PHARM: Day 2 Part 2

Overview of Ketamine

  • Ketamine is an illegal drug often referred to as K, Special K, vitamin K, or KitKat on the streets.

  • Clinics have been using ketamine to address mental health issues, including depression and PTSD.

  • It creates a feeling of disconnection and distorts the perception of sight and sound, similar to PCP.

Routes of Administration

  • Common methods of taking ketamine include:

    • Snorting

    • Oral intake

    • Injection

Effects and Duration

  • Ketamine acts relatively quickly, with effects lasting 30 to 60 minutes.

  • In cases of overdose:

    • Patients may be unconscious but do not typically exhibit decreased respiratory rates.

Historical Context and Data

  • As of February 2011, there were reported no deaths directly linked to recreational ketamine use.

  • The speaker emphasizes the need to understand ketamine's medical indications and practical dosing guidelines.

Practical Dosing Guidelines

  • For pain management, a recommended starting dose of ketamine is 0.1 to 0.3 mg/kg.

  • In a practical scenario for an adult with severe pain (like a broken femur), one might:

    • Administer 50 mg in a 100 mL bag, giving half over 15 minutes for gradual sedation.

Chemical Sedation Medications

  • Haldol (Haloperidol):

    • An antipsychotic medication used for patients who are disruptive but not dangerous.

    • The standard dose is 5 mg, often given with Versed (Midazolam) to enhance sedation.

    • Precautions include avoiding use in patients under the influence of stimulants like meth or cocaine.

  • Versed (Midazolam):

    • Used alongside Haldol to manage agitation in psychosis patients.

    • Dosing for adults requires adjustment based on patient response and agitation level.

  • Droperidol:

    • Another antipsychotic used for calming disruptive patients or treating nausea/vomiting and headaches.

    • The dosing is often half of the standard antipsychotic dose.

Adverse Effects of Antipsychotics

  • Potential negative effects include extrapyramidal reactions, which may require treatment with Benadryl (Diphenhydramine).

  • Keep an eye on QT prolongation, which could lead to dysrhythmia.

Ketorolac (Toradol)

  • An NSAID used in pain management, especially effective for renal colic (kidney stones).

  • Dosage for adults is typically administered IV 15-30 mg.

  • Contraindications include known allergies, risk of GI bleeding, and renal failure.

Pain Management Protocols

  • Various options to manage pain include:

    • Fentanyl (1-2 mcg/kg)

    • Morphine (2-10 mg)

    • Ketamine (0.15-0.3 mg/kg for sedation)

    • Consider NSAIDs for mild to moderate pain, like Tylenol or Toradol for specific cases.

Nitroglycerin in Acute Coronary Syndrome (ACS)

  • Used as a vasodilator primarily for chest pain associated with ACS or CHF.

  • Caution is advised in cases of inferior MI due to potential preload reduction.

  • When administering nitro, only give if the patient is actively experiencing chest pain with a rating above 1 on a scale of 1-10.

  • Monitor blood pressure and symptoms following administration.

Summary of Administration Protocols

  • For both droperidol and Haldol, maintain practical application in chaotic field settings.

  • Certain medications can be given intramuscularly through clothing when necessary, especially in emergency situations.

  • For ketorolac, highly effective for pain management in renal colic cases, monitor for side effects and contraindications.