![]() ![]() Once adequate sedation has been achieved, oxygenation can be provided to the patient. Typically for EMS providers, there is not another alternative medication so the effects of Ketamine on these patients can be treated with small bolus doses of a Benzodiazepine or a beta blocker. Patients with tachycardia or hypertension may not benefit from the effects of Ketamine. There is a subset of patient where Ketamine may not be desirable. Related: An Emergency Guide to Mechanical Ventilation This will achieve dissociated sedation in about thirty seconds. Ideal dosing for Ketamine is 1-2mg/kg slow IV push, however, consult your local protocol. Using Ketamine means there is no blunting of the patient’s ventilatory rate and it allows the patient to be in a dissociated state, which allows the application of pre-oxygenation. The agent of choice for this procedure, which you can be procedural sedation, is Ketamine. In some cases, to accomplish this, it may be necessary to sedate the patient. ![]() We know that optimizing the patient’s level of oxygen and carbon monoxide is paramount. Clearly, this cannot be completed on the delirious or combative patient. 1 Patients who are obese or have other comorbidities will take longer to pre-oxygenate. To appropriately pre-oxygenate a patient, it is required to provide three minutes of high FiO2 or at least eight vital capacity breaths. This can cause a patient to pull off any oxygen delivery devices or cause a patient to resist any detailed assessment, let alone interventions, by EMS. A patient who is hypoxic, hypercarbic, or both can become combative or delirious. This is where delayed sequence intubation (DSI) has its place. How will you accomplish this without being able to pre-oxygenate the patient first? Pre-Oxygenation Challenge ![]() Related: Basic Airway Management Turned Sideways The QuestionĪs you receive this patient’s information and approach toward the patient, you know he may need advanced airway management. The patient is becoming more hypoxic the more agitated he becomes. The transporting paramedic caring for the patient advises you that he is unable to keep continuous positive airway pressure (CPAP) or a non-rebreather on the patient and the patient is becoming combative. You are requested by an advance life support (ALS) transporting ambulance for an intercept for an RSI for an obese male patient with a full beard in respiratory distress that has progressed to extremis. So how do we handle these patients? Let’s look at a case. In EMS, we encounter patients who don’t need intubation, but may need RSI and are poor candidates for this based off their initial presentation. One of most advanced methods of airway management in emergency medical services (EMS) is rapid sequence induction (RSI). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |