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==Contraindications==
== Contraindications ==
===Absolute===
 
#<3 mo old
=== Absolute ===
 
#&lt;3 mo old  
#Known or suspected schizophrenia, even if currently stable or controlled w/ meds
#Known or suspected schizophrenia, even if currently stable or controlled w/ meds


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


==Preparation==
== Preparation ==
#Monitor
 
#BVM (ready)
#Monitor  
#Suction
#BVM (ready)  
#Atropine
#Suction  
##Only recommended for pts w/ impaired ability to mobilize secretions
#Atropine  
##0.01 mg/kg IVP; min 0.1mg, max 0.5mg
##Only recommended for pts w/ impaired ability to mobilize secretions  
#Versed
##0.01 mg/kg IVP; min 0.1mg, max 0.5mg  
##Pretreatment is nonmandatory in both adults and children
#Versed  
##Consider 0.03mg/kg IVP if pt has unpleasant recovery reaction
##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
 
##IV prefered over IM (faster recovery, less emesis)
#Give initial bolus  
##IV
##IV prefered over IM (faster recovery, less emesis)  
###Children: 1.5-2 mg/kg (over 30-60sec)
##IV  
###Adults: 1 mg/kg (over 30-60sec)
###Children: 1.5-2 mg/kg (over 30-60sec)  
###Repeat dose 0.5-1 mg/kg q5-15 PRN
###Adults: 1 mg/kg (over 30-60sec)  
##IM
###Repeat dose 0.5-1 mg/kg q5-15 PRN  
###Children: 4-5 mg/kg
##IM  
###Adult: 4-5 mg/kg
###Children: 4-5 mg/kg  
###Repeat dose 2-4 mg/kg if sedation inadequate 10min after initial dose
###Adult: 4-5 mg/kg  
###Repeat dose 2-4 mg/kg if sedation inadequate 10min after initial dose  
#Nystagmus = effect
#Nystagmus = effect


==Side Effects==
== Side Effects ==
#Airway misalignment requiring repositioning of head (occasional)
 
#Laryngospasm (0.3%)
#Airway misalignment requiring repositioning of head (occasional)  
##Only associated with unusually high IV doses
#Laryngospasm (0.3%)  
##Tx = BVM ventilation; intubation is rarely needed
##Only associated with unusually high IV doses  
#Apnea or respiratory depression (0.8%)
##Tx = BVM ventilation; intubation is rarely needed  
##Associated with rapid IV push
#Apnea or respiratory depression (0.8%)  
##Transient
##Associated with rapid IV push  
#Hypersalivation (rare)
##Transient  
#Emesis, usually well into recovery (8.4%)
#Hypersalivation (rare)  
#Recovery agitation (mild in 6.3%, clinically important in 1.4%)
#Emesis, usually well into recovery (8.4%)  
#Muscular hypertonicity and random, purposeless movements (common)
#Recovery agitation (mild in 6.3%, clinically important in 1.4%)  
#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 ==
#Return to pretreatment level of verbalization/awareness
 
#Return to pretreatment level of purposeful neuromuscular activity
#Return to pretreatment level of verbalization/awareness  
#Return to pretreatment level of purposeful neuromuscular activity  
#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==
== Intracranial pressure elevation ==
#NPO for 2hr
 
 
 
== Discharge Instructions ==
 
#NPO for 2hr  
#No independent ambulation for 2hr
#No independent ambulation for 2hr
==See Also==
[[Procedural Sedation]]


==Source==
== See Also ==
Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update
 
[[Procedural Sedation]]
 
== Source ==
 
Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update  


[[Category:Drugs]]
[[Category:Drugs]]

Revisión del 14:07 17 jul 2013

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

Intracranial pressure elevation

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=10974»