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PHARM Podcast 48 – Multinational PHARM panel discussion on emergency procedural sedation

Dr Alexander Sammel (@socalexmd)European-German working in Spain: ED & prehospital doctor. Opinions are personal. In love with medical education & my wonderful family… #FOAMed #GMEP #EMTOT

Dr Manrique Umana (@umanamd)Emergency Medicine Physician, Hosp. San Juan de Dios, San José, Costa Rica. Twitting in english and spanish. Personal views only. FOAMed addict

Dr Mattia Quarta (@squartadoc)ED physician. Ultrasound maniac. Thinking aloud into the void. Disturbing uni-eyebrow. Personal erratic views. #FOAMed


Hi folks!

Today’s podcast is a first ever for PHARM. Its the first time we have had 4 different doctors from 4 different countries across the globe at the same time, on the podcast!

Dr Alex Sammel, Spain

Dr Manrique Umana, Costa Rica

Dr Mattia Quarta, Italy

What we all have in common is a love of #FOAMEd and active Twitter accounts. I met my colleagues here all on Twitter . We all work in emergency medicine and/or prehospital medicine.

So what did we decide to discuss on the first Multinational PHARM panel discussion? Well Dr Carlo D’Apuzzo (@EMpillsblog) sent us a tweet request for an episode on procedural sedation. Thanks Carlo!

So what did we cover?

  1. Ketamine, IM & IV
  2. Fentanyl
  3. Intranasal delivery
  4. Ketofol

SHOW NOTE REFERENCES

Intranasal drug delivery

ACEP 2011 ketamine guideline

Ketofol vs propofol RCT ED sedation trial

This was one of the most enjoyable interviews I have done! Love the international FOAMEd community!

Stay safe and enjoy the interview.

Minh

Now on to the Podcast

Right Click and Choose Save-as to Download the Podcast.

6 Comments Post a comment
  1. Hi! Minh thanks for this great talk!!!Glad to hear the point of view and experiences of docs in this part of the world especially by my italian collegue Mattia!!!As a Ketamine fan I found very interesting its experimental intranasal use by US army; I hope to try it in the next future when on deployment.

    November 4, 2012
  2. Carlo D'Apuzzo #

    There is always something to learn! Thanks to all for your tips on this relevant topic.

    November 6, 2012
  3. Thankyou again for this really nice occasion to learn and share. It was a real pleasure!
    Surely we still will see the use of Ketamine only and with other mixes expand some more…

    Just here the link to that interesting page we mentioned:

    http://www.intranasal.net/Home/default.htm

    Scroll to the Fentanyl/Ketamine section for details and literature
    (note mention of a case from Cliff Reid ;-)

    I remember reading these references by the US Army from the site (one of them only
    partly, when you get to the different scores for the 43rd rifle shooting test morphine-ketamine
    it’s tiring).
    What really called my attention was the slide-show reference with one slide (nr.5) with perhaps
    the two most interesting points:

    Quote:
    “Optimal (IN) dose is 30-50 mg”
    “Absolute bioavailability is 35,5%” (suppose IN vs IV?!)

    in the same slide they mention 18 mg as iv analgesic dose (might be, used it already like
    that in a few cases with my own made-up calculation of 0,3 mg/kg iv to good effect)
    but the the 280 mg/kg iv as anesthetic dose is in my opinion/experience quite more than needed (well, perhaps I’m not taking in account obese soldiers?).

    But with IN Ketamine, so far, the very sparse literature has very varying doses for analgesia thresholds, whereas that means we still have to find the optimal dose or reflects a great interindividual difference I’m not sure…

    Anyways, so far the IN route stays interesting, I’m looking forward to hear/read more about this great option in the future.

    I’d love to hear of your thoughts/opinions and perhaps IN dosing tips!?

    Stay safe and as always: take good care of yourselves and others…

    November 6, 2012

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  2. The #FOAMtastic 2012 top ten from St.Emlyn's - St Emlyns

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