Precisely, Rowley! Am not sure why people are worried about "overdosing" on ketamine. I don't think it's possible! It's got a huge therapeutic index. And since there was no iv access, I suspect he would've needed at least 3 to 4 mg/kg, rather than under 1mg/kg as he actually received.
Adrian Fogarty
> from: Rowley Cottingham <[log in to unmask]>
> date: Wed, 30 Apr 2003 13:57:09
> to: [log in to unmask]
> subject: Re: Ideas please....
>
> More ketamine. You have only just waved the bottle under his nose. This
> is precisely the patient who soaks up ketamine. AND DON'T WORRY ABOUT
> THE HEAD INJURY!
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Vic Calland
> Sent: 30 April 2003 10:54
> To: [log in to unmask]
> Subject: Ideas please....
>
>
> Attended a MVC last night. Driver doing a 100mph plus put his car under
> the end of an HGV only doing 50mph. Dragged 200-300 yards down the road
> as the driver of the lorry regained control and came to a halt.
>
> Driver was late twenties, physically fit but on the heavier end of
> normal weight range. Trapped upright until the fire crew did a dash
> roll. Had 8cm transverse laceration of forehead with bit of skull in
> wound but amazingly had GCS of 12-13. Had bilateral bracing fractures;
> left elbow was a posterior dislocation, radius & ulna a comminuted
> compound fracture as crunchy as a bag of crisps; his right was a more
> classical Monteggia apart from the fact it was compound and the bone was
> protruding. He also has a fractured pelvis with a dislocation of the
> left hip.
>
> He had breath sounds bilaterally so we didn't realise he had a ruptured
> left hemidiaphragm until the CXR came back. At the time he wasn't too
> shut down, so we splinted the arms, gave him 50mg Ketamine im and free
> flow Entonox for the extrication (long board to the rear). We were only
> 5 minutes from the hospital so we ran with him rather than established
> an i.v. on scene. There they ended up with a right femoral vein access
> with a "security guard" watching it.
>
> I'd be interested to know if anyone has clever ideas for dealing with
> this kind of situation because his pain relief was not ideal by any
> means.
>
> Vic Calland
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