Procedural Sedation
Ketamine… your best friend in the ED
The ability of ketamine to produce dissociation is of great value to clinicians who perform painful procedures in general emergency medicine
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
Being Human…
Procedures done in the Emergency Department are really painful. Research done in Kenya (READ MORE) showed that we’re doing loads of these but anecdotally the patients received minimal analgesia. Stop the SCREAMING…learn Procedural Sedation and Analgesia…it’s easy and more humane
When you have to put the child to sleep for a painful procedure
When dosing oral midazolam for anxiolysis – like when you’re doing a procedure – you can dose above the listed limit of 0.5 mg/kg. In fact, you can dose up to 1 mg/kg!
For the child who is preschool and under I will typically give the following dose: 0.7 to 0.8 mg/kg
DO NOT FORGET THE PAIN KILLER!
