The days of hearing a patient crying from getting an emergent chest tube while awake and getting almost no sedation or pain medications is barbaric and should be over. Morphine 4mg ivp or Fentanyl 50 mcg ivp will not be enough. Not even lidocaine 200 mg injected locally is going to be enough.
But no good study on what to give these trauma patients. Hopefully chatting with Sergey Motov of Maimomedes Hospital, Brooklyn, NYC will enlighten me on how to use Ketamine better.
Here is my lesson with giving procedural sedation dose of ketamine 1-2mg/kg in an intoxicated from alcohol patient. I soon regretted that decision. Not the medication choice but the dosage and what happened to the patient. Too much respiratory depression from the likely combination of alcohol and ketamine.
The patient no longer was panicky from pain associated stab wounds to the chest and dyspnea from likely pneumothorax. I was happy he was calm after the ketamine, but desaturated as he became lethargic. Anesthesia who was present, freaked out and asked that the patient needed bagging up with BVM. Intubation could have been held off earlier when the patient was awake, but unavoidable when the patient desated and the powers that be in the room, Surgery and Anesthesia were afraid his traumatic injury was causing his lethargy and possible imminent demise.
I still believe in proving analgesia to these patients who are very neglected in trauma. just will give smaller quantities and more slowly. Next time 0.3mg/kg dose via 2 minute iv push or via 100 cc iv piggy back wide open. Again thank you Dr. Motov for the suggestion. I hope to experience better patient safety and outcome next time.
I was cut by the knive I handled. I hadnt grabbed the handle but the blade, but the patient survived. Experience comes with blood on the hands. Not intended but survivable mistake this time. I was able to wash the blood off but the mistake has permanently shaped my wisdom, scarring its imprint as a reminder.