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Dilt through an EJ. Meth user, totally out of control with afib/rvr and cannabinoid hyperemesis. anxious/dramatic and hyperkinetic.  No IV access with 4 attempts by a really good nurse. Figured I would give an EJ a try, and it worked. Next step would have been an IO. Dilt through an IO would have been a first as well. Haldol and ativan through the same EJ.

Hospitalist graciously accepted admit. 

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1 hour ago, ohiovolffemtp said:

Well done.  What other paramedic skills have you drawn on?

all of them. I honestly could not do this job without having been a medic first. 

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13 hours ago, EMEDPA said:

 still in our ICU. His only access is still my 20G EJ , despite multiple additional attempts by other folks. 

What's his anatomical hangup for central access?? Stenosed?

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2 hours ago, MediMike said:

What's his anatomical hangup for central access?? Stenosed?

scarred. he shot everywhere except his neck and his penis. An IJ would be an option, but this guy doesn't stay still. we had 2 folks holding him down for me to get the EJ. Failing that, it would have been b/l IOs.

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Ketamine!

I've heard you ED people have actual blowguns loaded with K-Darts? Now, is it just ketamine or are you required to mix a variety of drugs in it to make a cool new name?

Ketofoledex?

Dropofolamine?

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No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet.  Definitely a better choice for the wildly out of control than either Haldol or Geodon.

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8 hours ago, ohiovolffemtp said:

No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet.  Definitely a better choice for the wildly out of control than either Haldol or Geodon.

I gave ketamine to a guy who shook of not one, but TWO IM B52s. chilled him out right quick. 

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1 hour ago, EMEDPA said:

I gave ketamine to a guy who shook of not one, but TWO IM B52s. chilled him out right quick. 

Not in the ED, but back when doing anesthesia I had to give a guy 400mg of propofol just to start a colonoscopy. If I recall I went through 6 bottles in during that scope.

another lady with chronic back pain and methadone use, undergoing some back procedure if I recall, took an entire syringe of sufentanil before intubation.

some people are just damn tough

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On 9/15/2020 at 2:33 AM, ohiovolffemtp said:

No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet.  Definitely a better choice for the wildly out of control than either Haldol or Geodon.

I find ketamine IM responses really varied, 500 IM to a full size adult and they are limp with the death stare and 500 IM to another and it was still like wrestling a bear, both from meth use. 

Personally now that it's making a comeback I like 5 for fighting 10 for biting with droperidol. I find it more consistent.

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