Pharmacy Phriday #8: Atropine with Ketamine for Conscious Sedation of Pediatrics
Release Date: 01/29/2021
Podcast 700: Analgesics for Acute Musculoskeletal Pain
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Recent RCT compared pain relief in patients receiving five medications for acute musculoskeletal pain Acetaminophen 1000mg/ibuprofen 400 mg Acetaminophen 1000mg/ibuprofen 800 mg Acetaminophen 300 mg/codeine 30 mg Acetaminophen 300mg/hydrocodone 5mg Acetaminophen 325mg/oxycodone 5mg No significant difference in pain relief at 1 and 2 hours between all of 5 groups References Bijur PE, Friedman BW, Irizarry E, Chang AK, Gallagher EJ. A Randomized Trial Comparing the Efficacy of Five Oral Analgesics for Treatment of Acute...
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Podcast 699: Pediatric Fingernail Avulsions
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Traditionally, fingernails were replaced after avulsion using sutures Sometimes artificial material was placed when the fingernail was not available Recent study evaluated treatment of fingernail avulsions pediatric patients by replacing the nail versus cleaning and putting a non-adhesive dressing No difference in the aesthetics or patient satisfaction with the new fingernail between the two treatment groups References Seiler M, Gerstenberg A, Kalisch M, Kennedy U, Scheer HS, Weber DM. Non-operative treatment versus suture refixation of the...
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Podcast 698: Empathy, Burnout, and Patient Satisfaction
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores Patient satisfaction was not affected by what the physicians thought about their level of empathy or burnout Patient satisfaction was affected by the patient’s perception of empathetic behavior by the physician References Byrd J, Knowles H, Moore S, et al. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study [published online ahead of print, 2020 Nov 25]....
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Podcast 697: Kounis Syndrome
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Kounis syndrome is an allergic acute coronary syndrome Triggers include medications (antibiotics), insect bites, or other common allergens Believed to be due to mast cell activation, inflammatory cytokines, and platelet activation causing coronary vasospasm or plaque rupture in setting of existing atherosclerosis Consider Kounis syndrome in the setting of chest pain in anaphylaxis Treatment involves treatment of allergic reaction, although epinephrine should be used cautiously Avoid morphine as this can cause mast cell activation References...
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Podcast 696: ST Elevation and Differential Diagnoses
Emergency Medical Minute
Contributor: Peter Bakes, MD Educational Pearls: ST elevation clinical guidelines for myocardial infarction include: 2.5 mm elevation for males <40 in V2 and V3 2 mm elevation in males >40 in V2 and V3 1.5 mm elevation for females in V2 and V3 1 mm elevation in 2 or more contiguous leads (not V2 or V3) Differential diagnosis of ST elevation includes, but is not limited to: STEMI Electrolyte abnormalities Pericarditis/myocarditis Brugada syndrome LVH Bundle branch blocks Ventricular aneurysm References de Bliek EC. ST elevation: Differential diagnosis and caveats. A...
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Podcast 695: Einstein and Cellophane
Emergency Medical Minute
Educational Pearls: Albert Einstein had chronic abdominal pain as a middle-aged man Dr. Rudolph Nissen, founder of the Nissen fundoplication, performed exploratory surgery for this pain and found an abdominal aortic aneurysm (AAA) The only treatment for an AAA at that time was to wrap the vessel in cellophane, causing a fibrotic response to prevent rupture Einstein died 7 years after this surgery, likely from his leaking abdominal aortic aneurysm References Cervantes Castro J. Albert Einstein y su aneurisma de la aorta [Albert Einstein and his abdominal aortic aneurysm]. Gac Med Mex....
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Podcast 694: Complete Heart Block
Emergency Medical Minute
Contributor: Nick Hatch, MD Educational Pearls: Complete heart block or 3rd degree atrioventricular (AV) block is diagnosed via EKG and occurs when electrical signals from the sinoatrial (SA) node are blocked from reaching the ventricles via the AV node and AV bundles P waves and QRS complexes are independent Often QRS rate is around 40 The rate is slow because the ventricular purkinje fibers have an intrinsic rate of 20-40 bpm, whereas the SA node has an intrinsic rate of 60-100 bpm Treatment is usually with pacemaker, unless there is an identifiable etiology causing the heart block that can...
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Podcast 693: Humerus Fractures
Emergency Medical Minute
Contributor: Nick Tsipis, MD Educational Pearls: Humerus fractures can be characterized as proximal, midshaft, and distal fractures Proximal humerus fracture is the second-most common fracture in elderly patients Primary complication is with the axillary nerve and axillary artery Vast majority are managed nonoperatively with a sling, reduction usually not indicated Women comprise 70% of proximal humerus fractures, often secondary to fall with osteoporosis Midshaft humerus fractures are more often managed operatively, but can be managed nonoperatively Primary complication is...
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Podcast 692: Pelvic Fractures
Emergency Medical Minute
Contributor: Peter Bakes, MD Educational Pearls: Pelvis is comprised of the iliac, ischium, and sacrum Three mechanisms for pelvic fractures by Young-Burgess Classification Anterior-posterior compression causing open-book pelvic fractures that can be complicated by retroperitoneal bleeding or urethral injury Lateral compression causing rami fractures Vertical sheer causing offset of sacroiliac joint or sacrum Mechanically stable pelvic ring fractures can be conservatively treated with weight bearing as tolerated Unstable fractures and those with complications will require operative...
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Podcast 691: TXA in Head Bleeds
Emergency Medical Minute
Contributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival and neurologic outcomes when patient received TXA within 3 hours References CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a...
info_outlineEducational Pearls:
- Atropine has been shown to reduce hypersalivation as well as nausea and vomiting induced by ketamine sedation.
- Atropine can increase the occurrence of a transient rash, as well as tachycardia.
- There are no guidelines that recommend for or against atropine use in pediatric patients undergoing ketamine induced sedation.
- Ultimately, it is the providers decision to include atropine when performing ketamine sedation.
- Pediatric dosing for atropine is 0.01mg/kg IM.
- Heinz P, Geelhoed GC, Wee C, Pascoe EM. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Emerg Med J. 2006 Mar;23(3):206-9. doi: 10.1136/emj.2005.028969. PMID: 16498158; PMCID: PMC2464444.
- Chong JH, Chew SP, Ang AS. Is prophylactic atropine necessary during ketamine sedation in children? J Paediatr Child Health. 2013 Apr;49(4):309-12. doi: 10.1111/jpc.12149. Epub 2013 Mar 15. PMID: 23495827.
- Shi J, Li A, Wei Z, Liu Y, Xing C, Shi H, Ding H, Pan D, Ning G, Feng S. Ketamine versus ketamine pluses atropine for pediatric sedation: A meta-analysis. Am J Emerg Med. 2018 Jul;36(7):1280-1286. doi: 10.1016/j.ajem.2018.04.010. Epub 2018 Apr 5. PMID: 29656945.
Presented and Summarized by Devan Naughton, 4th year pharmacy student | Edited by Ruben Marrero-Vasquez