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" 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?
particularly on those big muscle guys with their dislocated shoulders, nice quick down, easy pop back into place, back up shorter recovery time and OTD
We use the conscious sedation policy as well. There is not a thing you can do differently. Protect the airway. Go back to your basic ABC's. The unfortunate thing about Ketamine is that there is no reversal agent. The fortunate thing is the 1/2 life is short. More bad news... The lingering affects these kids can have are scarier than ****! They can have the hallucinations, nightmares, and sweating at home- good time for parent education! I would rather sit on a kid to hold him down any day! Ketamine is not my favorite...
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" 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?
The worst part is having to be one-on-one, and not being able to leave the bedside. (Iwouldn't dare). We usually have 2-3 other patients, and have to rely on the other nurses to watch them, but I am ultimately responsible for them.
Help!! I'm a new ER nurse..used to be a hospice nurse...the last thing I want to do is to have to revert back to hospice nursing practice while in the ER. The ER I work in routinely uses Ketamine for sedation on pediatric patients for procedures. They also use diprovan when doing cardioversions. I asked the ER educator about scope of practice and nurses giving anesthesia meds such as diprovan and she said its not a problem with scope of practice. Hospital policy for moderate sedation allows for use of these medications and to be administered by RNs. Yet at another hospital I worked at RNs were forbidden to administer any anesthesia meds. Would my state board of nursing be a resource for resolving this issue? If not who should I talk to...
You should go by your state BON Katrinka. I don't want to get into the conscious sedation versus anesthesia provider debate, but I belive that you must find out the rules and have it in writing before you do anything you are uncertain of. Your manager will not stand up in court to back you if something goes wrong...
You should go by your state BON Katrinka. I don't want to get into the conscious sedation versus anesthesia provider debate, but I belive that you must find out the rules and have it in writing before you do anything you are uncertain of. Your manager will not stand up in court to back you if something goes wrong...
wow, so much hostility, conscious sedation by definitions means the pt can follow commands, if the pt can no longer follow commands after administration then you aren't doing conscious sedation no matter what protocol you are following, so if something should happen, it's your butt in court, i'd make the doc administer the drug himself
we use ketamine for sedation in children for lacs and ortho as most of the other posters here do, we also use atropine for reducing secretions while they are sedated. A dimmed quiet room with cardiac monitoring,pulse oximetry,pediatric amdu bag,suction,blood pressure monitor,O2 per nasal cannula are all available before administration begins. Our protocol requires one hour post administration monitoring before discharge and they must be alert before discharge.
Use it often in the ER. One hospital protocol stated that only an MD can give it if IV but that was just one. The research I've done says that it's very safe. it was used extesively in Viet Nam as a battle field anesthetic becuase it had little or no effect on respiratory drive. We use a flow sheet and treat it like any other conscious sedation procedure. Personally I prefer to hold the kid down (bruticaine) and do most procedures. When you absolutely can't use that approach ketamine is a good way to safely put the brat down. Mostly the decision is based on what the doctor is familiar with. Lately we have been using alot of etomidate. That stuff is a miracle.
JBRO made a very valid point that others seem to miss.
Conscious sedation: a medically controlled state of consciousness in which protective reflexes are maintained. The patient retains the ability to maintain airway and can respond appropriately to verbal commands. (American Society
of Anesthetists)1996
Deep Sedation: a medically controlled state of depressed consciousness in which the patient may not be able to maintain protective reflexes.(ASA 1996)
So tell me when we give ketamine how many patients respond verbally. And someone mentioned Brevital, it may be quick but they certainly aren't responsive. Remember when something goes wrong the legal parties will turn toward the legal definition and standard of care. The entire concept of conscious sedation protocols came from the litagation overload that ED's were seeing for doing what was considered an anesthesia procedure(conscious sedation). The protocols allowed the ED to perform the procedure without the anesthesia MD or CRNA. It gave them a legal leg to stand on. I have been to court while a manager of an ED in support of a nurse who was involved in a brevital "nightmare" where there was a very poor outcome. The nurse was found not guilty but the hospital and MD were found guilty because the patient was unresponsive during the brief relocation of his shoulder. Unresponsive was found NOT to be conscious sedation.
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
Tennis eyes-eyes rolling??? Adults swinging and agitated after 'some procedure that needed sedation'?? Sounds like the winning drug of choice to me----NOT:rolleyes: . I'd have to ask for hazard pay to give that drug. Hats off to the brave men and women that are those that push Ketamine (hopefully the hat wasn't knocked off by that swinging pt):rotfl:
( just a note: this wasn't meant as a dig, just struck me as funny--it's 5AM and I've had entirely too much coffee ).
For some reason some docs on our floor have recently started using ketamine for ortho surgeries. We've had 2 pts in the last month that have reported being "out of their bodies, watching the surgery". Anyone else heard this from pts???? It really freaks them out.
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 )
Sounds like the winning drug of choice to me----NOT:rolleyes: . I'd have to ask for hazard pay to give that drug. Hats off to the brave men and women that are those that push Ketamine (hopefully the hat wasn't knocked off by that swinging pt):rotfl:
teeituptom, BSN, RN
4,283 Posts
Brevital is so nice
makes reductions so much easier
particularly on those big muscle guys with their dislocated shoulders, nice quick down, easy pop back into place, back up shorter recovery time and OTD