Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

What Can EMS Expect From 2014? #1 Ketamine Again


 

What changes need to be made in 2014, if they have not already been made?

Ketamine – for those of you who already have ketamine, great work. Continue to improve patient care. Do not let the rest of us slow you down.

Excited delirium – ketamine is the fastest way to sedate a violent patient.

Pain management – ketamine dissociates without respiratory depression.

RSI (Rapid Sequence Induction/Intubation) – ketamine dissociates without respiratory depression.

Asthma – ketamine opens the airway.

Awake intubation – ketamine dissociates without respiratory depression.

Sedation for extrication – ketamine dissociates without respiratory depression.

Seizures– ketamine stops seizures.
 

Safety – ketamine is safe.
 

Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of ketamine (up to ten times that usually required) have been followed by prolonged but complete recovery.[1]

 

Is any other sedative that safe?
 

Here are some podcasts to explain in more detail.

Dr. Mel Herbert on ketamine.
Ketamine Update.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Baruch Krauss on ketamine.
Ketamine in the Emergency Department.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Sergey Motov on ketamine.
Ketamine for Everything.
Free mp3 Download From Free Emergency Medicine Talks

Dr. Scott Weingart on ketamine.
Podcast 104 – Laryngoscope as a Murder Weapon Series – Hemodynamic Kills
Page with a link to the free mp3 download, but watch the video first – it is excellent.

More from Dr. Weingart.
EMCrit Podcast 40 – Delayed Sequence Intubation (DSI)
Free mp3 DownloadFrom EMCrit.

Dr. Jim DuCanto on ketamine.
Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD
Page with a link to the free mp3 download, but watch the video first – it is excellent.

Dr. Minh LeCong on ketamine myths –

PHARM Podcast 75 Ketamine MythBusters
Part 1 – Blowing your mind

PHARM Podcast 76 Ketamine MythBusters
Part 2 – Take the pressure down

PHARM Podcast 77 Ketamine MythBusters
Part 3 – Are you mad enough?

PHARM Podcast 78 Ketamine MythBusters
Part 4 – A fitting end?

 

Would you prefer to have something to read about ketamine?
 

 

Dr. Reuben Strayer on ketamine.

The Ketamine Brain Continuum
December 25th, 2013
by reuben in PSA & analgesia
Article

Awake Intubation: A Very Brief Guide
July 7th, 2013
by reuben in airway
Article

Ketamine as a suicidality reversal agent
June 4th, 2011
by reuben in psychiatry
Article

Taming the Ketamine Tiger
January 27th, 2011
by reuben in PSA & analgesia
Article

Ketamine for RSI in Head Injury
April 3rd, 2010
by reuben in .trauma-general, .trauma-head & face, airway
Article

Another reason to use ketamine for RSI in sepsis
November 24th, 2009
by reuben in airway
Article
 

Is there any good reason to not be using ketamine in EMS?

Footnotes:

[1] Ketamine Hydrochloride (ketamine hydrochloride) Injection, Solution, Concentrate
[Bedford Laboratories]

FDA Label
DailyMed
Label

.

Comments

  1. An abstract published in the January 2014 issue of Prehospital Emergency Care noted that of 49 patients who recieved ketamine for chemical restraint, 3 cases of laryngospasm, 4 emergence reactions, and 14 patients requiring ETI were documented. Another case series (oct-dec 2012 issue of PEC) from the same area noted 2 instances of hypoxia and 1 instance of laryngospasm out of 13 patients given ketamine for excited delerium. Certainly, this is in stark contrast to the experience (EMJ, 2009) of London HEMS (maybe because this service is staffed with a physician). I’m not sold on ketamine, though I agree it likely has utility, doesn’t it deserve more rigerous evaluation before making it seem like some sort of wonder drug that should be adopted by all?

  2. Ketamine is a good drug and almost undoubtedly deserves more utility in EMS. I don’t understand why it ever fell as far out of favor as it did.

    However, if all one knew about ketamine was what they learned from the blogs and podcasts of late, one would think it truly a wonder drug that has no adverse effects and is the best choice in nearly every situation.

    The reality is that it probably offers significant advantages over more coventional drugs (fentanyl, midazolam, etomidate) in relatively few prehospital situations, and probably poses additional risks in some.

  3. You seem to be intimating that we should do things that are good for our patients. Are there doctors/managers/administrators in EMS that actually push for this? If so, I must be in the wrong place…

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