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ERCAST


Welcome to ERCast, a focused discussion on the questions, quagmires and known unknowns we face everyday in the emergency department.

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Dec 1, 2015

Reuben Strayer from empdates.com is our guest to discuss proper dosing of ketamine.

Take home message: At very low dose, you get analgesia with minimal effect on perception and emotion. At a very high dose, you’re going to get dissociation. In between high and low doses, you don’t know what kid of response you’re going to get.  It depends on the patient’s mood, what other drugs are on board, and the alignment of the stars in the sky. This is why using sub-dissociative ketamine as monotherapy for sedation is not a good idea- it might chill someone out, or it might take a crazy agitated patient and make them a crazy agitated patient now tripping on ketamine. Don’t use sub-dissociative ketamine alone for routine agitation; ketamine is not for routine agitation, it’s for tranquilization of the uncontrollably violent patient in full dissociative doses. For analgesia, use LOW DOSE - 10 or 15 mg in an adult. Do not push more than that or you will end up in recreational range or partial dissociation (which is not what you want).

Ketamine Dosing

Analgesic dose (0.1-0.3 mg/kg)

Recreational dose (0.2-0.5 mg/kg)

Partially dissociated dose (0.4-0.8 mg/kg)

Dissociative dose (>0.7 mg/kg)

 

Reuben's kick ass links

Here is a detailed review of the Ketamine Brain Continuum

The Amazing Intubation Checklist

Procedural Sedation Checklist