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Insight from the ED

Published on Sep 10, 2019

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PRESENTATION OUTLINE

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Ketamine - Insights from the Emergency Department

Photo by robnguyen01
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Untitled Slide

  • Associate Professor of Emergency Medicine, UBC
  • Staff Physician, Royal Inland Hospital, Kamloops
  • Cannabis Clinician & Researcher
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Disclosures

Board of Directors, KataCanada.org
Photo by Kristina Flour
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OUTLINE

  • Pharmacology
  • ED Use
  • Safety
  • Ketamine Associated Therapy
  • Regulatory Issues
Photo by Gareth1953 All Right Now
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PART 1

PHARMACOLOGY
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Untitled Slide

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NMDA Antagonists

Ketamine, PCP,ibogaine, dextromethorphan
Photo by biologycorner
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PCP

Photo by sheila_blige
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Ibogaine

Photo by The Drug Users Bible
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DEXTROMETHORPHAN

Photo by Luke Hollins
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Opiate Induced Hyperalgesia

NMDA mediated
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Speculation

Can manipulation of NMDA receptors be part of opiate dependency treatment?

Photo by Oberazzi
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Part 2

Emergency Department Use
Photo by Robert Couse-Baker
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Hamilton

No ketamine for emergency physicians
Photo by Srini Sundarrajan
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Vancouver

Ketamine for abscess drainage in IDU
Photo by Aditya Chinchure
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St. Paul's

KETAMINE FOR TRAUMA & INTUBATION
Photo by elefanterosado
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ABU DHABI

PEDIATRIC KETAMINE
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Abu Dhabi

Ketamine for pediatric laceration repair
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Ketamine for Kids

  • 4 mg/kg intramuscular
  • 1 mg/kg intravenous
  • 1-10 mg/kg intranasal
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Set and Setting

Photo by gl/gc?int=25
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Kamloops

KETAMINE FOR DEPRESSION
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MAPS - OAKLAND

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Acute Suicide Treatment

Antidepressant dosage: 0.5-1 mg/kg iv
synapse growth
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BURNING MAN

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Burning Man

Ketamine Dart - 5 mg/kg im for agitation
Photo by Trey Ratcliff
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EXTREME KETAMINE

  • Asthma
  • Status epilepticus
  • Sub dissociative dosing for pain
  • Delayed sequence intubation
  • Cannabis hyperemesis syndrome
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Pain-K Trial

Prehospital ketamine
9 km 4 hours
broken femur
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PART 3 - SAFETY

WHAT REALLY MATTERS?
Photo by C Drying
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Increased IOP

MYTH!
Photo by Insight Imaging: John A Ryan Photography
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Increased ICP

MYTH!
Photo by iem-student.org
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Psychosis

Photo by Christiaan Tonnis
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BLOOD PRESSURE

Photo by jasleen_kaur
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Complications

Vomiting
Photo by Steve E.
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Laryngospasm

  • children
  • break with 2 person BVM
  • Larsen maneuver
Laryngospasm in 0.3% of pediatric
Photo by iDanSimpson
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KETAMINE CYSTITIS

Photo by Lucas Davies
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What is the Maximum Dose?

J Emerg Med Sept 24, 2019
Photo by Jordane Mathieu
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PART 4 - KAT

Unexpected Meeting at Burning Man
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KETAMINE ASSISTED THERAPY

Photo by spike55151
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PART 5

Regulatory Issues
Photo by mag3737
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Untitled Slide

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CPSBC & Ketamine

  • Spravato & the corporate agenda
  • Parenteral vs other forms
  • Very limited access to iv
  • Interim guidance for chronic pain and mood disorders.
Photo by Online Marketing
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Education Needed

  • Increase awareness of set and setting.
  • Standardize dosing and treatment
  • Help Colleges with safety data
Photo by Alfons Morales
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My Questions

  • Separate pharmacology from psychotherapy
  • Do some benefits require psychedelic dosing?
  • The importance of hyperalgesia
Photo by Veronique Debord
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Coffee to stay awake; for everything else there's KETAMINE


@travels2little

Photo by Jason Dent
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Psychedelic Networking

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Ketamine Resources

Photo by 🇸🇮 Janko Ferlič

Ian Mitchell