Tamingthesru
Ketamine Fight Club: Ketamine in TBI
There has long been a concern for increases in ICP with administration of ketamine primarily stemming from reports of increased ICP in the Neurosurgery and Neuroanesthesia literature. These increases were described primarily in patients usually with CSF outflow obstruction undergoing elective neurosurgical procedures. In the time since these articles were published, the use of ketamine in a wide variety of patients with neurologic compromise has been reported. In fact, there have been a couple of recent systematic reviews and meta-analyses on this topic. These systematic reviews and meta-analyses have essentially analyzing all the same existing literature (which is generally poor in quality).
Prehospital Care, An International Perspective
The State of Affairs
The morbidity and mortality of trauma on a global perspective is humbling. Aside from HIV/AIDS and TB, trauma is the chief cause of mortality for 15 to 45 years of age (based on 2002 WHO data). 5.8 million deaths annually. 5.2 million of those deaths, or 90%, occur in low-and-middle-income countries (LMIC’s). Prehospital care in LMIC’s varies immensely. Total prehospital time, the training level of prehospital providers, transportation method, and access to emergency medical systems (EMS) are some of the better described aspects of prehospital care in LMIC’s. The attributes of the prehospital health care delivery system differ significantly on a country by country basis.