Use in the Prehospital Setting Background Multiple drug shortages are threatening the safe management of the most critically ill and injured patients Critical drugs such as etomidate midazolam ID: 674862
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Slide1
Ketamine for Induction
Use in the
Prehospital
SettingSlide2
Background
Multiple drug shortages are threatening the safe management of the most critically ill and injured patients.
Critical drugs such as
etomidate
,
midazolam
and diazepam have at times not been available to some of our EMS agencies.Slide3
Why Ketamine?
Ketamine
has long been used for procedural sedation in the emergency department.
More recently, concerns have been raised regarding possible negative effects of adrenal suppression in septic patients
intubated
using
etomidate
.
Therefore, several studies as well as discussions in the literature have since favorably reviewed the use of
ketamine
for induction.Slide4
Mechanism of Action
Ketamine
is a dissociative anesthetic agent, structurally similar to phencyclidine (PCP), which interrupts the connection between the cortex and the limbic system.
Stimulates
opiod
receptors and is thus a unique sedative agent in that it provides analgesia as well.
Stimulates catecholamine release
Increased BP, HR and cardiac output
Bronchodilatation
Slide5
Pharmacokinetics
Onset of anesthesia when given IV is 30 to 60 seconds.
The duration of the anesthetic effect is 5 to 10 minutes when given IV.
The duration of drug effect following IV dosing can last for hours. In this phase, the patient is responsive but has varying degrees of delirium.Slide6
Indications
Induction agent for rapid sequence intubation (RSI)
At this time,
ketamine
should only be used as an induction agent when the supplies of
etomidate
have been exhausted.
It is also used for procedural sedation and analgesia, however it will not be approved for these uses by EMS.Slide7
Precautions
Ketamine
should be used with caution in patients with elevated blood pressures.
Do not use
ketamine
in patients who may be in a hypertensive crisis
Patients emerging from the effects of
ketamine
may experience disturbing nightmares and hallucinations. Be sure to continue sedation after they are
intubated
with another sedative agent.Slide8
Precautions
May cause increased intraocular pressure and should not be used when globe rupture is a concern.
Increased ICP: This is controversial as several studies have shown minimal increase in ICP. In fact, an increase in CPP may actually be beneficial. However, when increased ICP is suspected, it may be beneficial to concomitantly give a dose of
midazolam
2 to 4 mg.Slide9
Drug Interactions
There are no major drug interactions to avoidSlide10
Dosing
The general induction dose is 2 mg/kg
A range of 1 to 2 mg/kg is provided to allow for a decrease in dose at the discretion of the medic, such as in elderly patients.