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Discussion

Ketamine

Hello...............:)

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" :eek: 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?

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The term "conscious sedation" is a misnomer in many instances. The focus is on maintaining protective airway reflexes and respiration rather than the patient's ability to respond to verbal stimuli. While verbal response may be indicative of this preserved function with more traditional sedative/hypnotics, that is clearly not the case when using a powerful dissociative such as ketamine. In the case of ketamine, response to verbal stimuli becomes much more arbitrary and has no predictive value in assessing a patient's respiratory/airway status. A better term, in this world of CYA health care, would be "procedural sedation". I think some people have already mentioned that.

People are using responsiveness as the target, but are missing the point that responsiveness is, in most instances, only an indication that you are on target. Furthermore, lack of responsiveness when using an agent like ketamine doesn't mean jack.

The term "conscious sedation" is a misnomer in many instances. The focus is on maintaining protective airway reflexes and respiration rather than the patient's ability to respond to verbal stimuli. While verbal response may be indicative of this preserved function with more traditional sedative/hypnotics, that is clearly not the case when using a powerful dissociative such as ketamine. In the case of ketamine, response to verbal stimuli becomes much more arbitrary and has no predictive value in assessing a patient's respiratory/airway status. A better term, in this world of CYA health care, would be "procedural sedation". I think some people have already mentioned that.

People are using responsiveness as the target, but are missing the point that responsiveness is, in most instances, only an indication that you are on target. Furthermore, lack of responsiveness when using an agent like ketamine doesn't mean jack.

Well said.

Ketamine works wonders, I love it.

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