Episode 900: Ketamine Dosing

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

  1. 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

  2. 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

  3. 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

Avsnitt(1145)

Podcast 671: Scapula Fractures

Podcast 671: Scapula Fractures

Contributor: Adam Barkin, MD Educational Pearls: Represents less than 1% of all fractures that occur, although it has a significant mortality rate of 2-5% Typically occurs in high-energy trauma and ...

17 Maj 20213min

Podcast 670: Operation Tat-Type

Podcast 670: Operation Tat-Type

Contributor: Dave Rosenberg, MD Educational Pearls: In 1951, Operation Tat-Type began tattooing adults with their blood type in an effort to prepare for rapid transfusions in the time of the Cold Wa...

12 Maj 20214min

Podcast 669: VTach Storm

Podcast 669: VTach Storm

Contributor: Gretchen Hinson, MD Educational Pearls: Three episodes of ventricular tachycardia within 24 hours or two episodes back-to-back Treat with IV amiodarone and IV beta-blockers initially as...

11 Maj 20215min

Podcast 668: Opioid-Induced Hyperalgesia

Podcast 668: Opioid-Induced Hyperalgesia

Contributor: Donald Stader, MD Educational Pearls: Opioids target kappa and NMDA receptors that can lead to central nervous system sensitization and therefore increased pain For patients with opioid-...

10 Maj 20214min

Podcast 667: Lactated Ringers for DKA

Podcast 667: Lactated Ringers for DKA

Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at whether lactated ringers might be a better choice for fluid resuscitation in patients with DKA compared to normal saline Norm...

4 Maj 20213min

Podcast 666: Pain Management & Patient Perspective

Podcast 666: Pain Management & Patient Perspective

Contributor: Jared Scott, MD Educational Pearls: About ½ of the patients in the ED present with some form of pain One study looked at patients presenting in pain and followed up two days after disch...

3 Maj 20215min

Podcast 665: Allergic Reactions after COVID Vaccinations

Podcast 665: Allergic Reactions after COVID Vaccinations

Contributor: Peter Bakes, MD Educational Pearls: Incidence 2.5-10 per million people occurring primarily in those with environmental allergens Typically occurs with mRNA vaccines in lipid nanopartic...

28 Apr 20214min

Podcast 664: Rabies Prophylaxis

Podcast 664: Rabies Prophylaxis

Contributor: Jared Scott, MD Educational Pearls: 1-3 cases of rabies per year in US with 55,000 people per year receiving rabies prophylaxis 90% of rabies cases come from wildlife, most commonly by ...

27 Apr 20215min

Populärt inom Vetenskap

svd-nyhetsartiklar
p3-dystopia
dumma-manniskor
pojkmottagningen
allt-du-velat-veta
det-morka-psyket
kapitalet-en-podd-om-ekonomi
rss-experimentet
dumforklarat
rss-vetenskapsradion-2
halsorevolutionen
rss-ufo-bortom-rimligt-tvivel
medicinvetarna
rss-vetenskapsradion
paranormalt-med-caroline-giertz
bildningspodden
rss-spraket
sexet
vetenskapsradion
4health-med-anna-sparre