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Sat Aug 4 20:25:27 BST 2007

ok, extrication  - I guess it's OK. Ketamine use for analgesic purposes is good, although due to the large inter-individual responsiveness, you will put some patients under general anesthesia with a full stomach with the risk of aspiration, you have to really watch out for that. 

Danke vielmals fur Ihre schone Worte !
I 

> Date: Sat, 4 Aug 2007 21:15:25 +0200> From: listen at doc-kalkum.de> To: trauma-list at trauma.org> Subject: Re: Ketamine + increase of ICP> > Ivan,> > I applaud your German!> > Die Applikation von Ketamin führt in Kombination mit Propofol oder einem Benzodiazepin beim kontrolliert beatmeten Patienten nicht zum ICP-Anstieg. Daher ist die Verabreichung von Ketamin nach aktueller Datenlage insbesondere beim hämodynamisch instabilen, beatmeten SHT-Patienten zulässig. Mathias - even in your German guidelines you are told to combine Ketamine with benzos or Propofol - and the increase in ICP is disproven only in pts. on controlled ventilation, which in the initial care of the trauma patients is not the case (it comes from a study on ventilated ICU patients only).> The text deals with patients under respiratory control. As I have> written before, it is crucial to avoid hypoxia. Once you decide to use> midazolam, propofol or the like that is exactly what you get - hypoxia.> Thus the need for intubation and ventilation.> Now if you deal with an - say: entrapped - patient in a car it may make> very much sense to administer small doses of ketamin and withhold> midazolam to avoid exactly this situation. Once the patient is> extricated and fully accessible you can proceed as you want.> > Cheers!> > Mathias> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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