Ketamine Considerations for Prehospital Use

At 3 a.m. you're toned out to a single vehicle accident with one passenger who slid off the road and wrapped his car around a light pole. A 44-year-old male is alert, rates his pain a 13 on a 1–10 scale, and reports he has asthma. Vital signs include a heart rate of 70, blood pressure of 90/60, and a respiration rate of 25. Extrication will be at least 30 minutes and the patient has multiple fractures. What drug will you consider that can manage this patient's pain, improve his cardiovascular state, and sedate him for extrication? Have you considered ketamine? History For 63 years ketamine has been administered across a spectrum of medical practices; from veterinary and human operating theaters to battlefield hospitals, EDs and now EMS. Its short-term usages that are of interest to EMS range from mild pain control and chemical restraint to complete sedation. From a prehospital standpoint, ketamine is easy to dose and administer, relatively safe, and has an onset time appropriate to field use. Because of the many mechanisms of action and broad range of uses, ketamine may be an excellent adjunct in the field. Synthesized in 1962, ketamine is an American pharmaceutical created by scientist Calvin Stevens, PhD, to be an anesthetic for operating room use. Its primary mechanism of action is N-methyl-D-aspartate (NMDA) receptor blockade (antagonism) for anesthesia. However, ketamine dissociates (i.e., the drug molecule breaks apart and attaches to various receptors) and affects ma...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Source Type: news