TIL: a mini https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> on one of my FAVORITE https://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze">s used in the https://abs.twimg.com/emoji/v2/... draggable="false" alt="🏥" title="Krankenhaus" aria-label="Emoji: Krankenhaus">...KETAMINE! Ketamine is an NMDA antagonist that can be used for pediatric sedation. Ketamine produces a dissociative state while also having analgesic properties! Here’s a picture of me beaming before procedural sedation!

In our pediatric population https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧸" title="Teddy bear" aria-label="Emoji: Teddy bear">, 1 mg/kg can be administered IV followed by 0.5 mg/kg resides for adequate sedation during a procedure https://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze">. No IV access? No PROBLEM! Ketamine can be given in many other routes...

For pain and sedation we can utilize IN https://abs.twimg.com/emoji/v2/... draggable="false" alt="👃" title="Nase" aria-label="Emoji: Nase"> ketamine! 1 mg/kg for pain or 4 mg/kg IN for sedation has been utilized. however, only 0.5 mL/nostril should be given for optimal absorption. Did you see our recent https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe">”Boogie Board”https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe"> on pediatric IN medication administration?

If IVhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze">or INhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👃" title="Nase" aria-label="Emoji: Nase"> isn’t optimal for your patient... Don’t fret! Ketamine can be given IM! Most commonly a dose of 4 mg/kg IM has been utilized for sedation! https://abs.twimg.com/emoji/v2/... draggable="false" alt="😴" title="Schlafendes Gesicht" aria-label="Emoji: Schlafendes Gesicht"> https://abs.twimg.com/emoji/v2/... draggable="false" alt="💤" title="Schlafsymbol" aria-label="Emoji: Schlafsymbol">

You may have heard of an https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤬" title="Gesicht mit Symbolen über dem Mund" aria-label="Emoji: Gesicht mit Symbolen über dem Mund">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤯" title="Explodierender Kopf" aria-label="Emoji: Explodierender Kopf">https://abs.twimg.com/emoji/v2/... draggable="false" alt="😳" title="Errötetes Gesicht" aria-label="Emoji: Errötetes Gesicht">emergence reaction that occurs with the use of ketamine! Dim lighting, https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤫" title="Schh!-Gesicht" aria-label="Emoji: Schh!-Gesicht"> quiet location, and having your patient “think https://abs.twimg.com/emoji/v2/... draggable="false" alt="😊" title="Lächelndes Gesicht mit lächelnden Augen" aria-label="Emoji: Lächelndes Gesicht mit lächelnden Augen">HAPPYhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😊" title="Lächelndes Gesicht mit lächelnden Augen" aria-label="Emoji: Lächelndes Gesicht mit lächelnden Augen"> thoughts” can all help mitigate this phenomena. Its important to set the tone for a positive experience....

Talking about a show or something your patient really enjoys seems to be beneficial in my experience! Even pulling out your phone and youtubing Spongebob https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧽" title="Sponge" aria-label="Emoji: Sponge"> or baby https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦈" title="Hai" aria-label="Emoji: Hai"> has done wonders for calming our https://abs.twimg.com/emoji/v2/... draggable="false" alt="😭" title="Laut schreiendes Gesicht" aria-label="Emoji: Laut schreiendes Gesicht"> pediatric friends prior to inductionhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💕" title="Zwei Herzen" aria-label="Emoji: Zwei Herzen">https://abs.twimg.com/emoji/v2/... draggable="false" alt="😂" title="Gesicht mit Freudentränen" aria-label="Emoji: Gesicht mit Freudentränen">

Historically, ketamine has been https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚫" title=""Betreten verboten!"-Zeichen" aria-label="Emoji: "Betreten verboten!"-Zeichen">avoidedhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🚫" title=""Betreten verboten!"-Zeichen" aria-label="Emoji: "Betreten verboten!"-Zeichen">in adults because of this emergence reaction (but can be mitigated w/ BDZ). Pediatric patients are RESILIENT https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌟" title="Leuchtender Stern" aria-label="Emoji: Leuchtender Stern"> & it appears that this reaction phenomena is VERY rare in those < 10 years old during the recovery phasehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="‼️" title="Doppeltes Ausrufezeichen" aria-label="Emoji: Doppeltes Ausrufezeichen">

Another reason why I https://abs.twimg.com/emoji/v2/... draggable="false" alt="❤️" title="Rotes Herz" aria-label="Emoji: Rotes Herz"> ketamine is because our is an excellent option for sedation/induction in patients with asthma https://abs.twimg.com/emoji/v2/... draggable="false" alt="💨" title="Staubwolke" aria-label="Emoji: Staubwolke"> as it https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> bronchospasm. this is caused by https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> in catecholamines, direct smooth muscle dilation and https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚫" title=""Betreten verboten!"-Zeichen" aria-label="Emoji: "Betreten verboten!"-Zeichen"> of vagal outflow.

Some patients may experience nausea, pretreating with ondansetron prior to ketamine administration can https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤮" title="Spuckendes Gesicht" aria-label="Emoji: Spuckendes Gesicht"> in our pediatric friends. We should also monitor for laryngospasm (although rare), increased secretions and https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben">https://abs.twimg.com/emoji/v2/... draggable="false" alt="❤️" title="Rotes Herz" aria-label="Emoji: Rotes Herz">HR.

Some pts experience nystagmus https://abs.twimg.com/emoji/v2/... draggable="false" alt="👁" title="Auge" aria-label="Emoji: Auge"> or ataxia, but those are usually self limiting!

I hope that this thread https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> helps you appreciate ketamine and all it’s wonder, especially in the ED settinghttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze">https://abs.twimg.com/emoji/v2/... draggable="false" alt="💤" title="Schlafsymbol" aria-label="Emoji: Schlafsymbol">!

PMID: 15107362, 25447557, 2203290

-Tori