decent base education if we want to professionalise EMS.

None of this is directed at anyone in particular. Just a couple of opinions.
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I actually never meant this thread to be about looking for "new" medications (not sure if you are refering to ketamine since its been around for awhile) or "scope expansion" I wanted to talk to people who use the medication in therapy of the ill and injured.
In my opinion the amount of drugs in my drug box and the amount of medic voodoo in my scope of practice means nothing. If any treatment we provide regardless of how long it has been in place was not for the best of our patients we should not use it. The goal of this type of discussion and medical study's testing new medications and treatment in the field is to enhance our ability to care for our patients since that is what our mission is. That being said I understand where you are coming from there is a focus from some that always are looking for something new just because there service doesnt have it. I assure you that was not my intention.
 
FFEMT427 said:
Your protocols allow for it to be used as a chemical restraint? Ive never heard of that being done just seditaves and haldol that sort of thing.
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if our supervisor feels its appropriate than the supervisor can give it, paramedics cant give it unless a supervisor is on scene
 
Smash said:
... Just make sure you don't push it too fast in big doses, or you might get a fright!
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I've seen the aftermath of pushing it too quickly (apnea). Just make sure you have airway equipment [and suction for vomiting] handy, as you probably WILL be assisting with ventilations.

We use it (in hospital) for reductions of fractures/dislocations, and minor surgical procedures in pediatrics. It does have an excellent sedative/amnesia effect, but I'm not totally sold on analgesia.

At my recent ACLS recert class, I had a cardiologist (of 39 years) blast the use of Ketamine in adults due to it's psychotropic effects... "it's for horses", she said.
 
tssemt2010 said:
works great on super combative patients
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Nice....nothing like giving a chemical "cousin" of PCP to a combative patient. Underdosing could make things worse....
 
usafmedic45 said:
Nice....nothing like giving a chemical "cousin" of PCP to a combative patient. Underdosing could make things worse....
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Yeah I think there are better alternatives for chemical restraint personaly but to each his own (I guess)
 
FFEMT427 said:
Yeah I think there are better alternatives for chemical restraint personaly but to each his own (I guess)
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That or more likely he either misunderstood why the ketamine was being used or is simply lying.
 
usafmedic45 said:
Nice....nothing like giving a chemical "cousin" of PCP to a combative patient. Underdosing could make things worse....
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and thats exactly why they only let supervisors here push it, we typically give versed but there has been one case in the year ive been here where we used ketamine on a guy, wouldve been easier if the police on scene had done there jobs but they refused to handcuff him because they didnt want to ride into the hospital with us
 
tssemt2010 said:
and thats exactly why they only let supervisors here push it, we typically give versed but there has been one case in the year ive been here where we used ketamine on a guy, wouldve been easier if the police on scene had done there jobs but they refused to handcuff him because they didnt want to ride into the hospital with us
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He wasn't bad enough for cuffs, but he was bad enough for ketamine?
 
Question, why do the paramedics need a supervisors aproval to push a drug under their belt? I understand medical control, but out here, the "supervisor" on scene on a medical call, is the paramedic. I'm kind of confused on who the supervisor is you are talking about?
 
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