Ketamine

Specialties Emergency

Published

Specializes in Emergency Room.

Hello...............:)

For some reason, I seem to be the ketamine queen in our er. The docs have started to use it on kids for extensive lacs or reductions when the kids are really (really, really) uncooperative or we are just not able to get them to be still for the tx. First time, it scared the holy *** out of me!. I looked it up before giving it, but still........... this fat little two year old went from screaming at the top of his lungs, and flailing all over the place, to this tranquil little (well, fat) kid laying limply on the stretcher with his eyes jerking back and forth. looked like he was watching tennis or something. can you say nystagmus (sp?). I got the doc because the mom was freaking out (causing me to try to look like I was NOT freaking out). He takes one look at the kid and says, "oh...he's just hallucinating" :eek: Our tech (college kid) happened to stroll by and announced to me that the kid was "in the K-Hole" (apparently the lingo when you do the drug illegaly, what do I know?:chuckle )

anyway, now I have administered it to three or four kids, and to my knowledge, none of the other nurses in the department have had this "wonderful learning opportunity" the kids come out of it fine, and I've had no problem. I have been following our iv conscious sedation protocol, but am wondering if I should be doing anything else? the protocol was written for adults, and all the little ketamine people are kids. I don't do peds! (I do that at home in my off time). anybody else have protocols specifically for ketamine or peds ivcs?

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But I have to say that the stuff I learn on these boards continue to amaze me.

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Specializes in Case Management, Acute Care, Missions.

Wow - sorry you had to go through that. I don't use it here in the states (I do med/surg), so I can't help you with protocol. But... I use it ALL the time in Zimbabwe - it's about the only drug readily available and we use it as sedation for adults and kids for procedures. The kids are kind of freaky with the eye thing, but usually come out of it ok - it's the adults that worry me - they can come out really agitated and swinging! We started combining it with valium for the adults and that seems to work to lessen the agitation.

Hope you are able to find the info you need!

Lori

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We used it about a week ago on a peds pt for a procedure. Had an immediate allergic reaction. turned bright red rash. we ended up giving benadryl and O2. Had to use fentanyl for the sedation.

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Ketamine is more often used in the OR as an anesthetic induction agent. I suggest contacting your hospital's chief CRNA/MDA, and asking for an inservice for the ER nurses. Ketamine's not the most uncomplicated drug, I'd be a little hesitant about giving without knowing the in's and out's.

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Ketamine is classified as an anesthesia drug according to my text PostAnesthesia Care A Critical Care Approach by Cecil B. Drain.

It is suggested that this be administered by an anesthesia provider. Your state may have rules and your E.R may have a policy though. Check this out carefully! Good luck.

p.s: Kids DO do much better w/Ketamine than adults. The effects can lat weeks with hallucinations and night terrors. I think they give Versed or Valium WITH thi Ketamine to avoid this most unpleasant "adverse reaction"

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I work peds med/surg and our policy is absolutely no ketamine on the floor, probably because we're not set up for kids in deep sedation. And nurses don't give it, even if we could use it on the floor it can only be administered by an anesthesiologist.

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Specializes in Emergency.

I've used ketamine many times in my short 6 months in the ER. It is usually ordered on kids to set a fracture. yes, the kid's eyes do roll back in their head, or shift from side to side ( only for a second). From what a doc told me, they like it because it doesn't cause resp depression. We use conscious sedation flowsheet, and consent must be signed. Parents are usually present. Recovery is normally short. I have not dealt with an allergic rxn to it.

I've never heard about it causing nightmares, this is interesting, i'll have to do more research.

xo Jen

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We use ketamine in our ED often as a pediatric sedation for lac repairs and ortho procedures.

Our kids are on O2, Sat/pulse monitors, and sometimes on EKG or NIBP depending on age/size. We keep the room quiet and discuss with the parents, prior to administration, the need for quiet administration AND emergence from this sedation. An informed consent is obtained for the sedation and a sedation flow sheet is used for pre, intra, and post sedation parameters such as LOC, pain, activity, sedation level, etc.

So far, in 2 years, I have not seen a bad outcome.

Our doses are weight based and calculated to the ER doc.

Stoko

The miracle isn't that I finished, the miracle is that I had the courage to start. John "The Penguin" Bingham

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Agree with Stokorn, sounds like about our protocol. Used it this week for an 8yr old with a new forked tongue - thanks to a dog bite. Went under in 5 min - used conscious sedation flow sheet, no VS variation noted, other than increased heart rate (10-20 beats - great way to identify when they have gone out) . My doc was great at describing the nystagmus, arm jerks to the parents. We gave atropine with the Ket to dry secreations. Doc uses Ativan for adults to decrease the hallucinations. Because of the extensive repair needed, we had to give an additional dose of Ketamine - because of that, I was at the bedside for an extra hour waiting for him to wake up - noone expected the extra time, but at was after midnight too, so maybe just sleeping it off - despite being tickled every couple minutes to see if he was coming around.

General opinion: love the stuff. They're out, you don't have to deal with the resp compromise, and you get done.

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Hey-

Use ketamine alot in ED for conscious sedation with kids- great drug, though they do get tachy, but no real compromise. However, when I was young and dumb, in a tiny hospital in Indiana, had to "assist" in post-op (I was tech) with a 16 yr old female post surgical that was given ketamine. The nurse asked me to stand next to the cart while she went to the next cubicle to get something. I didn't have a clue, so I patted the girl's arm and spoke to her. Her eyes flew open, she sat bolt upright and cold-cocked me! That's how I learned about post-ketamine hallucinations in "adults". I am now "senior staff" in the ED, so I always assign another nurse to a ketamined pt if the patient is bigger than me!;)

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Specializes in Med-Tele, ICU.
Ketamine is classified as an anesthesia drug according to my text PostAnesthesia Care A Critical Care Approach by Cecil B. Drain.

It is suggested that this be administered by an anesthesia provider. Your state may have rules and your E.R may have a policy though. Check this out carefully! Good luck.

At the ER I work at, nurses aren't allowed to administer Ketamine, only the docs :)

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