Providing acute medical care to severely agitated patients
in the pre-hospital setting is a significant challenge. These patients often
pose a serious safety threat to themselves and emergency medical services (EMS)
providers. The dilemma confronting paramedics is they can’t provide medical
care until the can restrain the individual and they can’t restrain the
individual until they provide sedation. This is a bit reminiscent of the
dilemma confronting individuals seeking their first job – you know how the
phrase goes. Currently, no real solution to this problem exists. Most agents
currently available act too slowly or require establishing an intravenous (IV)
line. Of course, if you can establish an IV, you probably don’t need to sedate
the patient in the first place.
The use of ketamine in the field by paramedics for
chemical restraint could be an important new development. This is a relatively
new concept, but if it proves safe and effective, it would absolutely change
medical practice. This alone makes the article by Scheppke et al. published in
this issue of the journal worth reading.1
The authors of this manuscript describe a
retrospective chart review of patients who received intramuscular (IM) ketamine
for chemical restraint in the field by EMS providers. The study covered a
39-month period and included patients from five different catchment areas who
received ketamine solely for chemical restraint in the field per a paramedic
protocol (standing order). Researchers abstracted the patients’ pre-hospital
medical record looking for specific endpoints. The primary outcome was the
adequacy and duration of field sedation. Secondary outcomes included the
elapsed time to achieve medical control of patients, any airway or respiratory
side effects, and the presence of hemodynamic compromise. The authors conclude
that ketamine was both safe and effective in sedating 50 out of 52 patients.
The average time to sedation and medical control was just over 2 minutes for
the 50 patients successfully sedated. No hemodynamic complications occurred,
and paramedics recorded only 3 cases of respiratory compromise requiring
intervention. Tastes great, less filling. So what’s not to like...
Read more at: http://ht.ly/Ss84o
By:
University of California, Irvine School of Medicine, Center for Disaster Medical Sciences, Department of Emergency Medicine, Orange, California
More at: https://twitter.com/hiv_insight
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