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 agree completely we are all rn's.... would you dialyze a pt?? i wouldn't......even though other nurses do- but then again they have had more training in it than myself.
this is to yogacrna or anyone else who has an opinion.....
to me this issue about ketamine is a serious one (we use it in our er) but another thing i will bring up is the use of anectine (succhynocholine)by paramedics. i worked as a medic for a long time before becoming a nurse and gave anectine and versed for rsi to numerous pts.....what do yall think of legal implications of that? i always thought as a paramedic my rear was hung out on a much further line than it is now because of such autonomy and no back up ( often only help is your emt partner, none else.........unlike in hospital where there are other nurses, techs, dr's...not to mention my role as an rn now does not allow me to intubate (which i do not miss doing that skill as it is very frustrating and frightening if you cannot get the tube-that is total life and death situation!!)....
also.....rsi in the field at all the ems places i worked at was on standing order protocol, we need not call a doc to get an order...
i am quite sure the package insert for anectine would say to be used by trained anesthesia personnel only......and i certainly have no formal training but gave buckets of it over the last several yrs.....
The 2 main reasons I come to the allnurses.com bb are (!) exchange of ideas with other nurses in different specialties and geographic areas, and (2) to learn new information.
While it is highly unlikely that in the foreseeable future I will be asked to give anyone ketamine, I still would like to educate myself - just because I like to learn. I also am interested, as we all should be, in "scope of practice" issues because we live in such a litigious society.
If in the future someone is offended by a post, could you just pm the person and not make the whole bb witness your catfight. I am not addressing this request to anyone in particular, its just that I get really frustrated when I am trying to read about an interesting subject and have to wade through all of the mudslinging.
We should be banding together and trying to help each other rather than ripping each other apart.
i agree completely we are all rn's.... would you dialyze a pt?? i wouldn't......even though other nurses do- but then again they have had more training in it than myself.
would I dialyze a pt? Yes, I would, and I have. PD is not something you have to have extensive training in. Hemo is different.
this is to yogacrna or anyone else who has an opinion.....
to me this issue about ketamine is a serious one (we use it in our er) but another thing i will bring up is the use of anectine (succhynocholine)by paramedics. i worked as a medic for a long time before becoming a nurse and gave anectine and versed for rsi to numerous pts.....what do yall think of legal implications of that? i always thought as a paramedic my rear was hung out on a much further line than it is now because of such autonomy and no back up ( often only help is your emt partner, none else.........unlike in hospital where there are other nurses, techs, dr's...not to mention my role as an rn now does not allow me to intubate (which i do not miss doing that skill as it is very frustrating and frightening if you cannot get the tube-that is total life and death situation!!)....
also.....rsi in the field at all the ems places i worked at was on standing order protocol, we need not call a doc to get an order...
i am quite sure the package insert for anectine would say to be used by trained anesthesia personnel only......and i certainly have no formal training but gave buckets of it over the last several yrs.....
just another point to ponder.......
Randy
Good question, Randy. Our paramedics in this area no longer do RSI, apparantly there were some problems very much like you are talking about. Helicopter flight medics, continue to RSI, however.
this is to yogacrna or anyone else who has an opinion.....
to me this issue about ketamine is a serious one (we use it in our er) but another thing i will bring up is the use of anectine (succhynocholine)by paramedics. i worked as a medic for a long time before becoming a nurse and gave anectine and versed for rsi to numerous pts.....what do yall think of legal implications of that? i always thought as a paramedic my rear was hung out on a much further line than it is now because of such autonomy and no back up ( often only help is your emt partner, none else.........unlike in hospital where there are other nurses, techs, dr's...not to mention my role as an rn now does not allow me to intubate (which i do not miss doing that skill as it is very frustrating and frightening if you cannot get the tube-that is total life and death situation!!)....
also.....rsi in the field at all the ems places i worked at was on standing order protocol, we need not call a doc to get an order...
i am quite sure the package insert for anectine would say to be used by trained anesthesia personnel only......and i certainly have no formal training but gave buckets of it over the last several yrs.....
just another point to ponder.......
Randy
But weren't you as the paramedic intubating the patient? In my opinion that is the difference....you did carry a lot of responsibility w/ that role, but you were also trained to intubate. It is in rare circumstances that a RN is allowed to intubate... at least in hospital. So while you were not a trained anethesia personal you were a trained paramedic who can intubate.
Yes We Were Trained Extensively In Intubation And Part Of The Paramedic Clinical Experience Is To Go To Surgery In A Local Hospital And Do Intubations On Surgery Pts........
Not Until The Mid 90's Though Did Paramedics Start Doing Rsi With Anectine, Prior To That If I Had An Airway That Needed Tubing And They Were Conscious I Would Try Nasotrachaeal Intubation. To Me That Was The Most Easy Skill Ever, Much Easier Than The Oral Route, But That Route Is Not Suited For Many Pts Such As Those With Head Trauma And After Anectine Became Part Of Protocols, That Became The Gold Standard...........
Yes We Were Trained Extensively In Intubation And Part Of The Paramedic Clinical Experience Is To Go To Surgery In A Local Hospital And Do Intubations On Surgery Pts........
Not Until The Mid 90's Though Did Paramedics Start Doing Rsi With Anectine, Prior To That If I Had An Airway That Needed Tubing And They Were Conscious I Would Try Nasotrachaeal Intubation. To Me That Was The Most Easy Skill Ever, Much Easier Than The Oral Route, But That Route Is Not Suited For Many Pts Such As Those With Head Trauma And After Anectine Became Part Of Protocols, That Became The Gold Standard...........
I guess that is why I'm missing your question. I know paramedics can intubate and you recieve a great deal of training on this. It is certainly a necessary skill for on the field work. And so because you are a paramedic you are allowed to intubate and you are giving Succ to intubate which is not the same as an RN who gives a med and loses an airway we cannot intubate.
So even though you as a paramedic were not "anesthesia personel" you were capable of intubating and you were giving the Succ in order to intubate. You are covered under RSI protocol and the purpose of you giving the med was to facilitate the intubation.
I think that is different than an RN administering a med such as ketamine or propofol for "conscious sedation" that puts the patient down deeper which is where the problem is.
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 )
athomas91
1,093 Posts
i agree completely we are all rn's.... would you dialyze a pt?? i wouldn't......even though other nurses do- but then again they have had more training in it than myself.