JCM | Free Full-Text | Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation.
— Read on www.mdpi.com/2077-0383/12/9/3124

JCM | Free Full-Text | Narrative Review: Low-Dose Ketamine for Pain Management

Pain is the leading cause of medical consultations and occurs in 50–70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia. In this narrative review, ketamine’s role as an analgesic is discussed, with both known and new applications in various contexts (acute, chronic, and neuropathic pain), along with its strengths and weaknesses, especially in terms of psychomimetic, cardiovascular, and hepatic effects. Moreover, new scientific evidence has been reviewed on the use of additional drugs with ketamine, such as magnesium infusion for improving analgesia and clonidine for treating psychomimetic symptoms. Finally, this narrative review was refined by the experience of the Pain Group of the Italian Society of Emergency Medicine (SIMEU) in treating acute and chronic pain with acute manifestations in Italian Emergency Departments.
— Read on www.mdpi.com/2077-0383/12/9/3256

The Paramedic Podcast • A podcast on Spotify for Podcasters

A free, exciting and eclectic podcast covering topics relating to the parts of paramedicine we don’t typically discuss. Tune in for some insightful conversations around paramedic mental health, post traumatic stress and growth, resilience, managing hyper vigilance, inspirational paramedic stories and so much more. *Note: all things discussed are individual opinions and views and is not a reflection of or in collaboration with the organisation in which we operate*
— Read on podcasters.spotify.com/pod/show/marissarose

SHock in TraUma

Some joker on Twitter called Chrimes took this at Aspen, Colorado

It is an oft quoted maxim of trauma resuscitation that shock is haemorrhagic until proven otherwise. Certainly for penetrating trauma this is all often 100% accurate but for blunt trauma it becomes less and less a reliable rule.

Cardiac causes of shock in trauma? Why yes dear reader. Classically the car driver who suffers a myocardial infarction then crashes the car. Albeit yes he/she may be in shock due to a smashed femur but what of their cardiogenic shock from the acute anterior MI? Would pouring litres of salty pasta fluid into their compromised circulation be prudent? Perhaps not.

But in blunt trauma why couldnt the heart be damaged as well? Myocardial contusion does occur. And folks with pre-existing cardiomyopathy do suffer trauma too! So maybe for that next trauma patient you need to consider these cardiac causes of shock as well. If bleeding is obvious of course then that must be stopped and circulating volume replaced appropriately

Vasopressors in Trauma — phemcast

Further reading Matt has kindly provided a list of references from his Trauma Care talk which this podcast is based on: Peri-operative and critical care management of the brain – current evidence. Anaesthesia: Vol 77, No S1. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition Vasopressors in Trauma: A […]

Vasopressors in Trauma — phemcast