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GCS-3K

Anand Swaminathan, MD FAAEM and Michael Perlmutter, MD
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12:22
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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01:23

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EMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDF

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Norman P., M.D. -

Ketamine is a lovely drug; I use it a lot.
But, I’ve had some recent cases when using it on agitated patients on methamphetamine, where, I’ve used ketamine and then had a hypertensive response, sometimes with SBP up to 180 or 190. Also, the meth users tend to metabolize the ketamine quickly. I’ve had 2 patients that woke up from the 4-5mg/kg IM after only being ‘down’ for 5 minutes or so.
So, if they’ve been using meth, I start with a B52 rather than ketamine and have have had good results, even though it may take the B52 (50mgBenadryl/5 Haldol/2 ativan or versed) a few more minutes to work.
One other concern: I had an agitated patient that was given ketamine, and he had baseline atrial flutter. The ketamine pushed him to a 1:1 flutter! Damn, when his heart rate sped up to 248 bpm, mine went up too! I added the B52 and was able to keep him stable and then his heart rate slowed within 20 minutes or so. But, concern for heart failure/pulmonary edema was sure on my differential when his pulse jumped from about 148 to 248. So, just be cautious if pt has afib or flutter.

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EM:RAP 2018 July Full episode audio for MD edition 229:23 min - 319 MB - M4AEM:RAP 2018 July German Edition Deutsche 120:44 min - 166 MB - MP3EM:RAP 2018 July Spanish Edition Español 90:31 min - 124 MB - MP3EM:RAP 2018 July Australian Edition Australian 35:17 min - 48 MB - MP3EM:RAP 2018 July Canadian Edition Canadian 24:10 min - 33 MB - MP3EM:RAP 2018 July French Edition Français 27:05 min - 37 MB - MP3EM:RAP 2018 07 July Individual MP3 Files 293 MB - ZIPEMRAP 2018 07 July Individual Summaries 742 KB - ZIPEMRAP 2018 07 July Spanish Summary 1 MB - PDFEMRAP Board Review Answers 2018 07 July Vol.18 07 116 KB - PDFEMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDFEMRAP Board Review Questions 2018 07 July Vol.18 07 407 KB - PDF

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