Who is Reuben Strayer, MD?
Emergency Medicine Physician who works in New York City
Author of emupdates.com
One of the authors of painandspa.org
Twitter @emupdates
Created the phrase “ketamine brain continuum”
No financial disclosure
A Special K Trip Part 3 – Ketamine for Analgesia & Tranquilization
And now for the conclusion of the 3-part ketamine series with Reuben Strayer. Today’s episode is Part 3 focusing on Ketamine for analgesia and extremely uncontrollable violent patients.
If you haven’t already, go back and listen to Episode 7 where Reuben talks about ketamine and how different dosing can have different applications in the ED setting. In Episode 8, Reuben talks about ketamine for PSA & RSI.
Ready to continue with your Ketamine trip w/Reuben? Here we go!
Ketamine for Analgesia
Who gets ketamine? Chronic pain, poly trauma, oncology pain, etc.
Dosing
- 0.3mg/kg
- 0.1-0.3mg/kg have been used.
No pumps for bolus dose? No problem.
- Of course, administering through a pump will always be the gold standard.
How to administer:
- Inject the analgesic dose into NS 100mL and infuse over 15 minutes.
- 15 minutes = 400mL/hr (best!)
- 10 minutes = 600mL/hr (not much difference)
- Why are we diluting the ketamine dose for administration? To prevent psychiatric emergence or your patient from “freaking out.”
- Ketamine drips – always use a pump. (Not everyone will get a drip)
- 0.1mg/kg and titrated every 30 minutes.
- No monitoring required.
- *Use your discretion, if you feel that your pt needs monitoring – put your patient on a monitor and alert your provider.
Some pretty good articles, full list below:
- Sergey Motov’s article on ketamine for pain in the ED
- Cheryl Allen’s article on administering ketamine in Pain Management Journal
- Sergey Motov interviewed on ketamine in EP Monthly
Ketamine for Tranquilization
Who gets it? Your huge guy where you have a small army of security and staff trying to hold him down and you are concerned for the patient’s and staff’s safety.
How often are you using this? Rarely.
Dose
- Dissociative Intramuscular (IM) Dose: 4-6mg/kg
- 500mg IM Adult dosing = approx. 100kg person
Monitoring required with airway capable provider at bedside.
Safety Pearl for Violent and Agitated patients (whether you use ketamine or not):
- Don’t attempt to put in an IV line! (If your provider asks, say “No thank you!”)
- Administer IM through the clothing.
- No alcohol swab needed.
- Team approach to hold down patient for patient and staff safety.
Now Listen to the Episode…
References
- Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesthesia, Essays and Researches. 2014;8(3):283-290. doi:10.4103/0259-1162.143110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258981/
- Motov, S., Rockoff, B., Cohen, V., Pushkar, I., Likourezos, A., Mckay, C., . . . Fromm, C. (2015). Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine, 66(3). doi:10.1016/j.annemergmed.2015.03.004 https://www.ncbi.nlm.nih.gov/pubmed/25817884
- Lee, E. N., & Lee, J. H. (2016, October 27). The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis. https://www.ncbi.nlm.nih.gov/pubmed/27788221
- Motov S et al. A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department. AJEM 2017; S0735 – 6757(17): 30171 – 7. PMID: 28283340
- Ketamine: How to Use it Fearlessly For All its Indications by Reuben Strayer. (2015, December 06). https://www.smacc.net.au/2015/12/ketamine-how-to-use-it-fearlessly-for-all-its-indications-by-reuben-strayer/
- Strayer, R. (n.d.). The Ketamine Brain Continuum. http://emupdates.com/?s=ketamine
- The POKER Trial: Go All in on Ketofol? (2016, November 25). Retrieved August 25, 2017, from http://rebelem.com/poker-trial-go-ketofol/ http://rebelem.com/poker-trial-go-ketofol/
- PharmERToxGuy, A. (2017, March 19). How to Administer Low-Dose IV Ketamine for Pain in the ED. https://pharmertoxguy.com/2017/03/06/how-to-administer-low-dose-iv-ketamine-for-pain-in-the-ed/
- Allen, C. A., & Ivester, J. R. (January 01, 2017). Ketamine for Pain Management-Side Effects & Potential Adverse Events. Pain Management Nursing. http://www.painmanagementnursing.org/article/S1524-9042(17)30383-1/fulltext
- Sergey Motov, MD and Nicholas Genes, MD, PhD. (2017, April 27). Motov’s Cocktails: Sub-Dissociative Ketamine. http://epmonthly.com/article/motovs-cocktails-sub-dissociative-ketamine/
Cite this post as:
Dirsa, Yun Cee. October 5, 2017. 010 A Special K Trip Part 3 (Analgesia & Tranquilization) w/Reuben Strayer, MD. Resus Nurse Podcast and Blog. Date retrieved December 9, 2023. https://resusnurse.com/2017/10/05/special-k-trip-part-3-analgesia-tranquilization-wreuben-strayer-md/.
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