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?
guys....i don't think that is at all how Kevin intended to sound....look - WE ARE ALL NURSES HERE...none of us especially CRNA's appreciates good nurses more....and i believe you are all likely great nurses.
what we are all trying to say is.....that if you knew what we NOW knew ...that you would be more judicious in what MD orders you follow...i - like you - gave the same meds...had the exact same mentality - and would have had a fit if someone were to tell me I was practicing on the edge of danger....but we aren't lying..and we aren't trying to make you to be "lowly" nurses....all we are doing is warning you...it is a patient care issue..and as nurses across the board THAT IS the most important thing...is it not??
i remember as a nurse - a new nurse....following a MD order that left my patient w/ brain damage...I did everything I was supposed to - but i wasn't trained extensively in fluid and electrolyte resus....too much Na+ too quickly and a little brain damage you have....my charting saved my butt - but this is just an example...i followed nursing protocols, i followed a MD order...and it still harmed the patient...the MD by the way lost the law suit and his license.
all we are saying is BE CAREFUL.....and try to take the advice of those such as Kevin and Yoga as a "pearl" of wisdom....they truly know their trade...and their information is right on. They would not degrade nurses..they are just trying to enhance learning...and benefit patients.
In over 3 decades of practice and in countless concious sedations, I have seen only 2 adverse reactions.
1. a CRNA came into ER squirted some meds for ortho and left without telling anyone and we found the pt in resp arrest. Fortunately resuscitated without adverse outcome,
2. This one was where an orthopedist was trying to reduce a hip dislocation under concious sedation. The orthopedist went into V fib, he too was resuscitated without adverse outcome. But I bet he never tried to reduce a hip again.
i unfortunately was not so lucky...i have seen 4-5 pt's (usually elderly) that did have complications from "conscious" sedation where they aspirated.....but i was not the one to administer the meds...*thanking God*....
ortho surgeon in vfib....dang...would not be fun....:)
That's hilarious.....are you saying that the CRNA would be of no help? In your ER, you must be able to intubate too---that's awesome! A CRNA could run the code, intubate, put in lines, blah blah blah. I guess all of that would render an anesthetist useless.
If you think about it we give lots of meds that could result in the death of the patient, maybe we should have CRNA's come in a give them for us too?
Veetach....ppaaaaahhhhleeeeaaassseee.... i was first an ER RN...CRNA education only enhances what we as ER nurses are able to do........that is not the point of this discussion and you know it. We are not talking about life and death situations in which a med could save/take a life.... we are talking about routine use of anesthetics for "conscious" sedation - where the patient is not actually "conscious" - so ARE YOU REALLY COVERED under your protocols if the patient is not able to answer and follow commands...after all it is "CONSCIOUS SEDATION" protocol -.....?????
Veetach....ppaaaaahhhhleeeeaaassseee.... i was first an ER RN...CRNA education only enhances what we as ER nurses are able to do........that is not the point of this discussion and you know it. We are not talking about life and death situations in which a med could save/take a life.... we are talking about routine use of anesthetics for "conscious" sedation - where the patient is not actually "conscious" - so ARE YOU REALLY COVERED under your protocols if the patient is not able to answer and follow commands...after all it is "CONSCIOUS SEDATION" protocol -.....?????
I dont know about yall
But our concious sedation protocols are all set up by the Anesthesia Committee. And meets their standards and guidelines
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 )
RNin92
444 Posts
ditto