Emergency Medical Minute22 Huhti 2024

Episode 900: Ketamine Dosing

Contributor: Travis Barlock MD

Educational Pearls:

Ketamine is an NMDA receptor antagonist with a wide variety of uses in the emergency department. To dose ketamine remember the numbers 0.3, 1, and 3.

Pain dose

For acute pain relief administer 0.3 mg/kg of ketamine IV over 10-20 minutes (max of 30 mg).
Note: There is evidence that a lower dose of 0.1-0.15 mg/kg can be just as effective.

Dissociative dose

To use ketamine as an induction agent for intubation or for procedural sedation administer 1 mg/kg IV over 1-2 minutes.

IM for acute agitation

If a patient is out of control and a danger to themselves or others, administer 3 mg/kg intramuscularly (max 500 mg).
If you are giving IM ketamine it has to be in the concentrated 100 mg/ml vial.

Additional pearls

Pushing ketamine too quickly can cause laryngospasm.
Between .3 and 1 mg/kg is known as the recreational dose. You want to avoid this range because this is where ketamine starts to pick up its dissociative effects and can cause unpleasant and intense hallucinations. This is colloquially known as being in the "k-hole".

References

Gao, M., Rejaei, D., & Liu, H. (2016). Ketamine use in current clinical practice. Acta pharmacologica Sinica, 37(7), 865–872. https://doi.org/10.1038/aps.2016.5
Lin, J., Figuerado, Y., Montgomery, A., Lee, J., Cannis, M., Norton, V. C., Calvo, R., & Sikand, H. (2021). Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study. The American journal of emergency medicine, 44, 306–311. https://doi.org/10.1016/j.ajem.2020.04.013
Stirling, J., & McCoy, L. (2010). Quantifying the psychological effects of ketamine: from euphoria to the k-Hole. Substance use & misuse, 45(14), 2428–2443. https://doi.org/10.3109/10826081003793912

Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMS II

Kokeile Premiumia

Nauti 14 päivää ilmaiseksi

Tilaa Premium

Jaksot(1144)

Podcast 759: Hyperkalemia and Myth of Kayexalate

Contributor: Nick Tsipis, MD Educational Pearls: Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples Hyperkalemia is commonly associated with end stage renal dise...

28 Helmi 20225min

Mental Health Monthly #10: The Elderly Psychotic Patient

Dr. Kim Nordstrom, a practicing emergency psychiatrist and associate professor with the University of Colorado, discusses various work-up models alongside valuable bedside tools for elderly patients w...

23 Helmi 202211min

Podcast 758: Vaccine Safety During Pregnancy

Contributor: Nick Tsipis, MD Educational Pearls: Observational study in Israel evaluated cohort of vaccinated pregnant women receiving the initial Pfizer-BioNTech COVID-19 mRNA vaccine Looked at 24,...

22 Helmi 20223min

Podcast 757: History of Fevers and Thermometers

Contributor: Chris Holmes, MD Educational Pearls: Dr. Carl Reinhold August Wunderlich, of the mid-1800s, was the first physician to suggest temperature was related to disease processes and his measur...

21 Helmi 20226min

Podcast 756: Violence Towards ED Staff

Contributor: Jared Scott, MD Educational Pearls: ACEP survey was done in 2018 looking at violence towards staff in the ED with only 10% of those solicited responding Survey found 47% of respondents w...

15 Helmi 20224min

Podcast 755: Tubo-Ovarian Abscess

Contributor: Peter Bakes, MD Educational Pearls: Tubo-ovarian abscess is a rare complication of pelvic inflammatory disease Usually presents with chief complaint of abdominal pain and is often diagno...

14 Helmi 20223min

Podcast 754: Balanced Fluids vs. Normal Saline, The Battle Continues

Contributor: Aaron Lessen, MD Educational Pearls: Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option The S...

8 Helmi 20223min

Podcast 753: Ring Cutting Raptors

Contributor: Aaron Lessen, MD Educational Pearls: Techniques regarding ring removal in the ED were evaluated in a recent study which looked at using trauma shears versus the motorized ring cutters A ...

7 Helmi 20222min

Kaikki yhdessä sovelluksessa

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi yhdessä paikassa.

Sinulle valikoitua sisältöä

Podme-sovelluksessa kokoat suosikkisi helposti omaan kirjastoosi. Saat meiltä myös kuuntelusuosituksia!

Jatka kuuntelua koska tahansa

Voit jatkaa siitä mihin jäit, myös offline-tilassa.

Premium

9,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa

Aloita 14 päivän kokeilu

Premium

13,99 €/kk

Kaikki premium-podcastit
Ei mainoksia
Ei sitoutumista, peruuta koska tahansa
Yksi lisäkäyttäjä

Kokeile 14 päivää maksutta

Suosittua kategoriassa Tiede

Tarinat ja äänet, joita rakastat kuunnella

Kuuntele kaikki suosikkipodcastisi ja -äänikirjasi

Lue lisää