Ketamine (Analgesia 2 PGD)

Question 1

Ketamine (Analgesia 2) indications

Answer 1

To provide effective relief of severe traumatic pain as part of a balanced analgesic regimen in:
- Multiple or significant fractures;
- Significant soft tissue injuries;
-Dislocations;
- Burns.

To provide effective relief of severe traumatic pain as part of a balanced analgesic regimen where the administration of morphine is clinically inappropriate because:
- Systolic BP < 90mmHg or absence of radial pulse;
- Respiratory compromise;
- Morphine contraindicated

Question 2

Ketamine (Analgesia 2) exclusion criteria

Answer 2

• Children aged under 2 years;
• Patients with current airway compromise where securing the airway will be difficult;
• Known previous adverse reaction/ hypersensitivity
• Uncontrolled hypertension (SBP ≥ 180mmHg and or DBP ≥ 110mmHg).
• Suspected acute ACS or acute heart failure
• acute porphyria;

Question 3

Ketamine side effects

Answer 3

• Dissociation
• Transient hypertonicity and nystagmus;
• Disinhibition;
• Transient hypertension and tachycardia may occur
• Laryngospasm;
• Depression of consciousness;
• Hyper-salivation;
• Vomiting up to 10% incidence;
• Respiratory rate increase;
• Respiratory depression (rare usually from rapid administration);
• Recovery reactions (emergence phenomena) including nightmares, delirium, excitation and physical combativeness <20%;
• Transient rash 10%;
• Anaphylaxis.