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12/03/2016

Douleur: Pendant l'évacuation, Kétamine = Morphine ?

Prehospital Pain Medication Use by U.S. Forces in Afghanistan

Shackelford SA et Al. Mil Med. 2015 Mar;180(3):304-9

 

We report the results of a process improvement initiative to examine the current use and safety of prehospital pain medications by U.S. Forces in Afghanistan. Prehospital pain medication data were prospectively collected on 309 casualties evacuated from point of injury (POI) to surgical hospitals from October 2012 to March 2013. Vital signs obtained from POI and flight medics and on arrival to surgical hospitals were compared using one-way analysis of variance test. 119 casualties (39%) received pain medication during POI care and 283 (92%) received pain medication during tactical evacuation (TACEVAC). Morphine and oral transmucosal fentanyl citrate were the most commonly used pain medications during POI care, whereas ketamine and fentanyl predominated during TACEVAC.

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Ketamine was associated with increase in systolic blood pressure compared to morphine (+7 ± 17 versus −3 ± 14 mm Hg, p = 0.04). There was no difference in vital signs on arrival to the hospital between casualties who received no pain medication, morphine, fentanyl, or ketamine during TACEVAC. In this convenience sample, fentanyl and ketamine were as safe as morphine for prehospital use within the dose ranges administered. Future efforts to improve battlefield pain control should focus on improved delivery of pain control at POI and the role of combination therapies.

| Tags : kétamine

Douleur: Kétamine d'abord ?

Prehospital and En Route Analgesic Use in the Combat Setting: A Prospectively Designed, Multicenter, Observational Study

Lawrence N. Petz  LN et Al. , Mil Med. 2015 Mar;180(3 Suppl):14-8

 

 Background:

Combat injuries result in acute, severe pain. Early use of analgesia after injury is known to be beneficial. Studies on prehospital analgesia in combat are limited and no prospectively designed study has reported the use of analgesics in the prehospital and en route care setting. Our objective was to describe the current use of prehospital analgesia in the combat setting.

 

Methods:

This prospectively designed, multicenter, observational, prehospital combat study was undertaken at medical treatment facilities (MTF) in Afghanistan between October 2012 and September 2013. It formed part of a larger study aimed at describing the use of lifesaving interventions in combat. On arrival at the MTF, trained on-site investigators enrolled eligible patients and completed standardized data capture forms, which included the name, dose, and route of administration of all prehospital analgesics, and the type of provider who administered the drug. Physiological data were retrospectively ascribed as soon as practicable. The study was prospectively approved by the Brooke Army Medical Center institutional review board.

Results:

Data were collected on 228 patients, with 305 analgesia administrations recorded. The predominant mechanism of injury was blast (50%), followed by penetrating (41%), and blunt (9%). The most common analgesic used was ketamine, followed by morphine.

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A combination of analgesics was given to 29% of patients; the most common combination was ketamine and morphine. Intravenous delivery was the most commonly used route (55%). Patients transported by the UK Medical Emergency Response Team (MERT) or U.S. Air Medical Evacuation (Dust-off) team were more likely to receive ketamine than those evacuated by U.S. Pararescue Jumpers (Pedro). Patients transported by Medical Emergency Response Team or Pedro were more likely to receive more than 1 drug. Patients who received only ketamine had a higher pulse rate ( p < 0.005) and lower systolic blood pressure ( p = 0.01) than other groups, and patients that received hydromorphone had a lower respiratory rate ( p = 0.04).

Conclusions: In our prospectively designed, multicenter, observational, prehospital combat study, ketamine was the most commonly used analgesic drug. The most frequently observed combination of drugs was ketamine and morphine. The intravenous route was used for 55% of drug administrations.

 

| Tags : kétamine

14/12/2013

Kétamine: Son intérêt en médecine de guerre

 

Kéta.jpg

Clic sur le document pour accéder au document. 

| Tags : kétamine

20/10/2012

Etomidate: Encore une méta-analyse à charge

Etomidate is associated with mortality and adrenal insufficiency in sepsis: A meta-analysis.

Chee Man C. et all. Crit Care Med 2012;40:2945–2953

 

L'étude kETASED a confirmé l'intérêt du recours à la Kétamine chez le patient en défaillance vitale. Il existe une polémique concernant les effets délétères de l'étomidate sur la fonction corticosurrénalienne. Bien qu'une analyse récente n'ait pu l'objectiver après administration unique, la controverse continue. Une méta-analyse incluant chez 865 patients porteur de sepsis plaide pour l'existence d'une telle surmortalité. 

On rappelle qu'en condition de combat, au delà de ce débat, l'agent d'induction de choix est la kétamine car son intérêt ne se limite pas à la simple induction. C'est aussi un agent de sédation et un antalgique.

 

Eeomidate.jpg

| Tags : kétamine, etomidate

30/04/2012

Sédation dissociative: La Kétamine

http://emupdates.com/wp-content/uploads/2011/01/ACEP-Keta...

| Tags : kétamine

26/09/2011

Kétamine: Utilisation préhospitalière

http://www.urgence-pratique.com/2articles/pharmaco/ketami...

| Tags : kétamine

17/10/2009

La kétamine pour l'intubation en séquence rapide

La kétamine: Que du bon. Un seul narcotique dans votre trousse, c'est celui là car vous pourrez vous en servir même sans abord vasculaire

| Tags : kétamine, intubation

La kétamine pour l'humanitaire

La kétamine: Que du bon. Un seul narcotique dans votre trousse, c'est celui là car c'est le plus sûr.

 

| Tags : kétamine

La kétamine améliore la survie encondition expériementale

La kétamine: Un effet bénéfique sur la survie du cochon en état de choc

| Tags : kétamine

La kétamine: Etude KETASED

La kétamine fait la preuve de son intérêt pour l'intubation préhospitalière. Elle entraîne moitié moins de dépression surrénalienne que l'étomidate pour des conditions d'intubation identiques

 

| Tags : kétamine, etomidate