Miscellaneous
Who is Reuben Strayer, MD? Courtesy of Reuben Strayer, MD Emergency Medicine Physician who works in New York City Author of emupdates.com One of the authors of painandspa.org Twitter @emupdates Created the phrase "ketamine brain continuum" No financial disclosure A Special K Trip Part 3 - Ketamine for Analgesia & Tranquilization And now for the conclusion of the 3-part ketamine series with Reuben Strayer. Today’s episode is Part 3 focusing on Ketamine for analgesia and extremely uncontrollable violent patients. If you haven’t already, go back and listen to Episode 7 where Reuben talks about ketamine and how different dosing can have different applications in the ED setting. In Episode 8, Reuben talks about ketamine for PSA & RSI. Ready to continue with your Ketamine trip w/Reuben? Here we go! Ketamine for Analgesia Who gets ketamine? Chronic pain, poly trauma, oncology pain, etc. Dosing 0.3mg/kg 0.1-0.3mg/kg have been used. No pumps for bolus dose? No problem. Of course, administering through a pump will always be the gold standard. How to administer: Inject the analgesic dose into NS 100mL and infuse over 15 minutes. 15 minutes = 400mL/hr (best!) 10 minutes = 600mL/hr (not much difference) Why are we diluting the ketamine dose for administration? To prevent psychiatric emergence or your patient from "freaking out." Ketamine drips - always use a pump. (Not everyone will get a drip) 0.1mg/kg and titrated every 30 minutes. No monitoring required. *Use your discretion, if you feel that your pt needs monitoring - put your patient on a monitor and alert your provider. Some pretty good articles, full list below: Sergey Motov's article on ketamine for pain in the ED Cheryl Allen's article on administering ketamine in Pain Management Journal Sergey Motov interviewed on ketamine in EP Monthly Ketamine for Tranquilization Who gets it? Your huge guy where you have a small army of security and staff trying to hold him down and you are concerned for the patient's and staff's safety. How often are you using this? Rarely. Dose Dissociative Intramuscular (IM) Dose: 4-6mg/kg 500mg IM Adult dosing = approx. 100kg person Monitoring required with airway capable provider at bedside. Safety Pearl for Violent and Agitated patients (whether you use ketamine or not): Don't attempt to put in an IV line! (If your provider asks, say "No thank you!") Administer IM through the clothing. No alcohol swab needed. Team approach to hold down patient for patient and staff safety. Now Listen to the Episode... References Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesthesia, Essays and Researches. 2014;8(3):283-290. doi:10.4103/0259-1162.143110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258981/ Motov, S., Rockoff, B., Cohen, V., Pushkar, I., Likourezos, A., Mckay, C., . . . Fromm, C. (2015). Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine, 66(3). doi:10.1016/j.annemergmed.2015.03.004 https://www.ncbi.nlm.nih.gov/pubmed/25817884 Lee, E. N., & Lee, J. H. (2016, October 27). The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis. https://www.ncbi.nlm.nih.gov/pubmed/27788221 Motov S et al. A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department. AJEM 2017; S0735 – 6757(17): 30171 – 7. PMID: 28283340 Ketamine: How to Use it Fearlessly For All its Indications by Reuben Strayer. (2015, December 06). https://www.smacc.net.au/2015/12/ketamine-how-to-use-it-fearlessly-for-all-its-indications-by-reuben-strayer/ Strayer, R. (n.d.).