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Prehospital analgesia using nasal administration of S-ketamine – a case series
The research and development unit, Jämtland county council, Östersund, Sweden.
Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
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2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, no 38Article in journal (Refereed) Published
Abstract [en]

Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.

Place, publisher, year, edition, pages
BioMed Central, 2013. Vol. 21, no 38
Keyword [en]
Analgesia; Drug administration; Intranasal; Emergency; Ketamine; Prehospital; S-ketamine; Trauma
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-96137DOI: 10.1186/1757-7241-21-38ISI: 000319116100001OAI: oai:DiVA.org:liu-96137DiVA: diva2:640746
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06

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Sjöberg, Folke

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Division of Clinical SciencesFaculty of Health SciencesDepartment of Hand and Plastic SurgeryDepartment of Anaesthesiology and Intensive Care in Linköping
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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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