Ketamine education 2014

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Ketamine Adam Frisch M.D. For the REMO Medical Advisory Committee

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REMO Restocking Reviewed 2010

KetamineAdam Frisch M.D. For the REMO Medical Advisory Committee

BackgroundKetamine can provide patients with sedation and analgesiaPatients can gain relief while still maintaining airway protection and respiratory driveParamedic level medication onlyReporting from Medical Director required after each useKetamine HydrochlorideClassification: Dissociative AnestheticSedative and analgesic properties

Onset:60-90 seconds - IV/IO1-2 minutes - IMDuration of action:10-15 minutes - IV/IO15-20 minutes - IMPharmacologyMechanism of Action: DissociationSelectively disrupts association pathways of the brain between thalamus and limbic systemCompetitive NMDA antagonist

Ketamine is an ideal alternative to other sedation medications because of its:Minimal respiratory depressionBenefit with reactive airway disease

Indications / ContraindicationsIndications: RSIExcited DeliriumFacilitated ExtricationAdjunctive pain management (very low dose)

Relative contraindications: Marked hypertensionMarked tachycardiaCardiac ischemia

Specific informationSupplied: (be aware of concentration)100mg/mL Dosing:1-2 mg/kg IV 3-5 mg/kg IM, may repeat oncePregnancy Category B

Must dilute for slow administration

Side EffectsApnea if rapid IV pushEmergence reactionHypersalivationGeneral uncomfortable feelingIn low, sub-dissociative dosesIncreased intraocular pressureDiscuss risk/benefit with physicianOtherParamedic level administration only (no CCT)Physician order ONLY Consider benzodiazepine use with findings of emergence phenomenonNo need to pre-treat, howeverConsider atropine for management of hypersalivation/secretions