Ketamine CPG Flashcards
Ketamine - Presentation
200 mg in 2 mL ampoule
Ketamine - Pharmacology
A rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antaganist)
Actions:
- Produces a dissociative state characterised by:
- a trance-like state with eyes open but not responsive
- nystagmus
- profound analgesia
- normal pharyngeal and laryngeal reflexes
- normal or slightly enhanced skeletal muscle tone
- occasionally a transient and minimal respiratory depression
Ketamine - Metabolism
By the liver and excreted by the kidneys
Ketamine - Primary emergency indications
- Rapid sequence intubation
2. Extreme traumatic pain refractory to opioid analgesia
3. Extreme agitation
- CPR interfering patient
Ketamine - Contraindications
- Known hypersensitivity
- Severe hypertension (SBP > 180)
Ketamine - Precautions
- Any condition where significant elevation of BP would be hazardous, e.g.
- Hypertension
- CVA
- Recent AMI
- CCF - If being administered for analgesia, inject slowly over 1 minute to minimise risk of respiratory depression and hypertension
Ketamine - Route of administration
IV
IO
IM
Ketamine - Side effects
Cardiovascular
Increase in BP and HR
CNS
Respiratory depression or apnoea
Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
Enhanced skeletal tone
Nausea and vomiting
Ocular
Diplopia and nystagmus with slight increase in intraocular pressure
Other
Local pain at injection site
Lacrimation
Hypersalivation
Ketamine - Special notes
Emergence reactions, hallucinations or other behavioural disturbances associated with ketamine administration for analgesia in adult patients may be managed with Midazolam.
Consultation with the RCH is required to administer Midazolam in paediatric patients.
Hypersalivation may be managed with suctioning, or in severe cases IV or IM atropine (MICA only)
IV effects:
Onset: 30 seconds
Peak: N/A
Duration: 10 minutes
IM effects:
Onset: 3 - 4 minutes
Peak: N/A
Duration: 12 - 25 minutes
