Ketamine for conscious sedation in peds in the ED

[nanb]

Our physicians in my ED want to use Ketamine for conscious sedation in children for short procedures. All of the nursing drug references I've looked at have no pedi references for use: dosages, route of administration, side-effercts etc. I've also looked at sources that say it's an anesthetic agent and not approved by the FDA for use in children. So, who out there uses it and where can I find some user friendly guidelines to educate my staff? I need a written reference to give them, not just an MD's order and our MD's telling me how safe and effective it is.:typing

[camoflage]

we use ketamine in our ed as well. we also give atropine to prevent bradycardia. i agree with the general notion that the ed doc should push it. also, the pt needs to be monitored and o2 on. plus have the intubation box at the bedside.

Probably beating a dead horse here, but just kind of scanning and noted this entry. Ketamine will cause tachycardia (unless the patient is catecholamine depleted) and will cause a marked increase in oral secretions. You are using atropine as "drying" agent, I would emphasize that if your department is using a drug (comment for all in general) then I would be intimately familiar with the pharmacokinetics and pharmacodynamics of the drug. Misinformation is dangerous.

[8great]

check with your board, it's out of our scope of practice in my state. We use it on kids, under age 14, bad reactions on older kids.Recent studies are questioning the long tern effects on kids.

[schroeders_piano, RN]

I am among those that hates ketamine. I have used it for conscience sedation and I had bad outcomes each time. I had one patient start having massive seizure activity after ketamine IV. I had a peds patient stop breathing after receiving ketamine IM. There are so many other meds that can be used that are safer. Ketamine is very closely related to LSD.

[teeituptom, BSN, RN]

Works great on kids in the ER

I love it then you dont have to listen to a screaming kid and freaked out parents.

[Dragonnurse1, ASN, RN]

Our hospital banned ketamine in the ER. We used topical lidocaine on a bandage to numb surface of the area and once the skin was numb we used plain lido. with a 27 short for less pain.

[RNcDreams]

I'm in a new grad program in an ED and we all just had to pass competencies on the use of Etomidate for conscious sedation with pedi ortho reductions, etc.... how have your experiences been with it, if you have used it?

[Dragonnurse1, ASN, RN]

We never used it. We had a pediatric cocktail that consisted of thorazine, phenergan and one other med that I can not remember. It worked great and we only had to wait until the child would drink something before discharge.:cheers:

[sunshineonleith]

so glad this thread caught my eye. i'm a new grad in the ED, have been on the floor for a month with a preceptor and started residency classes today. our educator came and talked to us about ketamine, and she stated that the hospital was looking into letting RN's push it. she was clear that at this point in time, only our docs are allowed to adminster it, but she was singing its praises like she was a drug rep. another girl in my class raised issue with its dissociative properties and predisposition to psychoses later in life, and the educator denied knowledge of this study and went on to talk about how often we use it.

she then gave the example of ped's soaking up versed and not having it affect them like it would an adult, and using ketamine as a backup. her specific example was of a child needing a head ct and not being able to get them to lie still enough. we went over the adverse effects, and i asked why we would be giving a kid needing a head ct a drug that raises ICP. her response? "it doesn't happen often enough for it to be a problem - we like this dug and use it often" (!!).

thank you all for your postings. my first day's lesson in the ed? don't trust what you hear unless you've done the research yourself. i won't be pushing ketamine unless i get a few more initials in my "RN".

[Dragonnurse1, ASN, RN]

Good for you. Stick to your guns. We had a Doc that wanted to use Lidocaine 2% on a child ( about 6 years ago) and not one of us (RN's) on duty would use the 2% especially on a 3 year old. The Doctor got angry and did it herself. The child died and not one of the RN's caught flack. The Doctor however was "let go" and the hospital settled out of court. The child was a member of one of the most influential famlies in town.

Listen to your gut. If your instinct tells you somethings not right question and if necessary call your supervisor on duty and explain to her/him:yelclap: