Video medication ER should learn. Best practice:prodedural sedation the advanced EM boot camp. Flashcards
Ketamine
emergency department
Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression and pain management. It is a novel compound that was derived from phencyclidine in 1962 in pursuit of a safer anesthetic with fewer hallucinogenic effects
Duration of action: : Intramuscular: 0.5–2 hours; Insufflation: 45–60 min; By mouth: 1–6+ hours;+
Elimination half-life: : Ketamine: 2.5–3 hours; Norketamine: 12 hours;
Metabolism: Liver, intestine (oral):: Major: CYP3A4, CYP2B6
Ketafol
emergency department
Ketamine is highly effective for brief medical procedures that do not necessitate skeletal muscle relaxation and can be utilized as a pre-anesthetic for the induction of general anesthesia when combined with other general anesthetic agents
Propofol
emergency department
Propofol, also known as Diprivan, is a non-barbiturate anesthetic and sedative used intravenously to help patients relax or sleep before and during medical procedures or surgery. It’s also used to sedate ventilated adults in the intensive care unit (ICU) for up to 72 hours. Propofol is the most common anesthetic induction agent in use today, replacing pentothal because it has fewer side effects and can make patients feel better when they wake up.
Propofol is prepared as a lipid emulsion that gives it a milky white appearance, earning it the nickname “milk of amnesia”. The emulsion contains soybean oil, glycerol, egg lecithin, and EDTA, a preservative. Because the emulsion can support microbial growth, strict aseptic technique must be used when drawing up propofol.
Propofol works by increasing the effects of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) at the GABAA receptor. It has a rapid onset of action, with patients becoming unconscious within 15–30 seconds, and a duration of action of 5–10 minutes.
Propofol can have side effects, including: Decreased blood pressure, Depressed or stopped breathing, Pain at the injection site, and Disturbances in cardiopulmonary physiology.
Because of its narrow therapeutic margin, propofol should only be administered by trained and experienced general anesthesia practitioners. The FDA also recommends against using propofol if you are allergic to eggs, egg products, soybeans, or soy products. You should also tell your doctor if you have epilepsy or other seizure disorders, high cholesterol or triglycerides, or liver or kidney disease before receiving propofol.
Propofol has also been used recreationally, but this is relatively rare due to its potency and the level of monitoring required for safe use. Deaths from self-administration have been reported, and the short-term effects sought through recreational use include mild euphoria, hallucinations, and disinhibition.
Nitrous oxide
Nitrous oxide is a colorless, non-flammable gas with a slightly sweet taste and smell that is used as a pain medication and anesthetic. It’s inhaled and typically takes effect within 30 seconds, lasting for about a minute. Nitrous oxide is commonly used during childbirth, after trauma, and as part of end-of-life care
