Ketamine in trauma

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Bill,

My practice is to use just enough ketamine so they won't look at me while I do what I need to do, usually, around 1 mg/kg IV. The accepted dose is 1 to 4 mg/kg, or, as my crazy nurse anesthetist says "1 - 1000". They used ketamine on me when doing my rotator cuff, they never intubated me, and I don't remember anything.

I had case today that you might easily see in a trauma patient, especially in the SICU the first day post-op. A woman presented to the ED with CC of SOB. She gives a great history without difficulty, doesn't seem dyspneic, and exam is unrmarkable. Ten minutes later, she has an O2 sat of 60%, was thrashing wildly about on the stretcher (big girl, I might add), and coughing up pink frothy sputum. I gave her 100 mg ketamine, and she immediately turned into a zombie and I easily intubated her while she was still breathing. She had acute LV failure, and I don't as of yet know why but I suspect cocaine. In Detroit, the trauma victim who is a victim of violent crime has cocaine in their urine if they have anything. And,...

Sorry, back to ketamine: I think using ketamine in the trauma victim is safe, compassionate, and economic in alleviating pain and suffering. I even use it in 'stable' ED patients needing a chest tubes or other things. They will salivate like a sailor on leave, but glycopyrholate, atropine, and/or a Yankauer should be all you need for that. I give a benzodiazepine (either lorezepam or diazepam) after the important things are done. But, I'm open to criticism...

Don Benson, DO

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