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
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.
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.
- 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.
- 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…
- 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/