I wouldnt have bothered with im ketamine, just given him iv ketamine and
lots more than 50mg. I often give 50mg just to reduce a shoulder (iv) as a
starting dose and top up as necessary. I agree completely with Rowley.
Interestingly, our new director of neuro intensive care uses it by the
barrel load. I used ketamine extensively in prehospital care in South Africa
and is a wonderful prehospital drug.
Cheers
Rob Dawes
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, April 30, 2003 1:57 PM
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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