Coffee to stay awake; for everything else there's

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Coffee to stay awake; for everything else there's KETAMINE

Published on Sep 10, 2019

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PRESENTATION OUTLINE

When the Going Gets Weird

Ian Mitchell, MD, FRCP

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No Disclosures

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Vancouver

Ketamine for abscess drainage in IDU

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Abu Dhabi

Ketamine for pediatric laceration repair

Untitled Slide

Associate Professor of Emergency Medicine, UBC
Staff Physician, Royal Inland Hospital, Kamloops
Scholar, Kamloops Family Medicine Residency Program
Cannabis Clinician & Researcher

Procedural Sedation

Subdissociative Dosing

Acute Pain: 10-20 mg iv over 10 min then 10-20 mg/hr infusion

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Ketamine for Kids

4 mg/kg intramuscular
1 mg/kg intravenous
1-10 mg/kg intranasal

Pain-K Trial

Prehospital ketamine

10.

Cannabis Hyperemesis Syndrome

Ketamine 15 mg/Chlorpromazine 12.5 mg

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Extreme Ketamine

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Burning Man

Ketamine Dart - 5 mg/kg im for agitation

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13.

DSI

1-1.5 mg/kg slow push

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Status Epilepticus

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Asthma

0.3-0.5 mg/kg iv over 2 min then same over 30 min

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Acute Suicide Treatment

Antidepressant dosage: 0.5-1 mg/kg iv

synapse growth

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Ideal Patient?

Depressed, asthmatic child with broken arm.

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Contraindications

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Increased IOP

MYTH!

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Increased ICP

MYTH!

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Psychosis

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Cardiac

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Complications

Vomiting

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Laryngospasm

children
break with 2 person BVM
Larsen maneuver

Laryngospasm in 0.3% of pediatric

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Ketamine Emergence Phenomenon

Solution: More Ketamine

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Other Issues

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Coadministration

Propofol + Ketamine = Ketofol

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Pre-experience Counselling

vs "It's going to get weird"

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What is the Maximum Dose?

J Emerg Med Sept 24, 2019

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Opiate Induced Hyperalgesia

NMDA mediated

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Education Needed

increase awareness of set and setting.
Standardize dosing and treatment

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32.

My Questions

Separate pharmacology from psychotherapy
Do some benefits require psychedelic dosing?
Will coadministered drugs affect results?

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