Cite this post as:
Scott Weingart, MD FCCM. EMCrit 291 – For Frak’s Sake, Ketamine is at least as Hemodynamically Stable as Etomidate!. EMCrit Blog. Published on February 9, 2021. Accessed on March 21st 2023. Available at [https://emcrit.org/emcrit/ketamine-hemodynamically/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: February 9, 2021
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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The takeaway for me is, that there is No induction drug, that lets the provider disregard the hemodynamics….
Great discussion – thanks for this. Ketamine is my go-to induction agent for most patients in shock. I will very occasionally use etomidate for quite specific circumstances, however. This is because, in my experience, while ketamine will rarely if ever lower blood pressure, I have had multiple cases where it will actually raise BP (before any instrumentation of the airway) and, perhaps more importantly, heart rate. Thus, for example, I tend to avoid it for aortic dissections, unsecured cerebral aneurysms, or active ischemic heart disease. Scott, I think a lot about your distinction between anatomically difficult airways (what people tend… Read more »
Nice podcast, Scott, and you bring up an important issue on the inability of retrospective (and registry) data to demonstrate hypotheses. At the risk of poking the hornet’s nest, for me the salient take-home though was your comment that one of the weaknesses of FOAM is that it allows the person with the largest megaphone and shiniest blog to set the narrative. Unlike papers published in “obscure journals” that are rarely read, FOAM is not peer-reviewed, and therefore not constrained by the same standards. I know you’ve commented on this in the past so I won’t continue. 🙂 Regarding the… Read more »
Erik thanks for writing At the risk of belaboring the argument you alluded to… All popular FOAM is peer reviewed far more extensively than conventional literature–it just happens immediately upon hitting publish. The social nature of social media is what allows for this. Each of my posts generates dozens of emails telling me every way in which people disagree–if there is anything we missed, it gets correct post haste. For brave folks, the comments section allows visible disagreement. The original post on Crit Care Now was actually peer-reviewed prior to publication, just like a journal article. My contention is that… Read more »
Hi Scott, Thanks for your response. Again, I apologize for deviating from the subject matter of the podcast…but I couldn’t resist after I heard your comment re FOAM While I understand your position and appreciate it, let’s just say we’re going to have to agree to disagree. Peer-reviewed work is vetted before it is foisted on the unsuspecting public; letters to the editor may follow. FOAM, on the other hand, is typically vetted after it is disseminated to the public. (And I appreciate that it may well be that your blog is reviewed before being posted). For the latter to… Read more »
Erik, feel free to deviate! your 1-4 have a number of theoretical possibilities. I can’t speak to the rest of the FOAM world, I can speak re: EMCrit and the big 5 sites in EM/Critical care in which these theoretical possibilities all collapse in the face of praxis: There are ample readers able to vet–in fact usually the world’s foremost experts Those very people in #1 are the most actualized to correct errors and disagreements In all of the the 6 sites mentioned, EVERY comment and email is read. And there would be an instant correction of any identified error… Read more »