Pharmacy Phriday #8: Atropine with Ketamine for Conscious Sedation of Pediatrics
Release Date: 01/29/2021
Podcast 657: Caustic Ingestion
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Acid and alkali ingestions have differing prognosis and immediate concerns Immediate issues can include superficial irritation, severe burns, esophageal perforation, and even airway compromise from edem Long term morbidity can include strictures Supportive care is typically all that can be provided in the emergency department Diagnostics may include imaging and endoscopy For more severe ingestions without immediate issues,, patients may be monitored for up to 24 hours References Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic...
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Podcast 656: Rashes
Emergency Medical Minute
Contributor: Peter Bakes, MD Educational Pearls: Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans Erythema multiforme is another targetoid rash that presents with multiple target lesions Characterized into erythema minor and major based on severity but typically resolves More severe hypersensitivity reactions include Stevens-Johnson Syndrome (<10% skin involvement), or Toxic Epidermal Necrolysis (>30% skin involvement) SJS and TEN is associated with NSAIDS including aspirin, antiemetics like phenergan, anticonvulsants like...
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Podcast 655: Hypothermia in Sepsis
Emergency Medical Minute
Contributor: Adam Barkin, MD Educational Pearls: Fever is an adaptive response to infection, but elderly and immunocompromised patients may not be able to mount a hyperthermic response in sepsis Patients with fever in sepsis end up receiving treatment earlier and have better outcomes Hypothermic patients with severe sepsis admitted to the ICU had a 32% mortality versus 21% mortality in those who had a fever on presentation 3-hour sepsis bundle compliance was less frequent in hypothermic patients than in febrile patients (56% versus 71%) Early broad spectrum antibiotics were administered less...
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Podcast 654: Depression in COVID
Emergency Medical Minute
Contributor: Aaron Lessen, MD Educational Pearls: Survey study compared depression symptom prevalence in the United States at the beginning of COVID compared to data acquired by a similar survey for 2017-2018 and found it was three-fold higher Mild symptoms: 25% during pandemic; 16% before Moderate: 15% during pandemic; 6% before Moderately Severe symptoms: 8% during pandemic; 2% before Severe symptoms: ~5% during pandemic; 1% before Those with lower income, less savings, and exposure to more stressors were at greater risk for developing depression symptoms References Ettman CK,...
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Podcast 653: Nitroglycerin Disimpaction
Emergency Medical Minute
Contributor: Ricky Dhaliwal, MD, JD Educational Pearls: Glucagon administered intravenously has a high rate of adverse events (nausea/vomiting) with very weak evidence NItroglycerin too has very limited evidence but a much better adverse event profile Mix 0.4 mg (1 sublingual tablet) nitro in 10 mL of water and administer orally Nothing beats upper endoscopy for effectiveness but in settings where GI is not immediately available, nitroglycerin may be worth an attempt given its better safety profile to other medications References Arora S, Galich P. Myth: glucagon is an...
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Podcast 652: Prosthetic Hip Dislocation
Emergency Medical Minute
Contributor: Jared Scott, MD Educational Pearls: While it is rare to have a native hip dislocation, it is relatively common to dislocate a prosthetic hip The mechanism for dislocation is usually adduction, flexion, and internal rotation the hip which can occur when walking Arthroplasty in the setting of trauma or fracture, posterior approach during surgery, and using a small femoral head increase the likelihood of later dislocation If a patient with a total hip arthroplasty says they were walking and then developed hip pain, do not discount a potential dislocation References Zahar A,...
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Dr. Don Stader Shares Personal Experience of Losing his Mother to COVID-19 and Ruminates on the Culture of Death in Medicine (UnfilterED #12 Excerpt)
Emergency Medical Minute
A heartfelt excerpt from with Dr. Don Stader.
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Podcast 651: Hereditary Angioedema
Emergency Medical Minute
Contributor: Katie Sprinkel, MD Educational Pearls: Hereditary angioedema (HA) is an autosomal dominant bradykinin-mediated disease affecting the airway, skin or gastrointestinal tract and typically presents with swelling in the absence of pruritus HA episodes last 3-5 days, typically occur first in childhood or adolescence, and decrease in frequency with aging Airway angioedema is the most dangerous but least common Skin angioedema is usually uncomfortable and should be monitored if involving the face GI angioedema involves nausea, vomiting, and severe abdominal pain No definitive...
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Podcast 650: PNES
Emergency Medical Minute
Contributor: Katie Sprinkel, MD Educational Pearls: Psychogenic Non-Epileptic Seizures (PNES) are due to a psychogenic rather than an epileptic cause Despite common assumption, PNES are not always volitional 20-40% of those with PNES can also have true epileptic seizures 20-40% True diagnosis requires a video EEG Characteristics of PNES include: Waxing and waning of the seizure intensity Eyes clenched shut Pelvic thrusting, rolling from side-to-side Ability to respond to verbal stimuli during the seizure Ability to recall information during the seizure Weeping or...
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Trauma Is A Journey #4 Coming Full Circle
Emergency Medical Minute
High in the mountains of Colorado, a crew of unsuspecting docs stumble upon the EMS scene of a head-on collision after an arduous mountain bike ride. Trauma is a Journey is a four part rural trauma mini series that recounts this tale as this group springs into action to assist the EMS crews dealing with two critical patients. Elizabeth Esty hosts a panel discussion with the key players: Dr. Dylan Luyten, Dr. JP Brewer, Dr. Madison Macht, Dr. Glenda Quan and Jeremiah Grantham as this story unfolds. This final episode explores how addressing psychological and emotional trauma is the final step...
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