The ability of ketamine to produce dissociation is of great value to clinicians who perform painful procedures in general emergency medicine
Analgesia
Topical NSAIDS
Topical NSAIDs provide good levels of pain relief in acute conditions such as sprains, strains and overuse injuries, probably similar to that provided by oral NSAIDs.
Procedural Sedation Errors
Error #1: Delaying deep sedation until fasting times are met
Error #2: Believing PSA carries less risk than endotracheal intubation
Error #3: Minimizing risk of airway and breathing complications while using ketamine
Error #4: Not having full intubation setup nearby
Error #5: Responding to hypoventilation or apnea with early and/or aggressive use of the bag-valve mask (BVM)
Error #6: If the oxygen saturation is ok, then the patient is breathing ok
Error #7: Withholding ketamine sedation on adults
Error #8: Adding an opioid with ketamine for sedation
Error #9: Using the same dosing strategy for propofol sedations as with fentanyl/midazolam
Error #10: Using the same PSA dosing strategy for the elderly
10 Ways to Safely Push Ketamine in the ED
- Push Ketamine for Analgesia
- Consider Ketamine for Procedural Sedation
- Reach For Ketamine in Rapid Sequence Induction (RSI)
- Dilate in Asthma
- Sedate Post-Intubation
- Keep It Handy as a Tranquilizer
- Manage Ketamine’s Psychiatric Distress
- Remember the Cardiac Factor
- Lock it Down: Prevent Abuse
- Limit Risks of Laryngospasm, Hypertonicity, Hypersalivation
Quick Tip: Finger tip dermal avulsion injuries
Quick Tip: For finger tip dermal avulsion injuries the first step in caring for any minor wound is controlling the patient’s pain. As a means of anesthesia, have the patient dip the injured finger in 1% lidocaine with epinephrine for 5 minutes. One can pour 10-20 cc of this solution into a small medicine cup or urine specimen cup, and the patient simply soaks the afflicted finger. Epinephrine has the added benefit of vasoconstricting the troublemaking-little bleeders