sub-dissociative dose ketamine administered prehospitally via breath-actuated nebulizer at 1.0 mg/kg for patients with acute pain

Pain

The PK-BAN package will be opened and weight -based dose of ketamine will be administered to the patient via BAN. The medication will be delivered with a minimum time of 5 min and maximum time of 15 min.

Nebutlized Ketamine

Maimonides Medical Center

Pre-hospital Nebulized Ketamine for Pain

Pre-hospital Utilization of Nebulized Sub-dissociative Dose Ketamine for Managing Acute Traumatic Extremity Pain: a Prospective Observational Study

The primary outcome will include a percentage of patients achieving a 20% or greater change in pain scores on numeric rating pain scale (NRS) ranging form 0 no pain to 20 severe pain for the baseline to 30 minutes post-analgesic administration.

The secondary outcomes will include a need for second or third dose, a need for rescue analgesia at either 15 and 30 minutes

Antonios Likourezos

Research Manager

The on-duty ED pharmacist will prepare a breath-actuated nebulizer with doses of 0.75 mg/kg sub-dissociative dose ketamine (SDK) to give to ED pediatric patients with moderate to severe pain based on a score of 0 to 10 on a Visual Analog scale where 0 is no pain, 5 is moderate pain and 10 is very severe pain.

The on-duty ED pharmacist will prepare a breath-actuated nebulizer with doses 1 mg/kg sub-dissociative dose ketamine (SDK), to give to ED pediatric patients with moderate to severe pain based on a score of 0 to 10 on a Visual Analog scale where 0 is no pain, 5 is moderate pain and 10 is very severe pain.

The on-duty ED pharmacist will prepare a breath-actuated nebulizer with doses of 1.5 mg/kg sub-dissociative dose ketamine (SDK), to give to ED pediatric patients with moderate to severe pain based on a score of 0 to 10 on a Visual Analog scale where 0 is no pain, 5 is moderate pain and 10 is very severe pain.

Nebulized Sub-dissociative Dose Ketamine at 0.75 mg/kg

Nebulized Sub-dissociative Dose Ketamine at either 0.75 mg/kg

Nebulized Sub-dissociative Dose Ketamine at either 0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg.

Nebulized Sub-dissociative Dose Ketamine at 1 mg/kg

Nebulized Sub-dissociative Dose Ketamine at 1.5 mg/kg.

Nebulized Sub-dissociative Dose Ketamine at Three Different Dosing Regimens for Treating Acute Pain in the Pediatric ED

Comparison of Nebulized Sub-dissociative Dose Ketamine at Three Different Dosing Regimens for Treating Acute Pain in the Pediatric ED: A Prospective, Randomized Double-Blind Trial

The primary outcome will include a comparative reduction in pain scores on numeric rating pain scale (NRS) between recipients of nebulized SDK given at three different doses at 15 minutes after analgesic administration. The Visual Analog Scale Ranges from 0 (no pain) to 10 (bery severe pain) with 5 being moderate pain

Noninvasive positive pressure ventilation (NPPV) plus standard of care in the management of children admitted to the hospital with status asthmaticus

standard of care treatment in the management of children admitted to the hospital with status asthmaticus

Status Asthmaticus

Noninvasive positive pressure ventilation (NPPV) will deliver pressurized gas through a nasal or oronasal mask, connected to a pressure targeted ventilator. NPPV provides ventilator support without the use of an endotracheal tube. Standard of care includes use of corticosteroids, oxygen, short acting β-agonist and inhaled ipratropium bromide.

Noninvasive positive pressure ventilation

Southern Illinois University School of Medicine website

American Lung Association - asthma webpage

Southern Illinois University School of Medicine

Non Invasive Positive Pressure Ventilation in Status Asthmaticus

Effect Of Early Initiation Of Noninvasive Positive Pressure Ventilation On ICU Length Of Stay In Children With Status Asthmaticus, A Prospective Randomized Trial

Number of hours patient hospitalized in PICU

Clinical asthma score (CAS) will be recorded in 2 hour segments by clinical evaluation of 5 items-respiratory rate, inspiratory-expiratory ratio, retractions, adequacy of air exchange and wheezing-on a 3-point scale. A higher score indicates worsening respiratory status.

Number of hours patient able to wear the NPPV mask will be recorded in 2 hour segments.

measure of clinical monitoring parameters:
Respiratory rate
pH
PaCO2

status asthmaticus/nausea

Pre-hospital Nebulized Ketamine for Pain

Nebulized Sub-dissociative Dose Ketamine at Three Different Dosing Regimens for Treating Acute Pain in the Pediatric ED

Non Invasive Positive Pressure Ventilation in Status Asthmaticus

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