Category: Health

Teen interventions services by Assisted Interventions Inc. New York: Assisted Interventions was founded on the principles of Dignity, Compassion and Safety in Intervention and Transport Services. We understand what it takes to bring a family to the point where they accept that their child is in need of help, and the difficult decisions they face in seeking professional treatment. Our many years of experience has prepared us to assist in that process and to be the “First Step” in the journey to restore the family culture to a healthy balance of love, understanding and respect. We recognize the significance of our role in assuring that this first critical step is positive in all aspects of our carefully planned approach. See more information at Assisted Interventions Inc.

Why should you stage an Intervention? Many reasons exist why you should consider arranging an intervention for your beloved person. The staging of an intervention will show you What Caused the Issue. If you are arranging an intervention that professionally trained interventionists are organizing, they can assist you in determining the source of the person you love dearly’s addiction. For example, in the case of alcohol abuse, many individuals begin to drink or misuse alcohol because of trauma or abuse. You may not be aware of this at first. An intervention can help identify the factors that caused your loved one to become involved in addiction or addiction to a behavior. In turn, they will aid you in putting preventative measures in place to prevent it from happening again. Repeat the same thing.

If, however, your teen is obstinate or angry and refuses to enter a treatment program, an interventionist may be able to help. A good interventionist is a trained professional who helps a person move out of addiction and into recovery. Anyone you consider should: Be trained in substance abuse or addiction, Have a level of expertise that allows them to provide comprehensive information to the patient and family members about treatment options, Be licensed or certified, Adhere to strict ethical standards that are clearly spelled out, Coordinate proper transport to treatment. Follow up after the initial intervention to advocate for your teen’s recovery.

What will my child need to bring with them? Your child brings only what is required by the program. They are not required to have I.D., money or a passport. A Travel Authorization Document signed by you will give us permission to transport your child. What do I do with my child’s medications, eyeglasses, retainer, etc? All medications MUST be placed in a clear plastic “zip-lock” bag. If there are any medications that you would like Assisted Interventions to administer, they should be placed in a separate clear “baggie,” along with specific written and signed (by a parent) instructions. Pre-packing of any eyeglasses or retainer may cause your child to become suspicious. We can gather those items when we arrive at your home for the intervention.

If you suspect that your teen is drinking or using drugs, looking for the warning signs of drug addiction and symptoms of teen drug use before the intervention will make the conversation hold more weight—in your mind and in your teen’s. Take note of your teen’s suspicious behaviors: How often does he break curfew? When did his grades start to drop? How much alcohol is missing from your liquor cabinet? How many pills off is your prescription bottle? Did you find evidence of drug use in his room or his car? By having your story straight, you will be more likely to get a straight story out of your teen.

Yet, parents are often unsure of how to respond when they find out their child is using drugs. They tend to be reactive rather than thoughtfully responsive, perhaps making it up as they go along. The problem with this type of off-the-cuff confrontation is that emotions often take over and lead to unproductive interactions. In especially challenging cases, a trained, professional interventionist is a great resource who can guide you through the process to get your child the help they need. This article covers the signs of adolescent drug addiction and outlines which steps to take in response, including hiring an interventionist, what to expect when confronting your child, and what happens post-intervention. Find even more information on Assisted Interventions Inc.

Prepare for the conversation: Your teen may try to steer the conversation in another direction. In order to gain a foothold, we suggest that parents come up with a readied list of questions to ask their teens before the intervention takes place. As a concerned parent, you likely already have an idea of what you want to ask your teen. A huge question in your mind may be, “Why?” Ask your teen why he likes using drugs, or why he started in the first place. You may want to ask him how often it is that he drinks or uses drugs, and with whom he is using. Try to get a sense for his situation, and to understand it from his perspective. This is an intervention, not a lecture.

Barbiturates addiction recovery Lake Worth, FL from Ahmad Bryant, CAP right now: We are committed to providing the initial phase of care in the recovery journey and support for lifelong recovery. We understand the importance of building a solid foundation during detox and residential care that will follow into the transitional phases of treatment. Our treatment philosophy stems from a recovery model that emphasizes support through holistic and evidence-based practices. At Flyland Recovery Network, our rehab center’s staff offers many years of experience with the disease of addiction. In addition, several members of the Flyland Family are in addiction recovery themselves. Read more info on https://flyland.com/.

Many people try drugs in their teenage years, and while parents sometimes chalk up drug use to experimentation or minimize the significance of it, there is a well-documented association between teen substance use and problems such as risky sexual behaviors, motor vehicle accidents, mental health issues, suicidal thoughts, homicides, and high school dropout rates. Chronic drug abuse may also lead to addiction, which can follow you well into adulthood. For these reasons—and many more—getting help for your teen right away, sometimes through an intervention, is extremely important.

Prescription stimulants are usually safe for those they are prescribed, but even people under the supervision of a doctor are at risk of developing an addiction. Those who use Adderall without medical assistance to get high or fuel all-night study sessions are at risk of developing an addiction. Due to the likelihood of Adderall addiction, the U.S. government designated Adderall to the same drug classification as cocaine and methamphetamine. Adderall is the brand-name prescription of amphetamine. Adderall stimulates the brain to overproduce certain chemicals like dopamine, which affects a person’s mood, motor activity and alertness.

Your teen will not be happy that you are approaching him about his drug use, and will likely become defensive in the beginning stages of the intervention. He may call you a liar, or a hypocrite because of your past behaviors. He may lie himself, or come back at you with accusatory questions, such as “Why are you going through my stuff?” This kind of remark should be expected, but can stump you if you are not prepared. Make a list of possible reactions your teen may have, and think of your responses. Remember to stay focused on your end goal—to stay focused on your teen’s drug use and his health—and do whatever you can to keep the conversation moving forward.

In addition to helping you control your breathing, meditation can help you clear your mind and focus on the benefits of detoxing from alcohol. Some small studies have found that meditation techniques, such as yoga, may help treat alcoholism when used with other therapies. However, more research is needed to prove that yoga is an effective complement to treatment. Overall, do whatever you can to make yourself as comfortable as possible. If you’re sweating, place a cold towel on your forehead or on the back of your neck. If you’re cold, bundle up in blankets. Prepare a playlist of your favorite songs or movies to pass the time.

An intervention is a conversation, not a confrontation. It does not always have to result in punishment or even rehab for your son right away. Rather, an intervention should be approached as a level-headed discussion, in which you, the parent, express your concern about your teen’s drug use. If you recently caught your teen using drugs, or simply have a feeling that he may be, you will need to start preparing your next steps. To help prepare you for a teen intervention, Turnbridge has compiled five key tips to help guide you into and through this breakthrough conversation. See more information at Ahmad Bryant, CAP.

Skilled professional swedish massage and spas centres in Northern Gyeonggi? Thai massage is a full body contact massage that uses a combination of Indian Ayurvedic principles, acupressure massage and yoga pose. It generally does not use oil and can be fully worn with the client. During the massage, the therapist will follow the lines identified with the body, and the client will be positioned in such a way that they follow these lines. Therefore, the client can expect him to be placed in a different position to get a good quality massage. Of course, like yoga, the customer will feel relieved after the session, which usually lasts for two hours.

May treat shoulder pain: Swedish massage may also offer short-term relief from shoulder pain, per the NCCIH. As with neck pain relief, you may consider talking with your massage therapist about regular sessions to maximize the benefits to your shoulder area. May treat fibromyalgia: Some studies have found massage therapy can help alleviate fibromyalgia pain, as well as anxiety and depression. However, there’s conflicting evidence regarding Swedish massage more specifically, the NCCIH reports.

Improve Posture: While postural imbalances have many sources, including overworked muscles due to repetitive strain, overcompensating muscles to ease stress on overworked muscles, prolonged sitting, or injury, Swedish Massage helps to ease the muscular holding that underlies postural imbalance. Increase Blood Flow: Massage therapy can dilate the blood vessels and widens the membrane pores, improving your body’s ability to deliver fresh blood to muscles and organs.

Did you know that there are other physiological effects? Massage can make us more relaxed by increasing endorphins and lowering cortisol will also happen because it lowers blood pressure! Advantages of business trip massage therapy: Business trip massage therapy has the advantage of improved sleep by reducing levels of cortisol, a stress hormone that can interfere with your ability to fall asleep at night. By raising oxytocin levels, oxytocin is known as the “kuddle” hormone, which helps you relax and feel calm. This increase in oxytocin also boosts your vitality, increases your confidence and makes you feel better connected with others.

The history of massage therapy started back to thousands of years. Some early articles has written about the use of massage, were found in China, on the dates back to about 2700 BC.(1) The early Chinese practice of massage, which was developed to include various aspects of Chinese medicine, spirituality and even some aspects of martial arts, formed the foundation of Asian massage, as we know it today. What is Asian Massage? The term Asian massage refers to any touch-based therapy that has evolved from the principles of Chinese and other Asian systems of medicine. The Asian massage technique is centered around the theory that the diseases and illnesses we suffer from are the result of blocked or unbalanced energy in the body.

A favorite with locals and tourists alike, the Dragon Hill jimjilbang is a seven-floor extravaganza fitted with indoor and outdoor baths, charcoal saunas, crystal salt rooms, ginseng and cedar baths, as well as a heated pool and play area for the kiddies. Other extras include a nail bar, golf, cinema, rooftop garden with barbeque restaurant, indoor Korean restaurant, and plenty of snack and resting areas. Discover extra info on https://ma4day.com/.

Located in the heart of Seoul, Gyeongbokgung Palace is one of South Korea’s most iconic buildings. The incredible palace finished construction in 1395. However, over the years, various other rooms and structures were added to this incredible building. The two museums that reside within the palace walls include the Museum of Korea and the National Palace Museum of Korea. There are still a number of ongoing restoration efforts aimed at restoring this fabulous building back to the epitome of its former glory.

For our Korean visitors:

암 증상 완화를 제공할 수 있음: 더 많은 증거가 필요하지만 NCCIH는 초기 연구에 따르면 암에 걸린 사람들이 통증, 피로 및 불안과 같은 증상을 해결하기 위한 보완 요법으로 스웨덴식 마사지를 사용하는 것이 도움이 될 수 있다고 제안합니다. 순환을 개선할 수 있음: 2016년 연구에 따르면 고전적인 마사지는 신체의 순환을 개선할 수 있습니다. 이러한 이유로 일부 전문가는 임신 중 마사지를 권장합니다. 그러나 이 연구는 더 오래되었고 이 이점을 보기 위해서는 더 많은 임상 연구가 필요합니다. 혈전의 병력이 있는 경우에도 주의해야 합니다.

유연성 및 동작 범위 증가: 스웨디시 마사지는 근육을 늘리고, 관절을 열고 윤활하며, 부종을 감소시켜 움직임을 완화하고 유연성을 증가시킬 수 있습니다. 스트레칭 기술을 통합함으로써 스웨덴식 마사지는 또한 보다 유연한 동작 범위를 증가시킬 수 있습니다. 전반적인 에너지 증가: 순환 증가와 스트레스 감소는 전반적인 에너지 증가로 이어질 수 있습니다.

신사동 강남구에서 쇼핑을 마치 신 후 스파 레이에서 쇼핑가를 아프게하십시오. 대부분의 한국 스파와 달리 Spa Lei는 소녀 전용이며 여성 손님을 수용 할 수 없습니다. 몸의 곡선을 이루는 돌이 깔린 바위 사우나는 특히 휴식을 취하며 온수 욕조의 마사지 제트는 당신과 당신의 여자 친구들이 나머지 여행을 위해이 성역에 머물기를 원할 것입니다. 네일 살롱과 파우더 룸에서 야외 카페와 보석과 란제리를 판매하는 작은 상점에 이르기까지 Spa Lei는 아름다움, 피트니스, 건강 및 패션을 하나의 패키지로 통합합니다. 발견하다 추가의 정보 여기 마사지포털.

명동의 번화 한 쇼핑 지구에 위치한 작은 R & R을위한 찜질방 형태의 오아시스를 찾을 수 있습니다. 피곤한 쇼핑 마라톤을 마친 후 명동 전통 사우나에서 휴식을 취하고 에너지를 회복하십시오. 증기 사우나에서 모공을 열고 얼굴을 깨끗하게하거나 스크럽으로 피부를 정돈하십시오. 당신이 관광에서 휴식을 취하고 제공되는 4 가지 패키지 중 하나와 함께 휴식을 취할 때 당신의 몸은 당신에게 감사 할 것입니다. 젊어지면 명동의 길거리 음식 마라톤으로 이동하십시오!

다른 생리학적 효과가 있다는 것을 알고 있었나요? 안마는 엔도르핀을 증가 시켜 우리를 더 이완되게 만들 수 있고 혈압도 낮추기 때문에 줄어든 코르티솔도 일어날 것입니다! 출장안마 테라피는 밤에 잠드는 당신의 능력을 방해할 수 있는 스트레스 호르몬인 코르티솔의 수치를 감소 시켜 향상된 수면의 장점이 있습니다. 옥시토신 수치를 높여주어 옥시토신은 긴장을 풀고 차분하게 느끼도록 도와주는 “커들” 호르몬으로 알려져 있습니다. 옥시토신의 이러한 증가는 또한 여러분의 활력을 증진하고, 여러분의 신뢰감을 증가시키며 다른 사람들과 더 잘 연결되어 있다고 느끼게 합니다.

Optical Shop/Glasses recommendations from Aarti Pandya, MD Atlanta: Dr. Pandya combines her extensive training and experience with a personalized and warm approach. Her compassionate demeanor and attentive manner are just some of the reasons why patients trust Dr. Pandya with their vision and eye health. Find even more details at Aarti Pandya, MD.

It’s Safe, Effective and Inexpensive: More than 2 million cataract surgeries are performed every year in the United States alone. It’s considered to be one of the safest and most effective surgical procedures available. Studies have shown that people who opt for cataract surgery have a lower mortality rate. Improved vision means you’re less likely to have a fall or be involved in a car accident.

Prolonged high blood glucose levels can stress the blood vessels of the eye, causing them to leak blood and other fluids into the retina. The resulting swelling and inflammation can cause a number of vision-related symptoms, ranging from minor nuisances to blindness. African Americans, Hispanics and Native Americans all face higher rates of diabetic retinopathy. If you have high blood pressure, high cholesterol or are not effectively managing your blood glucose levels your risk of diabetic retinopathy is increased substantially. Tobacco use and pregnancy also can increase your risk.

Almost all of us have experienced itchy, red or dry eyes at some point. Dry eye syndrome is characterized by a chronic lack of lubrication causing irritation in the eyes. Depending on the cause and severity of the condition, dry eye syndrome may not be completely curable. However, most cases can be managed successfully. If you experience constant irritation from dry eye, let our staff of experts help you relieve your symptoms. With years of collective experience, our team has helped countless patients manage chronic dry eye with the appropriate tools and treatments. Schedule a consultation with us today to learn more about the treatment options we offer.

Primary open-angle glaucoma is the most common variant, accounting for more than 90 percent of all cases. Initially it only affects peripheral vision, and its effects are gradual, making it difficult to diagnose without comprehensive testing. By the time most patients notice the associated vision changes, permanent damage has already occurred. Who Is at Risk? If you are over the age of 40, you are at greater risk of vision deterioration, and therefore more susceptible to glaucoma and other eye conditions such as cataracts and macular degeneration. But age is just one of a number of glaucoma risk factors.

Bäst hälsoråd med Farshid Sistani läkare? Innan du påbörjar ett nedtrappningsschema bör du prata med din läkare om riskerna med avgiftning hemma. Att minska alkohol kan komplicera andra medicinska tillstånd eller samtidigt förekommande psykiska störningar. Om du är van vid att dricka mer än 20 öl per dag rekommenderar experterna på HAMS följande nedtrappningsschema, som inkluderar åtta timmars sömn per natt. Ditt nedtrappningsschema bör vara flexibelt. Räkna med att känna obehag, inklusive ångest, svettning eller irritabilitet. Om du känner mer allvarliga symtom, såsom paranoia, ökad puls eller skakningar som ibland kallas alkoholskakningar, bör du minska långsammare och överväga att söka professionell hjälp. Om du känner allvarliga symtom, såsom hallucinationer, snabba hjärtslag eller desorientering, ring 911 omedelbart. Läs mer info på https://www.youtube.com/@farshidsistani.

Vad är blodplättar? Blodplättar är en av de tre typerna av blodkroppar, tillsammans med röda och vita blodkroppar. Blodplättar är små och klibbiga och deras uppgift är att förhindra blåmärken och stoppa blödningar efter en skada. Blodplättar, som röda och vita blodkroppar, bildas i benmärgen. En grov uppfattning om hur många blodplättar som cirkulerar i blodomloppet (trombocytantal) kan göras från ett blodprov. Det normala antalet trombocyter är mellan 150 och 400 x 109/L. I många fall av ITP är trombocytantalet mindre än 30 x 109/l vid presentationen. Ett lågt antal trombocyter kallas “trombocytopeni”.

Vilka är symptomen på idiopatisk trombocytopen purpura? Normalt antal blodplättar ligger i intervallet 150 000 till 450 000. Med ITP är trombocytantalet mindre än 100 000. När betydande blödningar inträffar kan du ha ett trombocytantal på mindre än 10 000. Ju lägre trombocytantal, desto större är risken för blödning. Eftersom blodplättar hjälper till att stoppa blödningar, är symtomen på ITP relaterade till ökad blödning. Men varje person kan uppleva symtom på olika sätt.

Föräldrar var mer benägna att rapportera att formuleringarna med förlängd frisättning var “mycket hjälpsamma” med akademisk prestation, beteende kl. skolan, beteende i hemmet och sociala relationer. Med formler med förlängd frisättning behöver föräldrar inte lita på att deras barns skola ger medicinen. Om du överväger medicinering för ditt barn med ADHD, fråga din vårdgivare om detta alternativ. Vi frågade föräldrar hur starkt de instämde i ett antal påståenden om att få sitt barn att ta medicin. Medan de flesta instämde starkt i att om de var tvungna att göra det igen skulle de fortfarande få sitt barn att ta medicin (52 procent), 44 procent instämde starkt i att de önskade att det fanns ett annat sätt att hjälpa sitt barn förutom medicin, och 32 procent instämde starkt i att de var oroliga om biverkningar av medicin. Sammantaget är processen att få ett barn att ta medicin mot ADHD en av att ständigt väga kostnader och fördelar. Som beskrivits ovan rapporterade föräldrar att biverkningar är vanliga. Och de två stora klasserna av mediciner (amfetamin och metylfenidater) var inte “mycket hjälpsamma” i många av de områden vi frågade om. (Till exempel var de bara “mycket hjälpsamma” med beteendet hemma i 30 procent av fallen.) Men jämfört med andra vanliga strategier som används för att hantera ADHD, var det att få ett barn att ta medicin den mest hjälpsamma för föräldrar att hantera ADHD . Så i många fall kan medicinering vara något som en förälder kan försöka hjälpa sitt barn med ADHD.

Du kan inte läsa andras känslor heller. Det är sant att läsning av känslor är en del av interpersonell kommunikation, men om du är alltför känslig för att bli kritiserad av andra, kommer en ansiktsmask att ta denna potentiella källa till ångest bokstavligen ur bilden. Fri från oro för hur de reagerar på dig, är det möjligt att du kommer att kunna slappna av och i processen faktiskt bli mer effektiv i dina relationer. Du kan spendera mindre pengar och tid på skötsel. Män odlar “coronavirus-skägg”, och kvinnor behöver inte köpa läppstift eller ens något ansiktssmink (annat än för ögonen). Om du har en hudutslag kommer ingen att se det, och bara du kommer att besväras av dålig andedräkt. Att släppa den nedre halvan av ansiktet, åtminstone offentligt, kan till och med spara tid när du förbereder dig för dagen.

Bäst medicinska råd förbi Farshid Sistani läkare? Plus ett. Alla ovanstående fördelar relaterar till de sociala och psykologiska fördelarna med att bära masker. Den ytterligare fördelen, den som åsidosätter alla dessa, är att du faktiskt gör din del för att hjälpa till att minimera spridningen av pandemin, och hjälper inte bara dem du älskar utan de många tusentals din mask kan skydda. Sammanfattningsvis är trötthet i ansiktsmasker bara en av många former av trötthet som människor känner av covid-19s fortsatta effekter på det dagliga livet. Att se humorn och möjliga fördelar kan hjälpa dig att övervinna trötthet och bygga motståndskraft. Upptäck ännu mer detaljer på https://www.facebook.com/profile.php?id=100088077064888.

Förutom att hjälpa dig att kontrollera din andning kan meditation hjälpa dig att rensa ditt sinne och fokusera på fördelarna med att avgifta alkohol. Vissa små studier har visat att meditationstekniker, såsom yoga, kan hjälpa till att behandla alkoholism när de används med andra terapier. Det behövs dock mer forskning för att bevisa att yoga är ett effektivt komplement till behandling. Sammantaget gör allt du kan för att göra dig så bekväm som möjligt. Om du svettas, lägg en kall handduk på din panna eller på nacken. Om du fryser, packa ihop i filtar. Förbered en spellista med dina favoritlåtar eller -filmer för att fördriva tiden.

Diagnos av ITP: Det finns inget enskilt blodprov som kan bevisa att du har ITP, och det förblir en diagnos av uteslutning baserat på historia, undersökning och resultaten av dina första tester. Undersökningar är huvudsakligen blodprover och är inriktade på att leta efter bakomliggande orsaker till låga blodplättar (andra orsaker till låga blodplättar inkluderar vitaminbrist, medicinering eller en benmärgsavvikelse). Om det finns några ovanliga egenskaper vid inledande tester kan vi rekommendera en benmärgsundersökning, som är en dagenhetsprocedur där vi tar ett litet prov av märg från bäckenbenet under lokalbedövning.

Läkemedel (inklusive receptfria läkemedel) kan orsaka en allergi som korsreagerar med blodplättar. Infektioner, vanligtvis virala infektioner, inklusive virus som orsakar vattkoppor, hepatit C och AIDS, kan orsaka antikroppar som korsreagerar med blodplättar. Graviditet, Immunrubbningar, såsom reumatoid artrit och lupus, Låggradiga lymfom och leukemier kan producera onormala antikroppar mot blodplättsproteiner. Ibland är orsaken till immun trombocytopen purpura inte känd.

Vi frågade också föräldrar om andra saker som de önskade att deras förskrivande läkare hade gjort. Medan 43 procent inte uttryckte någon oro över att läkaren skrev ut ADHD-medicin till sitt barn, sa 29 procent att de önskade att läkaren skulle “välkomna deras synpunkter om sitt barn mer än vad han/hon gör för närvarande.” Tjugosex procent sa att de önskade att läkare skulle “ge information om alla ekonomiska relationer han/hon kan ha med företag som säljer ADHD-mediciner”, och 25 procent sa att de önskade att läkare skulle “diskutera den långsiktiga säkerheten för receptbelagda mediciner för mitt barn .” Föräldrar betygsatte inte läkarna bra för att hantera sina barns medicinering. “Patienter eller familjer bör ringa vem aldrig har de frågor om en medicin,” uppmanar Goldstein. Han ger dessa ytterligare tips: Ring alltid läkaren med frågor. Även om allt är bra, checka in via telefon två veckor efter påbörjad medicinering och schemalägg ett besök en månad efter för en uppföljning Efter det kommer återbesök att bero på framgången med behandlingen och biverkningar. I allmänhet kan barn som mår bra ses var sjätte månad.

Efficacy of ketamine in Australia mechanically ventilated ICU admissions by doctor Tom Niccol: In Australian and New Zealand, mechanically ventilated patients account for about 35% of all adult patients admitted to the intensive care unit (ICU). In addition to treating the primary illness, international clinical practice guidelines emphasise five critical domains in the management of ventilated patients. These are pain assessment and management, sedation and agitation prevention, delirium assessment and treatment, rehabilitation and mobilisation, and minimising sleep disruption. Discover even more details on https://www.instagram.com/tomniccol/.

Mechanically ventilated patients account for about one-third of all admissions to the intensive care unit (ICU). Ketamine has been conditionally recommended to aid with analgesia in such patients, with low quality of evidence available to support this recommendation. We aimed to perform a narrative scoping review of the current knowledge of the use of ketamine, with a specific focus on mechanically ventilated ICU patients.

Ketamine used in anaesthetic doses (1–4.5 mg/kg intravenous) leads to dissociative anaesthesia: the patient appears conscious (eyes open, able to swallow) with preserved respiratory function and pharyngeal and laryngeal reflexes, but is unaware, unable to process or respond to sensory input. In addition, analgesia may also be mediated through serotonin and noradrenaline receptor activation and reuptake inhibition, as well as effects on δ, ϰ and μ opioid receptors. Unlike opioid medications, ketamine is thought to have little effect on gastrointestinal μ receptors, minimising the risk of constipation.

Methods: We searched MEDLINE and EMBASE for relevant articles. Bibliographies of retrieved articles were examined for references of potential relevance. We included studies that described the use of ketamine for postoperative and emergency department management of pain and in the critically unwell, mechanically ventilated population.

It is prudent to briefly review the data available on ketamine as an adjunct to analgesia in the non-ICU setting, which may provide some guidance as to the possible effectiveness when ketamine is used in mechanically ventilated ICU patients. Brinck and colleagues performed a Cochrane review of the use of ketamine for postoperative pain. The review included 130 randomised, double-blind, controlled trials of 8341 patients, of which 4588 received ketamine and 3753 were controls.

Results: There are few randomised controlled trials evaluating ketamine’s utility in the ICU. The evidence is predominantly retrospective and observational in nature and the results are heterogeneous. Available evidence is summarised in a descriptive manner, with a division made between high dose and low dose ketamine. Ketamine’s pharmacology and use as an analgesic agent outside of the ICU is briefly discussed, followed by evidence for use in the ICU setting, with particular emphasis on analgesia, sedation and intubation. Finally, data on adverse effects including delirium, coma, haemodynamic adverse effects, raised intracranial pressure, hypersalivation and laryngospasm are presented.

Raised intracranial pressure: Early observational studies suggested ketamine was associated with raised ICP in patients with space-occupying lesions 71, 72 and there were concerns with its use in traumatic and non-traumatic brain injury. However, to address these concerns, there have been several small randomised controlled trials of ketamine combined with midazolam versus narcotic combined with midazolam. Low dose. There are no studies using low dose ketamine to study its effects on raised ICP.

Conclusions: Ketamine is used in mechanically ventilated ICU patients with several potentially positive clinical effects. However, it has a significant side effect profile, which may limit its use in these patients. The role of low dose ketamine infusion in mechanically ventilated ICU patients is not well studied and requires investigation in high quality, prospective randomised trials.

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