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?
Unfortunately, that's not true. Anesthesia drugs have a way of sneaking up on you. What in one patient may be the correct dose, in another patient of the same size and weight the dose may have very little effect, and in yet a third patient may be enough to start a fatal spiral downward. Knowing the med isn't enough, you have to know what to do when that med does more than you expect.
Quick, without looking it up, answer the following questions.
1. Name 2 genetic disorders where succinylcholine is absolutely contraindicated.
2. How are those disorders diagnosed?
3. How do you reverse succinylcholine?
4. Explain the difference between depolarizing and non-depolarizing muscle relaxants at the myoneural junction.
If you have to look up even one of those answers, you are practicing substandard nursing if you are administering succinylcholine. You should be reported to the RN Board as an unsafe practitioner.
I have driven a car for over 40 years, but wouldn't attempt to drive at NASCAR. Go to anesthesia school if you want to do anesthesia. Please for the patients sake.
Quick, without looking it up, answer the following questions.
1. Name 2 genetic disorders where succinylcholine is absolutely contraindicated.
2. How are those disorders diagnosed?
3. How do you reverse succinylcholine?
4. Explain the difference between depolarizing and non-depolarizing muscle relaxants at the myoneural junction.
If you have to look up even one of those answers, you are practicing substandard nursing if you are administering succinylcholine. You should be reported to the RN Board as an unsafe practitioner.
I have driven a car for over 40 years, but wouldn't attempt to drive at NASCAR. Go to anesthesia school if you want to do anesthesia. Please for the patients sake.
Yoga CRNA
One, we dont use succs for mild concious sedation. You should know that.
Most commonly Fentanyl and versed, or ketamine for children.
holy moly...........just wanted to know if there were specific PEDIATRIC conscious sedation guidelines that were, in any way, different from the ones that are oriented to adult patients. Of course we get consent, oral airway/BVM at bedside, cardiac monitoring, oximetry, iv (usually once ketamine starts to work), 02, crash cart. Last hospital I worked at, we even were required to have a respitory therapist at bedside when IVCS was initiated (I liked that). I think I misspelled respitory. anyway.....?
We do have separate peds guidelines, and have to re-cert yearly with testing...in our hospital, there seems to be a territorial issue with anesthesia re: conscious sedation. However, they wouldn't go so far as to be there for every sedation, or on call for it, either. So they had us all take the tests that the docs take for sedation. Much to their surprise, I'll bet, we all passed it. Anesthesia blocked us from using brevitol however, much to our doc's dismay. It is probably a gray area everywhere. Distributing very scarce resources, and getting re-imbursed for it (will ER patients PAY for the anesthesiologist?) So, we muddle on...
Also. I'd like to reply to yoga CRNA: I've been in critical care every minute of my nursing life, and if I don't or can't remember the drugs and EVERY SINGLE indication/contrindication, the book is open at the bedside. and I am reading it. It may actually mean one more minute of bagging, but hey, I can't remember EVERYTHING. There are many situatiions where I have a "vague idea" in the ER. I am responsible enough to find out before proceeding. The nurses you have to worry about are the ones who DON'T know what they don't know. Not the ones who can't remember everything.
We do have separate peds guidelines, and have to re-cert yearly with testing...in our hospital, there seems to be a territorial issue with anesthesia re: conscious sedation. However, they wouldn't go so far as to be there for every sedation, or on call for it, either. So they had us all take the tests that the docs take for sedation. Much to their surprise, I'll bet, we all passed it. Anesthesia blocked us from using brevitol however, much to our doc's dismay. It is probably a gray area everywhere. Distributing very scarce resources, and getting re-imbursed for it (will ER patients PAY for the anesthesiologist?) So, we muddle on...
Also. I'd like to reply to yoga CRNA: I've been in critical care every minute of my nursing life, and if I don't or can't remember the drugs and EVERY SINGLE indication/contrindication, the book is open at the bedside. and I am reading it. It may actually mean one more minute of bagging, but hey, I can't remember EVERYTHING. There are many situatiions where I have a "vague idea" in the ER. I am responsible enough to find out before proceeding. The nurses you have to worry about are the ones who DON'T know what they don't know. Not the ones who can't remember everything.
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 )
one more minute of bagging, but hey, I can't remember EVERYTHING. There are many situatiions where I have a "vague idea" in the ER. I am responsible enough to find out before proceeding. The nurses you have to worry about are the ones who DON'T know what they don't know. Not the ones who can't remember everything.
EMTPTORN
117 Posts
Eloquently Put New Ccu Rn