the 100% directionless thread

[NysEms2117]

The East Side was all kinds of fun last night. Everyone on their motorcycles without helmets and people crashing into each other leaving the clubs. Intubations for everybody.

I had a day like that a few weeks back! You will sleep like a rock for days in advance lol. (at least i did). E-Beers en route

 

[StCEMT]

The East Side was all kinds of fun last night. Everyone on their motorcycles without helmets and people crashing into each other leaving the clubs. Intubations for everybody.

I assume this was outside the city?

 

[VFlutter]

I assume this was outside the city?

East Saint Louis / Brooklyn.

 

[StCEMT]

East Saint Louis / Brooklyn.

Didn't realize you did flights from there, seems like driving would be easier unless it was around 1600 and all the rush hour traffic is crossing the bridge?

 

[NomadicMedic]

Everyone leaving Pops!

 

[Jim37F]

Well, got my ruck done in 1:43.52 (time hack was 1:35) and apparently after adding water my ruck was more like 64lbs instead of the 55lb minimum. Oh and they measured the 10K course (it was like a public park jogging path around a lake in town), the path wasn't quite long enough so we had to go past the start point and keep going to hit the end point....which was like a mile past the parking lot so it was complete the ruck, here's your time, congrats, you now get to ruck a bonus mile back!

 

[NysEms2117]

And in the ****ty weather capital of America it is finally 70 and sunny!!!!!!!!!!!!!!!!!!!!!!! Off to the range

 

[GMCmedic]

One of our local services is rolling out a ketamine protocol at 4mg/kg IM or 1-2mg/kg IVP for pysch and pain control. 1-2mg/kg IVP and 3mg/kg IN for Peds.

My only experience with Ketamine is at my current employer but those doses seem unnecessarily high considering our induction dose for RSI is 2mg/kg IVP and nets the results you would want from an induction agent.

I have a feeling this will ruin it for all of us.

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[NomadicMedic]

One of our local services is rolling out a ketamine protocol at 4mg/kg IM or 1-2mg/kg IVP for pysch and pain control. 1-2mg/kg IVP and 3mg/kg IN for Peds.

My only experience with Ketamine is at my current employer but those doses seem unnecessarily high considering our induction dose for RSI is 2mg/kg IVP and nets the results you would want from an induction agent.

I have a feeling this will ruin it for all of us.

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sure it's not 0.1-0.2mg/kg IV for the pain management dose? Maybe a typo?

 

[GMCmedic]

sure it's not 0.1-0.2mg/kg IV for the pain management dose? Maybe a typo?

That was obviously my assumption, but Ive asked multiple people if its a typo and theyve all stated that QI, medical director, and ED staff from the med control hospital all presented it this way and the protocol went active with those dosages. My wife works there Part time( very very part time) and I already asked her to not give Ketamine in those doses. Ill post the pysch protocol which is all I have a copy of. Youll see those doses are AFTER 5mg Versed.

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[VFlutter]

Didn't realize you did flights from there, seems like driving would be easier unless it was around 1600 and all the rush hour traffic is crossing the bridge?

We usually don't unless there is extended extrication or they really need to be RSI'd


Our Ketamine is 1-2mg/kg Intubation (4mg/kg IM), 0.1-0.5mg/kg post-intubation sedation, 0.5 - 1mg/kg (2mg/kg IM) for Severe Agitation, and 0.1-0.25mg/kg for Pain.

So i'd say 1-2mg/kg for pain is pretty excessive and inappropriate. It is disassociative dosing.

 

[Handsome Robb]

That was obviously my assumption, but Ive asked multiple people if its a typo and theyve all stated that QI, medical director, and ED staff from the med control hospital all presented it this way and the protocol went active with those dosages. My wife works there Part time( very very part time) and I already asked her to not give Ketamine in those doses. Ill post the pysch protocol which is all I have a copy of. Youll see those doses are AFTER 5mg Versed.

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We give 5mg/kg IM for combative patients/chemical restraint. Completely disassociating those patients is the safest for everyone involved, patient and providers alike. We follow up with 2mg/kg IV PRN or we can do a ketamine drip if we're further than 20 minutes out from the hospital.

Our pain management dosing is 10mg q5 prn.

Ketamine is a super safe drug, the biggest issue we've had is some transient apnea which has always resolved in under a minute.

The way that protocol reads it looks like you can use versed OR ketamine. It doesn't say you have to use versed first.


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[GMCmedic]

We give 5mg/kg IM for combative patients/chemical restraint. Completely disassociating those patients is the safest for everyone involved, patient and providers alike. We follow up with 2mg/kg IV.

Our pain management dosing is 10mg q5 prn.

Ketamine is a super safe drug, the biggest issue we've had is some transient apnea which has always resolved in under a minute.

The way that protocol reads it looks like you can use versed OR ketamine. It doesn't say you have to use versed first.


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I havent tried ketamine for chemical restraint, we have haldol and I love it.

My issue is with the pain control protocol, particularly the PEDS.

And you are correct, I went back and reread it. The Versed first was a recommendation from their QA guy jut he notoriously flip flops. When I worked there 2 years ago, ketamine was the worst drug ever.

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[StCEMT]

@Chase gotcha, makes sense.

Ketamine is 5mg/kg IM for excited delirium, 2mg/kg for induction, 0.2mg/kg for pain here.

 

[GMCmedic]

Ours is 0.25mg/kg for delirium and pain. 2mg/kg for induction.

The delirium dose is light but we can use that in combination with haldol and versed. Ive never had the need to use anymore than just haldol.

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[RocketMedic]

Those seem like unnecessarily high doses for pain. I have never had a problem with 0.2mg/kg for analgesic purposes.

 

[Akulahawk]

One of our local services is rolling out a ketamine protocol at 4mg/kg IM or 1-2mg/kg IVP for pysch and pain control. 1-2mg/kg IVP and 3mg/kg IN for Peds.

My only experience with Ketamine is at my current employer but those doses seem unnecessarily high considering our induction dose for RSI is 2mg/kg IVP and nets the results you would want from an induction agent.

I have a feeling this will ruin it for all of us.

Sent from my SAMSUNG-SM-G920A using Tapatalk

At those doses? Yes, it will. All those are dissociation-level doses...

sure it's not 0.1-0.2mg/kg IV for the pain management dose? Maybe a typo?

Typo? I sure as heck hope those doses are typos...

We usually don't unless there is extended extrication or they really need to be RSI'd


Our Ketamine is 1-2mg/kg Intubation (4mg/kg IM), 0.1-0.5mg/kg post-intubation sedation, 0.5 - 1mg/kg (2mg/kg IM) for Severe Agitation, and 0.1-0.25mg/kg for Pain.

So i'd say 1-2mg/kg for pain is pretty excessive and inappropriate. It is disassociative dosing.

I tend to agree. My experience with Ketamine in the ED has been with these same doses you wrote and I've had good results with those doses.

 

[TransportJockey]

Hmmm the girlfriend just got her first pistol... a purple Sccy CPX-2. Now the running debate is whether the service will run a call for a shot 22YOF accidental or 29YOM cause he pissed off the GF at my address lol.


Hmmm... Vent training tomorrow... IABP webinar tomorrow... and an additional 12-lead webinar tomorrow. Way to cramp 6 hours of CME in one day lol

 

[CALEMT]

How about that Angels game @VentMonkey down 6 runs in the bottom of the 9th and we make a comeback to win the game.

 

[VentMonkey]

How about that Angels game @VentMonkey down 6 runs in the bottom of the 9th and we make a comeback to win the game.