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?
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
I'm not trying to be rude, but it terrifies me that people without even the most basic knowledge of the drug are giving and recoving pts. This is very basic knowledge about ketamine.
I have been invited to post a response in this forum because I am both a CRNA and a JD. I really don't care in what state or what your hospital policy states, I think an RN who is not a CRNA should not administer ketamine, even on a physician's order. Don't take my word for it, read the package insert for Ketamine. It clearly states that Ketamine is an anesthetic agent and should only be administerd by an EDUCATED anesthesia provider. I can assure you that the package insert would be admitted into court and you would have to answer the question of where you received your anesthesia education.
Don't for a minute believe that you have no liability because you were just following the doctor's orders. I am very familiar with a case where the RN was giving sedation and a patient died. It is a long story, but it was in criminal court and the RN got convicted for practicing medicine without a license and involuntary manslaughter and spend jail time. The physician was acquited and, while he did lose his license did not go to jail.
While the legal argument is interesting, I am much more concerned with the fact that you are administering a VERY potent anesthestic to patients with full stomach and with limited knowledge of anesthesia. If my granddaughter came into your ER, there is NO WAY would I consent to her having ketamine.
Anesthesia should be given by anesthesia people, if you want to do it, we would love to have you in our profession. Check the Nurse Anesthetist Forum for more information.
Feel free to argue with me on this; but you better do your research and understand the pharmacology of this agent.
I have been invited to post a response in this forum because I am both a CRNA and a JD. I really don't care in what state or what your hospital policy states, I think an RN who is not a CRNA should not administer ketamine, even on a physician's order. Don't take my word for it, read the package insert for Ketamine. It clearly states that Ketamine is an anesthetic agent and should only be administerd by an EDUCATED anesthesia provider. I can assure you that the package insert would be admitted into court and you would have to answer the question of where you received your anesthesia education.
Don't for a minute believe that you have no liability because you were just following the doctor's orders. I am very familiar with a case where the RN was giving sedation and a patient died. It is a long story, but it was in criminal court and the RN got convicted for practicing medicine without a license and involuntary manslaughter and spend jail time. The physician was acquited and, while he did lose his license did not go to jail.
While the legal argument is interesting, I am much more concerned with the fact that you are administering a VERY potent anesthestic to patients with full stomach and with limited knowledge of anesthesia. If my granddaughter came into your ER, there is NO WAY would I consent to her having ketamine.
Anesthesia should be given by anesthesia people, if you want to do it, we would love to have you in our profession. Check the Nurse Anesthetist Forum for more information.
Feel free to argue with me on this; but you better do your research and understand the pharmacology of this agent.
YogaCRNA
I for one appreciate your input. I know that in my hospital there are some docs that choose to use Ketamine. It scares the #@$* out of me. Our procedural sedation policy does not preclude it's use...but our policy is VERY vague.
The anesthesiologists pulled Brevital from use in the ED without them being there...we used that A LOT. Talk about a scary drug...everyone got bagged.
Thanks Yoga for pointing out the package insert. I was going by a Textbook, but I REALLY truly believe that Ketamine should be given by an anesthetist. As for Resp depression, I believe it can cause laryngospasm.
I have been invited to post a response in this forum because I am both a CRNA and a JD. I really don't care in what state or what your hospital policy states, I think an RN who is not a CRNA should not administer ketamine, even on a physician's order. Don't take my word for it, read the package insert for Ketamine. It clearly states that Ketamine is an anesthetic agent and should only be administerd by an EDUCATED anesthesia provider. I can assure you that the package insert would be admitted into court and you would have to answer the question of where you received your anesthesia education.
Don't for a minute believe that you have no liability because you were just following the doctor's orders. I am very familiar with a case where the RN was giving sedation and a patient died. It is a long story, but it was in criminal court and the RN got convicted for practicing medicine without a license and involuntary manslaughter and spend jail time. The physician was acquited and, while he did lose his license did not go to jail.
While the legal argument is interesting, I am much more concerned with the fact that you are administering a VERY potent anesthestic to patients with full stomach and with limited knowledge of anesthesia. If my granddaughter came into your ER, there is NO WAY would I consent to her having ketamine.
Anesthesia should be given by anesthesia people, if you want to do it, we would love to have you in our profession. Check the Nurse Anesthetist Forum for more information.
Feel free to argue with me on this; but you better do your research and understand the pharmacology of this agent.
YogaCRNA
i agree with you. just out of curiosity, what are your thoughts on diprovan?
i agree with you. just out of curiosity, what are your thoughts on diprovan?
Dipravan (Propofol) is an anesthesia induction agent and should be used only for that, except in the ICU in VERY controlled conditions. Again, read the package insert and see if you meet the qualifications to administer an anesthetic.
I use propofol every day in my clinical practice and I have observed variable patient response to the drug. First of all, it is a potent respiratory depressant and causes patients to lose their airway. Secondly, it is a potent vasodilator and causes hypotension. That could be disasterous in patients who are actively bleeding. The big advantage of the drug (unlike Ketamine) is that it is very short-acting if used alone. I used it the other day for a long local anesthetic in a drip. The patient lost her airway at least three times, needed a nasal airway, oxygen, her blood pressure dropped, then she got major hypertension and on and on. I have over 40 years experience doing these cases and they have never gotten easier.
we use it for peds too. I havent had a problem with any of the patients I have had. We use our normal conscious sedation protocol, (peds cart at bedside, O2 etc) I like it because it wears off quickly.
The elimination half-life of ketamine is close to 5 hours. It is a LONG LASTING drug.. If you don't believe me, do a Google search (ketamine Half-life).
Please tell me how you can administer a medication that you know nothing about???
Yoga, All I know is from my experience with the drug. It did NOT last 5 hours, it wore off fairly quickly. The last time I gave it, was on a peds patient with a vulvar laceration. It lasted maybe 20 minutes, enough time for the lac to be repaired.
I am interested, though in your opinions on a few things. Is it necessarily illegal for an RN (not being an anesthetist) to administer Ketamine? I totally understand your concern with non-anesthetists adminitering anesthesia. I agree. In the busy ED, we have the potential to have to administer very dangerous drugs, and believe me, I am not any more happy about it than you. Just last month I was ordered to give Diprovan in a conscious sedation situation. I refused. I was working per diem in a small ED, and they didnt think it was necessary to even have a crash cart OR an ambu bag at the bedside.!!!! I am pretty sure, by the docs reaction that their nurses did it all of the time.
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 )
kyti
122 Posts
I'm not trying to be rude, but it terrifies me that people without even the most basic knowledge of the drug are giving and recoving pts.
This is very basic knowledge about ketamine.