Ramblings of an Emergency Physician in Texas
Weird Oddities: No running with sharp objects!
Beware: unpleasant photo.
via Mike at FFM. Ketamine would be my drug of chioce here.
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Ouch! Bet that hurt. I’d have loved to see the look on the triage nurses face when she saw that one.
Or just a quick yank and leave the room quickly (assess for damage later). Not sure I’d tie up a nurse on one-to-one for this. The IV start could hurt as much as the fork-pull.
(Although I am a very big fan of ketamine–safe and effective.)
That looked forking painful.
If my kid did that, I’d be needing the ketamine.
One more reason for me to stay in the NICU. No parent needs to see the nurse crying.
all i have to say — wow
Agree with Whisperer.
Must have paid attention to Obi Wan Kenobi. “Use the fork, Luke, use the fork.”
No, not Mommy’s good silver!!!
But seriously I’d be a bit afraid just to yank it out. It looks like the tines are going either side of the septal cartilage and I’d be concerned about damage to the septum and a developing hematoma. I might wuss out and call ENT. He’d probably take it out the same way I would but if the kid gets septal necrosis I won’t have a lawyer asking me why heartless Dr. Goatwhacker didn’t call ENT.
Holy cow! My first thought was surgery, but I guess what goes in can come out backwards.
I hate Ketamine, so do most of the docs I work with. They either LOVE it or HATE it, nothing in between. We don’t use it.
I don’t like the emergence reactions the few times I have seen it used, and the docs who want to use it won’t allow an IV to be put in. With all due respect to those physicians, if I am monitoring a medication that alters consciousness, I am going to have an IV available! One doc I know had a fatality the first time he ever used it – a respiratory arrest.
The problem is Versed doesn’t work on kids very well, at least in my experience. You give it, they get hyper.
Here is what I would say to a parent if I was giving informed consent (totally tongue-in-cheek, I’ve never really done this) : D
Hi there! We are going to help your son sleep so we can get the fork out of his nose. He won’t feel anything and he will not remember what we do. The medication we use is Ketamine. It is an animal anesthetic and is a derivative of PCP. What? Oh yes, THAT PCP. Ketamine was also a popular hallucinogenic drug at one time, until it was made illegal for that purpose. And don’t worry if your son twitches and hallucinates as the drug wears off. It will scare the hell out of you, but we are used to it and have all the emergency equipment available if your kid freaks out.
Oooo, yeah, give me some of THAT!
Actually, if I saw it used more, I’m sure I’d be more comfortable with it.
I’ve used ketamine a lot, and like it. It’s actually a lot easier to start with IM ketamine, then after the patient has gone off to sleep start an IV, then more sedation can be given as needed.
Two other thoughts: 1) fatalty due to respiratory arrest from ketamine is probably reportable, and most likely means the doc and hs team weren’t prepared (suction, a bag, etc). Laryngospasm is described with ketamine use, and in general you just need to gently bag the patient through the rest of the procedure. If it happened, which I sincerely doubt.
2) Yes, versed alone can make kids crazy (disinhibition), but when I’ve used it with Ketamine it usually takes care of (most of) those icky emergence reactions. Emergence reactions which aren’t remembered by the patients, and that when explained to the parents by a calm, professional and reassuring staff are utterly no big deal in the long or short term.
Ketamine is a good drug, used by appropriately trained professionals. Let’s not scare anyone for no reason.
Yep, that is exactly what happened to that doctor.
The patient had a respiratory arrest and the pediatric “crash cart” was neither well stocked or had the appropriate equipment.
I should also note that this was an anecdote told to me by the doc and occurred many, many years ago at the beginning of his practice in a large teaching hospital ER.
Everyone I’ve ever worked with (except for two docs) has not wanted to use Ketamine at all, which may be coloring my feelings, adding to my discomfort. Now that I think about it, the older docs seem not to like it while the younger docs do like it.
I’ve never seen it used with Versed at all! Sounds like I need to get some more experience with it, because I know there are a lot of docs who swear by it (I just haven’t worked with any of them yet.)
What do you think about Etomidate being used on kids? Someone brought that up as a possibility. I thought that was a bit drastic, although Etomidate is a great drug for RSI.
There’s no way in hell I would’ve been able to leave that thing in there and take my kid to the ED.
Yank! Apply pressure!
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