Month: March 2019

Episode 32: Ketamine

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ketamine

 

 

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Huge thanks to the team at World Extreme Medicine and WEM Cast for sharing the interview with Richard Harris.

 

 

 

Dosing

These are a guide only, each patient will need a bespoke approach depending on their pre-existing condition, degree of cardiovascular compromise, conscious level and drugs already administered. Clearly you also need to remain within your scope of practice and the guidelines for your organisation.

  • For analgesia (IV/IO): 0.1 – 0.5mg/kg
  • For analgesia (IN): 3mg/kg
  • For sedation (IV/IO): 1mg/kg
  • For sedation (IM): 4-5mg/kg
  • For anaesthesia (IV): 1-2mg/kg

Click here for an example of how ketamine can affect patients.

Know the concentration you carry!

Click here for an example of what can occur if the incorrect concentration of ketamine is administered.

References

  1. The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries. YMEM. American College of Emergency Physicians; 2015 Mar 1;65(3):248–254.e1.
  2. McQueen C, Crombie N, Cormack S, Wheaton S. Prehospital use of ketamine for analgesia and procedural sedation by critical care paramedics in the UK: a note of caution? Emergency Medicine Journal. 2014 Dec;31(12):1029.
  3. Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al. Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Emergency Medicine Journal. 2014 Oct;31(10):840–3.
  4. Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012 Jun 1;59(6):504–12.e1–2.
  5. Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al. Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled Trial. Ann Emerg Med. 2012 Jan 11.
  6. Bredmose PP, Lockey DJ, Grier G, Watts B, Davies G. Pre-hospital use of ketamine for analgesia and procedural sedation. Emerg Med J. 2009;26(1):62–4.
  7. Howes MC. Ketamine for paediatric sedation/analgesia in the emergency department. Emerg Med J. 2004 May 1;21(3):275–80.
  8. Porter K. Ketamine in prehospital care. Emerg Med J. 2004 May 1;21(3):351–4.
  9. Gunning M, Perkins Z, Quinn T. Trench entrapment: is ketamine safe to use for sedation in head injury? Emerg Med J. 2007 Nov 1;24(11):794–5.
  10. McGlone RG, Howes MC, Joshi M. The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis. Emerg Med J. 2004 May 1;21(3):290–5.
  11. Roback MG, Wathen JE, MacKenzie T, Bajaj L. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures. Ann Emerg Med. 2006 Nov 1;48(5):605–12.
  12. Newton A, Fitton L. Intravenous ketamine for adult procedural sedation in the emergency department: a prospective cohort study. Emerg Med J. 2008 Aug 1;25(8):498–501.
  13. Chang LC. Raty SR. Ortiz J. Bailard NS. Mathew SJ. The Emerging Use of Ketamine for Anesthesia and Sedation in Traumatic Brain Injuries. CNS Neuroscience & Therapeutics. 2013; 19: 390–395
  14. Morris C. Perris A. Klein J. Mahoney P. Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent? Anaesthesia. 2009; 64(5): 532-539.