Prehospital use of Ketamine

[medicsb]

PennStar (aeromedical component of the Hospital of the University of Pennsylvania) has a protocol for administering ketamine to combative trauma patients for whom they cannot establish an IV. After the ketamine, they're to establish an IV or IO and then RSI. It's a very rarely used protocol from what I understand.

 

[Smash]

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.

With all due respect to the doctor, how much experience do you think a cardiologist would have with ketamine, as opposed to an emergency physician or anaesthesiologist?

That comment sounds like someone who does not understand the drug, or who is hanging on to deeply engrained prejudice in the face of the evidence that ketamine is a relatively safe, very effective and versatile medication.

The emergence phenomenon is reasonably well understood, not hugely common, and easily managed.

 

[usafmedic45]

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?

Usually a senior provider. The service I worked at we had additional skills as more experienced ALS provider than the "regular" guys because our medical director found it easier to keep the smaller number of supervisors adequately trained and qualified on the less frequent procedures than to try to maintain it and dilute the experience by allowing everyone to do it.

 

[usafmedic45]

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

I call bull:censored::censored::censored::censored:. There's no reason to use ketamine like that when better options exist.

PennStar (aeromedical component of the Hospital of the University of Pennsylvania) has a protocol for administering ketamine to combative trauma patients for whom they cannot establish an IV. After the ketamine, they're to establish an IV or IO and then RSI. It's a very rarely used protocol from what I understand.

It doesn't sound like the same scenario the newbie is talking about. What you're describing is a well established practice to gain airway control. What he seems to be describing is simply to knock the patient down for the convenience of all involved with a drug never intended for use like that (at least in humans).

 

[usalsfyre]

I think I know the system he's referring to, and they do actually use ketamine for chemical restraint. I don't know if the above use is what I would have done though.

 

[tssemt2010]

I call bull:censored::censored::censored::censored:. There's no reason to use ketamine like that when better options exist.



It doesn't sound like the same scenario the newbie is talking about. What you're describing is a well established practice to gain airway control. What he seems to be describing is simply to knock the patient down for the convenience of all involved with a drug never intended for use like that (at least in humans).

im not sure what my supervisors reasoning for it was but it sure as hell was ketamine

I think I know the system he's referring to, and they do actually use ketamine for chemical restraint. I don't know if the above use is what I would have done though.

i would have gone for versed as apposed to ketamine for sure, but not my decision, or my report so it didnt make a difference to me, wouldve been much easier if the cops had just restrained his *** to begin with, we also have extremely aggressive protocols, only things supervisors are on scene for is RSI and thats because of a problem an agency we mutual aid with had, and we do not use medical control for anything, all standing orders

 

[systemet]

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.

Smash: I don't disagree with the sentiments of the last two posts, but they are not apposite to the conversation about ketamine.

Sorry if I derailed the thread. I agree that having a discussion about ketamine, or other medications is worthwhile and productive.

I share the reservations of previous posters about using ketamine as chemical restraint.

 

[dmiracco]

We use Ketamine in the prehospital setting and I can tell you that it is a great and fairly safe medication when given appropriately.

 

[usafmedic45]

We use Ketamine in the prehospital setting and I can tell you that it is a great and fairly safe medication when given appropriately.

That's most medications. It's when you use them inappropriately that they bite you in the ***.

 

[redcrossemt]

One of our air providers uses it for intubation. I am not sure if they use it for analgesia or painful procedures, but have definitely seen good results with it in the hospital.

Possibly of interest to others, I really like West Michigan Air Care's MAI protocol chart and the discussion that accompanies it here:

http://www.aircare.org/pdfs/AirWaves_Vol13No2.pdf

http://www.aircare.org/pdfs/AirWaves_Vol13No3.pdf

http://www.aircare.org/pdfs/AirWaves_Vol13No4.pdf

http://www.aircare.org/pdfs/AirWaves_Vol13No5.pdf