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> I have never had an emergence reaction
--> What about your patients?
If you lived with UK weather, you'd resort to humour as well...
I have SEEN one such reaction in a patient I was not managing. Never had one in my patients either.
> can only think of a single vomiter
--> Before this thread, I had not associated vomiting with Ketamine...
> I use ketamine on a VERY frequent basis
--> I don't.
Not even on my patients...
Only about 10-20 times a year
Last time was on my most recent shift, for a suspected pelvic fracture, stable, but in too much pain after lots of IV morphine. We really wanted to get into the CT, so we needed some calming down for the procedure and analgesia for getting patient on & off machine with the fracture...
> perhaps my presedation karma is superb
--> Maybe your resus room is oriented properly to the sun and the trees outside...
Do you have a fountain?
> I don't use Versed
--> I sometimes do...
(I'll resist the quip this time - how mature of me)
I use it for SOME adults, not children, typically when it's in a team situation when I know I will have lots of people around the patient, so no problem with leaving the patient later or with midazolam delaying their departure, as they are not leaving anyway. Hence nothing to lose...
> I use atropine to prevent secretions from irritating the vocal cords...
So maybe it's Atropine, rather than Karma, which does the job midazolam is supposed to do? Could it be that atropine reduces emergence reactions?
> Perhaps some would argue that I too am practicing anectdotal medicine in this regard.
No argument here - you ARE practicing anecdotal medicine... And good for you!
It's called being a doctor and we all do it... Nothing to be shy about.
Anecdotal medicine is what we do most of the time... It's even what we do to the non-control sample group in a proper RCT, UNTIL we have the evidence...
I spend much of my lecturing time on the virtues of evidence-based medicine...
I start by stating to the audience that I spend most of my clinical time intentionally using anecdotal medicine, 'cause there is still very little evidence out there...
Telly addicts unite!
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