Written by, Sarah Pruitt, DO PhD MSc (Emergency Medicine)
This is a write up highlighting the below scholarly article and displays an avenue that can be used in low and middle, income settings.
https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1801920
Ketamine is readily available in most resource limited settings. This article shows that it has found favor and acceptance as an alternative use for analgesia in trauma patients. It allows for less need for opiates and in places where narcotics are scarce, this is a very good alternative.
The above paper is a consensus statement from the American College of Surgeons Committee on Trauma (ASC-COT) and the American College of Emergency Physicians (ACEP).
Key Points:
Pathophysiology – Ketamine is a non-competitive, N methyl D-aspartate receptor antagonist and potent dissociative agent
Properties – sedative, anesthetic, analgesic
Use – Acute trauma, safe in head injuries and eye injuries. Can be combined with opiates. Caution is used with benzos.
Indications: Analgesia – comparable to opiates but has less effect of BP. Can be used in moderate to severe pain.
Contraindications: Kids less than 3 months. Patients where an elevated BP or tachycardia could be dangerous
Dosing:
Analgesia – 0.1-0.3mg/kg (max 30mg) IV every 20 minutes with max of 3 doses (Slow IV push, over 1 minute)
0.5 – 1.0mg/kg Intranasally
Non weight-based dosing for an adult: 50mg IM every 30-60 minutes until pain is controlled or nystagmus develops OR 20mg slow IV/IO push every 20 minutes with same end points
Procedural sedation – 1mg/kg IV (100mg max)
Peds – ALWAYS WEIGHT BASED! Same dosing: 0.1-0.3mg/kg IV with same end points (slow IV push).
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