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Tue Aug 26 17:17:00 BST 2008

Don,

I appreciate your expertise — not to mention your well-honed turn of
phrase (salivate like a sailor on leave — I love it!). 

Bill

>>> <bensonblues at comcast.net> 8/26/2008 2:40 AM >>>
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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