Cowley Alan, Williams Julia, Westhead Pete, Gray Nick, Watts Adam, Moore Fionna
South East Coast Ambulance Service NHS Foundation Trust.
Brighton and Sussex University Hospitals NHS Trust.
Br Paramed J. 2018 Mar 1;2(4):25-31. doi: 10.29045/14784726.2018.03.2.4.25.
This project aims to describe pre-hospital use of ketamine in trauma by South East Coast Ambulance Service critical care paramedics and evaluate the occurrence of any side effects or adverse events.
A retrospective analysis of patients receiving pre-hospital ketamine for trauma between 16 March 2013 and 30 April 2017. Administrations were identified from Advanced Life Saving Interventions and Procedures reports submitted by the clinician and, later, from an electronic database. Each was scrutinised for patient demographics, doses and reports of side effects or adverse events.
A total of 510 unique administrations were identified. Following the exclusion of 61 records, 449 (88.0%) administrations remained. The most common indication for administration of ketamine was lower limb injury, with 228 (50.8%) administrations. Ketamine was only administered intravenously, and the median dose of ketamine for all administrations was 30 mg (interquartile range 20-40 mg). The gender split was dominated by males who accounted for 302 (67.3%) administrations compared to 147 (32.7%) females. The median age of patients was 44 years (interquartile range 28-58 years), with women on average being older than men. Telephone calls to a consultant were made for 243/449 (54.1%) of the administrations, reflecting a need for sanctioning of the drug, advice on dosages or indications, for example.
Critical care paramedics within a well governed system are able to safely administer ketamine within an approved dosing regimen under a Patient Group Direction. Median doses are in keeping with nationally approved guidelines. Reported side effects were within the described frequencies in the British National Formulary. Prospective studies are now needed in order to confirm the safety and efficacy of ketamine administration among the advanced paramedic population.
本项目旨在描述东南海岸救护车服务中心重症护理医护人员在创伤患者院前使用氯胺酮的情况，并评估任何副作用或不良事件的发生情况。
对2013年3月16日至2017年4月30日期间接受院前氯胺酮治疗创伤的患者进行回顾性分析。给药情况从临床医生提交的高级生命支持干预和程序报告中识别出来，后来又从电子数据库中获取。对每份报告进行仔细审查，以了解患者的人口统计学信息、剂量以及副作用或不良事件的报告。
共确定了510次单独给药。排除61份记录后，剩下449次（88.0%）给药。氯胺酮给药最常见的指征是下肢损伤，有228次（50.8%）给药。氯胺酮仅通过静脉给药，所有给药的氯胺酮中位剂量为30毫克（四分位间距20 - 40毫克）。性别分布以男性为主，男性给药302次（67.3%），女性给药147次（32.7%）。患者的中位年龄为44岁（四分位间距28 - 58岁），女性平均年龄比男性大。在449次给药中有243次（54.1%）向顾问医生进行了电话咨询，例如反映出需要批准用药、获取剂量或指征方面的建议。
在管理完善的系统中，重症护理医护人员能够在患者群体指导下，按照批准的给药方案安全地使用氯胺酮。中位剂量符合国家批准的指南。报告的副作用在《英国国家处方集》描述的频率范围内。现在需要进行前瞻性研究，以确认在高级医护人员群体中使用氯胺酮的安全性和有效性。
