Kiwiology Posted November 16, 2013 Posted November 16, 2013 Panadeine (paracetamol 500 mg + codeine 8 mg) is available in up to 100 tabs here as a pharmacy only medicine i.e. can only be sold by a pharmacist but does not require an Rx. So Emergentologist if you're only using ketamine for sedation what do you use for acute severe pain e.g. patients with severe burns or multiple long bone fractures?
Kiwiology Posted November 16, 2013 Posted November 16, 2013 Dilaudid, morphine or fentanyl And when that stops working or plain just doesn't work? It gives me acute severe pain to think about the people I've been to who we've loaded up on morphine who were still in wretched agony and viola a little ketamine and they're nicely analgised and disassociated. Ketamine is very, very popular in Downunderland, New Zed and UK. I'm not trying to be a dick; I am genuinely curious as to why you're not using it?
ERDoc Posted November 16, 2013 Posted November 16, 2013 No dick at all, it's a legitimate question about the differences in treatments. I don't know of very may places in the US that use it for pain control. It has been reserved for sedation. I'm not sure if it comes from FDA approval issues or hospital policy. We pretty much load people up with narcs until respiratory arrest or hypotension.
island emt Posted November 16, 2013 Posted November 16, 2013 No dick at all, you've been peeking under his bloomers again doc. Here in the US Ketamine is mostly an animal trank and was very popular with the street drug trade for a few years as special K . lots of break-ins to vet clinics.
paramedicmike Posted November 16, 2013 Author Posted November 16, 2013 (edited) It gives me acute severe pain to think about the people I've been to who we've loaded up on morphine who were still in wretched agony and viola a little ketamine and they're nicely analgised and disassociated. Currently, ketamine is approved as an anesthetic. I can't find anything pointing towards approval for analgesic usage in the US. I think in the case you outline here the ketamine isn't acting in a pain management role. It is working as an adjunct to the morphine allowing for better sedation of the patient. Better sedation allows for better effectiveness of the analgesics. Interestingly enough, I did find this article discussing analgesic uses of ketamine in an ED setting. This study discusses ketamine use alone as opposed to morphine. Edited November 16, 2013 by paramedicmike
Kiwiology Posted November 16, 2013 Posted November 16, 2013 (edited) How very interesting. I would be a bit dumbstruck if the hospital had a policy which prevented its use in analgesia, after all, its an analgesic, and a bloody good one. Ketamine has legitimate analgesic properties (as a u-and-mu-opioid receptor agonist) especially in low doses which do not produce a primarily sedating or anaesthetising effect so it has both properties depending on the dose you give. But in saying that, the mate in US went to an ED for excruciating toothache and they gave him, wait for it, nothing, because they did not have a "tooth pain protocol"; I sure hope that hospital has a stroke protocol because I damn near needed it after hearing that. A freaking Doctor has a license to practice medicine independent of some muppet protocol, or so I thought! No diss mate but if I get both my femurs shattered in a road crash or severe burns from my amaetur meth lab going ka-boom I want something a touch stronger than bloody morphine or fentanyl. What about midazolam, if somebody is in wretched agony and you've loaded them up on opiates without any great effect would you give them some small increments of midazolam for some anoxylysis? esp thinking about somebody with a fractured femur and who has skeletal muscle spasm? Edited November 16, 2013 by Kiwiology
paramedicmike Posted November 16, 2013 Author Posted November 16, 2013 Actually, it's an NMDA receptor antagonist.
ERDoc Posted November 16, 2013 Posted November 16, 2013 (edited) As long as the benzo is for anxiolysis or muscle spasms you can give it. If you are giving it for pain control in addition to the narcotics it is considered procedural sedation and brings about the required paperwork. Edited November 16, 2013 by ERDoc
Richard B the EMT Posted November 16, 2013 Posted November 16, 2013 Tylenol 3, with codine is OTC in Canada? A bunch of my friends are now headed to the Port Authority bus terminal.
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