Enhanced Care skills Flashcards
Indications for Ketamine
To provide effective pain relief of severe traumatic pain as part of a balanced analgesia regime in:
- multiple or significant fractures
- significant soft tissue injury
- dislocations
- burns
- or where morphine is contraindicated
Characteristics of Ketamine dissociation
- airway reflexes maintained
- normal or enhanced muscle tone
- substantial or complete analgesia
- total amnesia is typical
- cardiovascular stability
Ketamine inclusion criteria
Adults and children over 12 years old
Ketamine exclusion criteria
- Children under 12
- Patients with current airway compromise where securing the airway will be difficult
- known previous adverse reaction / hypersensitivity
- GCS <12
- Uncontrolled hypertension >180SBP, or >110DBP
- Suspected acute ACS
- Known raised ICP or intraoccular pressure
- Acute porphyria
- Concurrent administration or theophylline
- Eclampsia or Pre-eclampsia
Ketamine onset, peak and duration
Onset: 30secs
Peak: 2 mins
Duration: up to 40 mins
Ketamine: minimum monitoring
- SPO2
- 3 lead ECG
- BP
- ETCO2
Ketamine dose
0.5mg/kg
10mg increments
Ketamine: Side effects
Anxiety, behavioral abnormalities, diplopia, nystagmus, nausea, vomiting, tachycardia, hallucination, increased muscle tone
Ketamine treatment of emergence
- reassurance & calming
- diazepam 2.5mg aliquots up to 10mg (10 min intervals)
Airway: Anticipated difficult BVM
Mask seal
Obesity
Age
No teeth
Stiff lungs
Difficult airway: change something significant
Oxygenation is king
Head position
ELM
Laryngoscope
Pal/person
Quadrangle of Trauma
Coagulopathy
Metabolic Acidosis
Hyocalcaemia
Hypothermia
Indications for Finger Thoracostomy
Treatment of Tension pneumothorax in cardiac arrest:
- SCUBA
- Asthma
- TCA
Must be positively pressure ventilated
Indications for Surgical Airway
Can’t Intubate, Can’t Oxygenate
Complications of Surgical Airway
Bleeding
Insertion in soft tissue
Complications of Finger Thoracostomy
Sharps
Damage to organs, vessels and nerves
Bleeding
Open Pneumothorax
Damage to long thoracic nerve
Infection / Empyema
Retained Foreign Body
Kit required for Intubation
Laryngoscope blade/handle
Bougie
ET tube
Syringe
Catheter mount
Filter
ETCO2
Thomas Tube Holder
Magills forceps
Suction
Back-up airway
Lube
Kit required for surgical airway
Scalpel
Trachael dilators
Bougie
Size 6 pre-cut ET tube (cuffed)
Kit required for Finger thoracostomy
Chloraprep
Scalpel
Spencer wells forceps
Landmarks for finger thoracostomy
4th intercostal space just anterior to the mid axilla line
Triangle of safety
Lateral border of the pectoralis major
Anterior border of the latissimus dorsi
5th intercostal space
Landmarks for FONA
Cricothyroid membrane
- inferior to the thyroid cartilage
- superior to the cricoid cartilage
Airway Assessment
Look externally
Evaluate the 332
Mallampati score >3
Obstruction
Neck mobility
Prior to Ketamine administration, you need to…
Have performed an airway assessment
Have monitoring on
