Diferencia entre revisiones de «Ketamine»

Sin resumen de edición
Sin resumen de edición
Línea 18: Línea 18:
#BVM (ready)
#BVM (ready)
#Suction
#Suction
#Atropine [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]
#Atropine
#Versed (ready) [0.05mg/kg IVP]
##Only recommended for pts w/ impaired ability to mobilize secretions
##0.01 mg/kg IVP; min 0.1mg, max 0.5mg
#Versed
##Pretreatment is nonmandatory in both adults and children
##Consider 0.03mg/kg IVP if pt has unpleasant recovery reaction
#"Happy Place"
#"Happy Place"


==Administration==
==Administration==
#Give initial bolus
#Give initial bolus
##Children: 1.5-2 mg/kg IV (over 30-60sec)
##IV prefered over IM (faster recovery, less emesis)
##Adults: 1 mg/kg IV (over 30-60sec)
##IV
##Nystagmus = effect
###Children: 1.5-2 mg/kg (over 30-60sec)
#May repeat boluses at 0.5-1 mg/kg increments
###Adults: 1 mg/kg (over 30-60sec)
#IV prefered over IM (faster recovery, less emesis)
###Repeat dose 0.5-1 mg/kg q5-15 PRN
##IM dose 4-5 mg/kg in children
##IM
###Repeat dose if sedation is inadequate after 5-10min or if additional doses required
###Children: 4-5 mg/kg
###Adult: 4-5 mg/kg
###Repeat dose 2-4 mg/kg if sedation inadequate 10min after initial dose
#Nystagmus = effect
 
==Side Effects==
==Side Effects==
*Airway misalignment requiring repositioning of head (occasional)
#Airway misalignment requiring repositioning of head (occasional)
*Laryngospasm (0.3%)
#Laryngospasm (0.3%)
**Only associated with unusually high IV doses
##Only associated with unusually high IV doses
**Tx = BVM ventilation; intubation is rarely needed
##Tx = BVM ventilation; intubation is rarely needed
*Apnea or respiratory depression (0.8%)
#Apnea or respiratory depression (0.8%)
**Associated with rapid IV push
##Associated with rapid IV push
**Transient
##Transient
*Hypersalivation (rare)
#Hypersalivation (rare)
*Emesis, usually well into recovery (8.4%)
#Emesis, usually well into recovery (8.4%)
*Recovery agitation (mild in 6.3%, clinically important in 1.4%)
#Recovery agitation (mild in 6.3%, clinically important in 1.4%)
*Muscular hypertonicity and random, purposeless movements (common)
#Muscular hypertonicity and random, purposeless movements (common)
*Clonus, hiccupping, or short-lived nonallergic rash of face and neck
#Clonus, hiccupping, or short-lived nonallergic rash of face and neck


==Discharge Criteria==
==Discharge Criteria==
Línea 50: Línea 58:
#Do NOT have to wait until the pt can ambulate or tolerate PO
#Do NOT have to wait until the pt can ambulate or tolerate PO


==Discharge Instructions==
#NPO for 2hr
#No independent ambulation for 2hr
==See Also==
==See Also==
[[Procedural Sedation]]
[[Procedural Sedation]]

Revisión del 18:35 11 jul 2011

Contraindications

Absolute

  1. <3 mo old
  2. Known or suspected schizophrenia, even if currently stable or controlled w/ meds

Relative

  1. Major procedures involving posterior pharynx (e.g. endoscopy)
    1. Typical minor ED oropharyngeal procedures are okay
  2. Airway instability (e.g. tracheal stenosis, tracheal surgery)
  3. Active pulmonary infection, including URI or asthma (unless for induction)
  4. CAD, HTN, CHF
  5. CNS masses, hydrocephalus (head trauma okay)
  6. Glaucoma/acute globe injury
  7. Thyroid disorder or on thyroid medication

Preparation

  1. Monitor
  2. BVM (ready)
  3. Suction
  4. Atropine
    1. Only recommended for pts w/ impaired ability to mobilize secretions
    2. 0.01 mg/kg IVP; min 0.1mg, max 0.5mg
  5. Versed
    1. Pretreatment is nonmandatory in both adults and children
    2. Consider 0.03mg/kg IVP if pt has unpleasant recovery reaction
  6. "Happy Place"

Administration

  1. Give initial bolus
    1. IV prefered over IM (faster recovery, less emesis)
    2. IV
      1. Children: 1.5-2 mg/kg (over 30-60sec)
      2. Adults: 1 mg/kg (over 30-60sec)
      3. Repeat dose 0.5-1 mg/kg q5-15 PRN
    3. IM
      1. Children: 4-5 mg/kg
      2. Adult: 4-5 mg/kg
      3. Repeat dose 2-4 mg/kg if sedation inadequate 10min after initial dose
  2. Nystagmus = effect

Side Effects

  1. Airway misalignment requiring repositioning of head (occasional)
  2. Laryngospasm (0.3%)
    1. Only associated with unusually high IV doses
    2. Tx = BVM ventilation; intubation is rarely needed
  3. Apnea or respiratory depression (0.8%)
    1. Associated with rapid IV push
    2. Transient
  4. Hypersalivation (rare)
  5. Emesis, usually well into recovery (8.4%)
  6. Recovery agitation (mild in 6.3%, clinically important in 1.4%)
  7. Muscular hypertonicity and random, purposeless movements (common)
  8. Clonus, hiccupping, or short-lived nonallergic rash of face and neck

Discharge Criteria

  1. Return to pretreatment level of verbalization/awareness
  2. Return to pretreatment level of purposeful neuromuscular activity
  3. Do NOT have to wait until the pt can ambulate or tolerate PO

Discharge Instructions

  1. NPO for 2hr
  2. No independent ambulation for 2hr

See Also

Procedural Sedation

Source

Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update

Obtenido de «https://www.wikem.org/w/index.php?title=Ketamine&oldid=3603»