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 am currently in Singapore and apparently they are having a big problem down here with teenagers overdosing on ketamine right now. They have huge posters all over showing kids passed out in bathrooms and on the street from it. Not sure where they are sourcing it from. Probably the kids feel it is safer because it is not a narcotic with the strict drug laws down here.
But are they wrong!!!!! :uhoh21:
Vets use it frequently and it is probably easier to break into a vet's office than a hospital!
Kids...they will find SOMETHING to abuse...
How about Chloricidine (sp?)?
Who would have thought about OTC cold medicine?!!?
Around here the pharmacies have it behind the counter and you have to ask for it from the pharmacist!
I am currently in Singapore and apparently they are having a big problem down here with teenagers overdosing on ketamine right now. They have huge posters all over showing kids passed out in bathrooms and on the street from it. Not sure where they are sourcing it from. Probably the kids feel it is safer because it is not a narcotic with the strict drug laws down here.
But are they wrong!!!!! :uhoh21:
Vets use it frequently and it is probably easier to break into a vet's office than a hospital!
Kids...they will find SOMETHING to abuse...
How about Chloricidine (sp?)?
Who would have thought about OTC cold medicine?!!?
Around here the pharmacies have it behind the counter and you have to ask for it from the pharmacist!
The first statement highlights exactly what I am saying. I have no problem with "conscious sedation." However, the minute you pick up the propofol or the ketamine, you have passed from conscious into unconscious sedation. The idea of conscious sedation is that the patient is calm, sedated, but conscious. They will respond to questions, rouse to voice, etc. The next time you give a patient ketamine, ask them a question once they assume the "thousand yard stare." The only response you are likely to get is a funny look from the physicians and nurses around you. I have worked in a busy ED in a Level I trauma center. I thought the same things you do. Then I started doing anesthesia, and realized just how lucky I had been.
As to taking call to the ED, I do. I currently work in a rural hospital, and anesthesia drugs are not available to the ED. If there is need of deep sedation, I (or my partner) am called in to do it. Just off the top of my head, I can recall four patients with dislocated shoulders we have been called in to sedate for reduction in the last year. And that's just the shoulder dislocations. I have no idea how many times total I've been called in to provide deep sedation in the ED. And I don't at all mind coming in to do it. If your anesthesia personnel are unwilling to do so, that is something for your ED director and hospital administration to get involved in. Were I you, I wouldn't want the potential liability of performing anesthsia.
I'm not saying that all sedating or anesthetic drugs should be taken from the ED. On the contrary, many hospitals, the one where I work included, go too far in the other direction. I don't think that sub-q administration of 0.3 cc of 2% lidocaine should be done only by qualified anesthesia providers, but my hospital does. I think Versed is a wonderful drug for use in the ER. But you really have to try to make someone apenic on Versed, and you still may not be successful. You can make someone apenic and hypoxic with propofol without even realizing it happened. That's where the education and experience in giving anesthetics becomes critical.
Kevin McHugh, CRNA
Ok so you are saying that Ketamine is too dangerous for a lowly ER RN to administer, even if we have the patient adequately monitored, rescuscitation equipment at the bedside and follow the protocol set forth by the hospital and approved by the medical staff that allows us to give it. You are preaching to the choir here. we do not order the drug to be given, why arent you, as an entire specialty appealing directly to the physicians who order the drug instead of coming here and attempting to convince us not to give it?
I said it before, if you are all this concerned about ER RN's giving medications that you dont deem them capable of giving why dont you appeal to those responsible for making these meds available for us to give? We are not standing around holding our breath for the opportunity to give Ketamine. Personally I hate conscious sedation, I have many other patients to take care of, and it just ties me down when I could be working with others.
I dont want to be a CRNA, if I wanted that I would have gone to school to do it.
The first statement highlights exactly what I am saying. I have no problem with "conscious sedation." However, the minute you pick up the propofol or the ketamine, you have passed from conscious into unconscious sedation. The idea of conscious sedation is that the patient is calm, sedated, but conscious. They will respond to questions, rouse to voice, etc. The next time you give a patient ketamine, ask them a question once they assume the "thousand yard stare." The only response you are likely to get is a funny look from the physicians and nurses around you. I have worked in a busy ED in a Level I trauma center. I thought the same things you do. Then I started doing anesthesia, and realized just how lucky I had been.
As to taking call to the ED, I do. I currently work in a rural hospital, and anesthesia drugs are not available to the ED. If there is need of deep sedation, I (or my partner) am called in to do it. Just off the top of my head, I can recall four patients with dislocated shoulders we have been called in to sedate for reduction in the last year. And that's just the shoulder dislocations. I have no idea how many times total I've been called in to provide deep sedation in the ED. And I don't at all mind coming in to do it. If your anesthesia personnel are unwilling to do so, that is something for your ED director and hospital administration to get involved in. Were I you, I wouldn't want the potential liability of performing anesthsia.
I'm not saying that all sedating or anesthetic drugs should be taken from the ED. On the contrary, many hospitals, the one where I work included, go too far in the other direction. I don't think that sub-q administration of 0.3 cc of 2% lidocaine should be done only by qualified anesthesia providers, but my hospital does. I think Versed is a wonderful drug for use in the ER. But you really have to try to make someone apenic on Versed, and you still may not be successful. You can make someone apenic and hypoxic with propofol without even realizing it happened. That's where the education and experience in giving anesthetics becomes critical.
Kevin McHugh, CRNA
Ok so you are saying that Ketamine is too dangerous for a lowly ER RN to administer, even if we have the patient adequately monitored, rescuscitation equipment at the bedside and follow the protocol set forth by the hospital and approved by the medical staff that allows us to give it. You are preaching to the choir here. we do not order the drug to be given, why arent you, as an entire specialty appealing directly to the physicians who order the drug instead of coming here and attempting to convince us not to give it?
I said it before, if you are all this concerned about ER RN's giving medications that you dont deem them capable of giving why dont you appeal to those responsible for making these meds available for us to give? We are not standing around holding our breath for the opportunity to give Ketamine. Personally I hate conscious sedation, I have many other patients to take care of, and it just ties me down when I could be working with others.
I dont want to be a CRNA, if I wanted that I would have gone to school to do it.
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
Yoga,
Your knowledge is oh so impressive, but your reading skills are lacking. I said i gave Anectine when I was a Paramedic, not as a nurse. If you or your family ever needed RSI by such a poorly trained and uneducated Paramedic then please have your "medic alert" bracelet on showing no RSI by one who cannot answer the following questions.......
You act as if it is the individual's idea to make protocols or to make policy on these issues but it is not. Paramedics work under the license of a medical doctor under written protocols set forth by this doctor.
Oh, and by the way....our hospital has Anectine in the RSI kit for us lowly trained RN's to give, too. Is our hospital policy wrong? Are all the polocies of the major local hospitals wrong, not to mention all the Helicopter Ambulance services?
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
Yoga,
Your knowledge is oh so impressive, but your reading skills are lacking. I said i gave Anectine when I was a Paramedic, not as a nurse. If you or your family ever needed RSI by such a poorly trained and uneducated Paramedic then please have your "medic alert" bracelet on showing no RSI by one who cannot answer the following questions.......
You act as if it is the individual's idea to make protocols or to make policy on these issues but it is not. Paramedics work under the license of a medical doctor under written protocols set forth by this doctor.
Oh, and by the way....our hospital has Anectine in the RSI kit for us lowly trained RN's to give, too. Is our hospital policy wrong? Are all the polocies of the major local hospitals wrong, not to mention all the Helicopter Ambulance services?
Your knowledge is oh so impressive, but your reading skills are lacking. I said i gave Anectine when I was a Paramedic, not as a nurse. If you or your family ever needed RSI by such a poorly trained and uneducated Paramedic then please have your "medic alert" bracelet on showing no RSI by one who cannot answer the following questions.......
You act as if it is the individual's idea to make protocols or to make policy on these issues but it is not. Paramedics work under the license of a medical doctor under written protocols set forth by this doctor.
Oh, and by the way....our hospital has Anectine in the RSI kit for us lowly trained RN's to give, too. Is our hospital policy wrong? Are all the polocies of the major local hospitals wrong, not to mention all the Helicopter Ambulance services?
Your arrogance preceeds you.
Regards
EMTP, I couldnt have said it better, I like your style! :)
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 )
teeituptom, BSN, RN
4,283 Posts
thats why they are monitored and pulse oxed and ambu bag is right there.
life is simple
its only complicated if you make it that way