First episode of EMCrit Members Q&A
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Thank you for your clear explanation. Since patients with severe heart failure are often tachycardic, I thought ketamine would be difficult to use. However, given the situation, I realize that’s not always the case. I’ll try using ketamine next time.
Hoshino, If the patient is tachycardic, a little fentanyl will blunt that. Usually when they are already tachy, ketamine doesn’t make it any worse as ketamine is only an indirect sympathomimetic.
In the massive shunt physiology patient that can’t be preoxygenate to 90 + % and you decide to do it ketamine “awake”…What’s the satO2 that you accept? Do you procede even with a sat in the 80s? 70s and stable? I imagine the alternative is to cric awake. And what s your set up for mantaining oxygenation during the attempts? Fiberotic vs VL is just a matter of operator preference in this case? Thank you