In November 2016, I had the pleasure of having my first article published in a peer reviewed journal. Ketamine has a long history of use in medicine, and this article gives an overview of the use of Ketamine in emergency situations. The article is available in print in the November edition of the Journal of Emergency Medical Services (JEMS) and is also available online. You can find an interactive version of the quiz that appears in the article here on my site. In fact, you might want to take the quiz before reading the article, just to see how good your current knowledge of the effect, administration, dosage, and effects of Ketamine are.
My thanks to Pennwell publications and editors Ryan Kelley and Allie Daugherty for their work. And a special “thank you” to Paramedic Leah Rife for being dedicated enough to the cause of medicine to pose for images in the middle of 48 hour shift.
If you are in need of training, demonstrations, or guest speakers at your organization, please feel free to contact me.
A quick table of contents for the article:
The author, Dr. Lindsay Henderson, MD
Introduction
History of Ketamine
Pharmacology, Administration, and Dosage
Airway, Sedation, and Intubation
Pain
Cardiology, Neurology, and Physiology
Secondary Effects, Considerations, and Contraindications
Illicit Use
Wrapping Up
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science
In November 2016, the full article will appear in JEMS magazine, both on their website – JEMS.com – and in magazine publication. How much do you think you know? Before you read the article, take this quiz to see how much you really know about how to use ketamine in emergency situations.
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At 0300 hrs you are toned out to a single vehicle accident with one passenger who slid off the road and wrapped his car around a light pole. A 44 year old male is alert, rates his pain a 13 on a 1-10 scale, and reports that he has asthma. Vital signs are: heart rate 70, blood pressure 90/60, and respirations of 25. Extrication will be at least 30 minutes and the patient has multiple fractures. What drug will you consider that can manage this patient’s pain, improve his cardiovascular state, and sedate him for extrication? Have you considered ketamine?
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You’ll also note the chart: the information enclosed was not published with the article due to space restrictions. Ketamine is a dissociative molecule meaning the drug breaks apart (or dissociates) and attaches to many different receptors. This binding results in either the turning on of receptors (upregulation) or turning them off (down regulation) causing various effects. In this case, we focus specifically on 3 major channels and receptors that provide the desired effects of ketamine for field use: sedation, hypnosis, analgesia, and bronchodilation/vasoconstriction. Note that many other channels and receptors are effected by ketamine molecules.
Molecular Systems affected by Ketamine
ACTION
ALTERATION BY KETAMINE
NMDA
“Turned on” by glutamate. NMDA is an excitatory receptor for locomotion, breathing, behavior, learning, & memory.
Temporarily blocks glutamate, resulting in sedation of locomotion, relaxation of breathing, sedation, disruption of memory.
HCN-1
Contributes to cortical and cardiac rhythms.
Promotes cortical synchronization and rhythms, contributing to hypnosis .
Nicotinic acetyl-choline ion channels
Modulates regulation of dopamine, serotonin, and dopamine.
Inhibits glutamate causing downregulation contributing to analgesia .
L-type Ca2+ channels
Excitation-contraction of skeletal, cardiac, and smooth muscles.
Inhibits channels resulting in vasodilation and bronchodilation
Fig 1. Summary of receptors affected by ketamine that are pertinent to EMS use. Demonstrates the pathophysiology and dissociative pharmacology of ketamine. NMDA= n-Methyl-d-Aspartate. HCN-1=hyperpolarisation-activated cyclic nucleotide channels.
References for Figure 1
Sleigh J, Harvey M, Voss L, et al. Ketamine-more mechanisms of action than just NMDA blockade. Trends in Anesthesia and Critical Care. 2014; 4. 76-81.
Blanke M, VanDongen A. Biology of the NMDA Receptor. CRC Publishing: Boca Raton, pp 283-312,2009.
Chen X, Shu S, Bayliss D. HCN1 channel subunits are a molecular substrate for hypnotic actions of ketamine.The Journal of Neuroscience. 2009;29. 600-609.
Tassonyi E, Charpantier E, Muller D. The role of nicotinic acetylcholine receptors in the mechanisms of anesthesia. Brain Bulletin. 2002;15. 133-150.
Kaye A, Bannister R, Anwar M, et al. Pulmonary vasodilation is mediated in part by L-type calcium channels. Anesthesia and Analgesia. 1998;87. 956-962
For the in depth article, go to JEMS.COM starting November first.
This post, the quiz, and the table are Copyright 2016, Dr. Lindsay Henderson, M. D. If you wish to use or replicate any of the above information, please contact me.
Do you like to get dirty!? Feel a little muddy soil squish through your fingers and dry into soft dirt on your palms? Breathe in the smells of fresh earth and summer time all year round? You don’t have to get SUPER “mom-is-really-angry-“that you ruined your new shoes muddy, just a little garden dirt on your hands. Because guess what?! Most kids spend SEVEN hours a day inside sitting on their backsides on games and phones. Think of how much more fun you might have spending twenty minutes outside creating some new plants to decorate your house and room with? Think what cool things you could create with seven whole hours a day!
Biology is life. The word itself means to study life. I don’t get the chance to bring biology projects to conventions and lessons so I am hoping you can bring them into your life. Nature is life and this is the easiest, cheapest, perfect introduction into “household nature”. I love that in doing this you and your parents have the chance to see if there’s a green thumb behind that texting thumb! Who is the best gardener at your house? Has anyone ever done any gardening? Who can grow the biggest plant or keep it alive the longest? I think this is a great thing to do in your family!
I’ll save you the HOW to do this for the video! But the why– propagation or the taking a piece of a plant to grow a whole new plant is it’s own little form of household magic, It’s a great way to create gifts for family or friends, do a school science project everyone can participate in, or even as a project your friends can carry home from a birthday instead of a sugar laden favor. Spoiler alert–the next post I’ll show you how to propagate spider plants; I just did a ton of them to decorate my sister-in-laws wedding with.
So many benefits! Fast! Easy! Cheap! Basically not too dirty if you try to avoid that sort of thing in your life. You connect with nature and you’re part of adding more green and life to this planet.
I can start a new portulaca [port-u-lack-ah] from a stem of my mature one in less than 5 minutes. You could really stretch this to a 20 minute project if you wanted! Propagation just means you start a new plant from the seeds, stems, roots, or part of another plant to grow a new one.
Fast Portulaca facts! These are succulents meaning they thrive in dry, low maintenance conditions, little water, and bright sun. They don’t drop too many leaves, bloom almost daily in hot sun, and with care can live through the winters indoors. They attract lots of bees and butterflies and can be at home in pots, planted in the ground, or hanging baskets. Those indoor glass round terrariums are a trend right now; succulents grow well in them hanging in windows.
Lots of succulents besides portulaca can be easily grown and propagated from the leaves and stems of parent plants. If you live someone that they grow wild, you can go on a nature hike and collect broken off leaves or stems after a rain that have broken off. This is a great way for kids to start their own!
Your possibilities are endless, but the most important part is you’re introducing your kids to gardening and simple easy contact with nature.
Enjoy propagating some plants and send me pictures of your garden!
Photo credits: All L. Henderson
Portulaca blooms almost daily, in massive bursts and close up by sunset. (Einstein quote)
Garden variety Portulaca that I’ve had for about 16 months. It survived a winter indoors in Northern Pennsylvania & came back stronger.
My big portulaca broke last winter after moving in from Kansas to Pennsylvania. I took the tiny broken pieces, deposited them in a record bowl with another succulent and the took off blooming! You can mix lots of succulents together for a beautiful basket of variety.
My neighbor of 34 years moved last week and she shared some stems from her plant. This is about 2 weeks of growth on a freshly propagated plant!
Twenty four hours after filming, this “baby” portulaca is starting to get roots and adjust to its new pot. .
Video Coming Soon! Due to some technical issues, we had to pull the previous one, and we’ll be uploading a new one shortly.
If you’re going to create a universe, you’re going to have to have energy to run it! The world we live in wouldn’t exist in the same way without magnetism, currents, and electricity! One of my favorite things to build with kids is a monopolar engine. It’s simple, quick, inexpensive and really fun. And it only takes 3 items.
You’ll need one AA battery, some copper wire (16 gauge on a spool is great), and a rare earth or neodymium magnet. I got my copper wire for around $5.00 at a large chain hardware store and several of those also carry the rare earth magnets. You can also order them online. The ones I used in this video are ½” in diameter and ¼” thick and perfectly fit the bottom of an AA battery. They come in an 8 pack so you can make up to 8 engines at once.
The video tutorial explains the basics but some helpful hints along the way. Shape the wire and work with it a bit before you put the magnet on the battery. Keeping the copper wire connected to the battery and magnet for too long generates enough heat to get hot. If it’s getting hot you’re not quite doing it right! The wire should be loose and just touching the positive end at the top and the magnet at the bottom! Wrapping it too tight will generate too much heat and the wire won’t move. Be careful with the magnets. The bigger they are, the stronger they are and they can slam into each other with a good deal of force. Once you have a shape, attach your magnet to the negative end of the terminal and put your wire on. You may have to tweak your wire shape several times. This is a great way to see the personality of your kids. I’ve seen kids happily spend 15 minutes getting the perfect shape and others are done in 5 seconds. A perfect shape is just one that stays on the battery and moves in a circular motion! I would love to see any shapes and engines that you create! Please send me pictures or videos!
Discuss what shapes work best and why you think they do. Talk about what you might be able to use this for in the future. Remember, we don’t have a known use for a monopolar engine except to demonstrate current flow but if you and your child invent it, the possibilities are endless!
And last but absolutely not least, I’d like to take a minute to dedicate this post to a really wonderful friend Scott and his lovely new bride Kelly! I met Scott while discussing monopolar engines and engineering so I’d like to take this moment to wish the new Mr. & Mrs. the magic of always being able to generate all the energy, electricity, and magnetism to keep a marriage flowing and moving forward forever. There are four things you must never do: lie, steal, cheat, or drink. But if you must lie, lie in the arms of the one you love. If you must steal, steal away from bad company. If you must cheat, cheat death. And if you must drink, drink in the moments that take your breath away. Congratulations.
Photo credit of Scott & Kelly: Lynn Kennedy Photography
“Every kid starts out as a natural born scientist and then we beat it out of them. Few trickle through with their wonder and enthusiasm for science intact.” Carl Sagan
I was honored to be part of the first annual ICT Comic Con & Science Fiction Convention. Apparently it was so popular I wasn’t the only one who was parking for 27 minutes and THAT is a very good thing! Smiles and laughter were everywhere and there was some great cosplay happening. But the absolute best parts of the day were the junior scientists.
My favorite quotes of the con: “Is this a SCIENCE THING?! OMG I LOVE SCIENCE!” and “Mom! Look ! I’m doing science and it’s not even for school!” I witnessed so much excitement about hands on stress free science projects where kids could play and learn without pressure. Parents and kids were totally absorbed in working together to build engines and make rubber balls. Science is a place to bond with your kids and encourage them to retain the wonder and creativity of childhood always. I am constantly honored to be a part of that.
I was very graciously provided the use of a booth table by Mr. Davis Ray Sickmon, Jr and the board of ICT Comic Con and this was the first time I’ve done projects at a booth instead of classroom style. It was amazingly fun and super crazy! I do want to thank Mr. Sickmon and ICT Comic Con for generously inviting and allowing me to donate some time to engaging the future science minds of Kansas on a Saturday morning! You have contributed to encouraging minds and that is priceless.
It’s always a toss up between making rubber balls and engines for what might be the most popular event. Although, the 5-7 year old crowd was pretty thrilled at the warring acid-base volcano and everyone loved creating lighting up the space by creating human energy circuits. Borax crystals fascinated all ages proving that there is no age limit or education gap science can’t somehow bridge. Everyone knows something and everyone can contribute!
I got some fantastic suggestions too for my website. In the upcoming few weeks I’ll be designing a science themed birthday party idea where with just a few supplies you can create some junior mad scientists at your kitchen table and I’ll be adding some biology and more projects to my “creating your own universe” series (we’ve built crystals and generated energy for a planet…what else do we need?!). I always want suggestions for videos you’d like to see, science you’d like to do, and projects!
The Doctor and Davis… thank you for supporting science for kids! (credit Davis Ray Sickmon, Jr)A group of new scientists discover the magic of creating a polymer rubber ball. (credit L. Henderson)
Want to master the universe and do in days what it took the earth millions of years to accomplish? All it takes is Borax washing detergent, boiling water, a pipe cleaner, and a jar. No, really.
Create some beautiful crystals in three days for about $5.00 (or less if you’ve already got a box of Borax hanging around the house. If you don’t have it, you’ll find it in your laundry detergent section at any grocery or big box store). Watch my video for step by step instructions and if you simply can’t wait, skip to the end to see the crystals.
Borax is a mineral called Sodium Tetraborate and has a naturally occurring crystal form. It’s been ground into a fine white powder and when you put it into a solution and let it cool again the elements will reform into a crystalline structure. You boil some water, add borax, drop in something (pipe cleaners for example) for the crystals to go on, wait a few days and you’ve got the beginnings of your own universe. Today, crystals; tomorrow a new life form.
Do you need something to do this weekend? Drop into Wichita, Kansas for their first ever ICT ComicCon and Science Fiction Convention this Saturday, August 27th, 2016 from 10am-6pm. And guess what?! Totally free. Meet great authors and entertainers, watch some awesome stuff, and put on your best cosplay for a day at the con!
Why am I so excited about promoting this? Well, it’s new and those of us who live in the Midwest and Plains states don’t often get the access to all the geeky, nerdy, science-y amazing events that bigger cities in more urban places do. We want things like this to get a great turnout and support that will end up bringing more awesome experiences to your doorstep in the long run!
I’ve been asked to participate and I’m very honored to be a part of the first annual event! Mr. Davis Ray Sickmon, Jr., game developer, author, and general all around wizard of the web and I have built a project called “Positive Geeking”! Sounds fun, doesn’t it? By all means drop by about 11am and see what it’s all about! I’d tell you more but I like to leave a little mystery . . .
Of course there will be some Sciencing with the Doctor. Crystals, electrons, earth magnets, and perhaps a little bounce! There’s always something magic happening when The Doctor comes to call.
Sciencing with The Doctor: 10-11am
Positive Geeking with Mr. Davis Sickmon: 11-1130am
Sweltering in the heat yet? Does the pool that froze you in June feel like bathwater now? Do you have a countdown timer until the first day of school begins? Do yourself a favor and take the kids to a museum. Sometimes an adventure into science starts in seeing something you never imagined you could lay eyes. Ten-billlion year old diamonds? I think yes. A working butterfly hatchery? Absolutely! Magic in the eyes of your kids? Come on, even if you had to pay for that it would be priceless. Sometimes you have to see an old thing from a new light, or maybe see it for the first time. Museums spark the imaginations of kids; they spark curiosity and questions and an excitement about the world around them. Summer goal? Make a museum scavenger hunt: have your kids seek out the following:
1) One thing you loved that you never saw before.
2) Find something that grosses you out.
3) Share something you learned that you didn’t know before.
4) Something you want to learn more about when we get home.
5) Tell me about your favorite thing you saw today and why.
As your children see things they’ve never seen before, before you explain what it is, ask them what they think it is and what they would do with it if it was in their house. Ask them to choose what things they would buy if those things were for sale or they could find one. Make the museum an adventure! Most of them are free or reduced in price and air-conditioned. I love the ‘discovery’ center for kids but don’t rule out the classic museums. There is science to everything: how paints were made, how cannon balls fire, why fabric disintegrates over the years. Talk about that kind of stuff with your kids and look it up at home. All of you may discover a whole science you never thought you’d love!
I missed the boat on having children–for many reasons–and after much deliberation on that matter I realized that when the master was ready the students would come. Meaning, of course, that when I was ready to have children in my world they would simply show up; hopefully not on my doorstep in a basket or wandering around like stray kittens. I won’t be seeing my eyes in the face of my son or hearing the echoes of my laughter in my daughter and I’m okay with that because I’ve decided that, being childless, I have so much time and knowledge and magic that I can share with so many kids.
SO–TO THE TEACHING. Kids need magic and they need play and they need that brilliant imagination stoked with all sorts of kindling for the ideas of tomorrow. After much thought, I choose to provide magic and play to kids in the form of dress up. Kids NEED to know it’s okay to practice chemistry with a tiara on. Because pretending you’re a Princess using magic to escape a dungeon is a whole lot better than waiting for someone to rescue you. Pretending opens the mind and sparks the imagination and allows kids to think “WHY? And, HOW” and it opens a tiny door toward learning. Kids that dream big dream their way to stars and space and medical discoveries. Kids that ask “Why?” develop new ways to clean the ocean’s trash, stop poachers, and test for cancer.
But where do you get to make magic with kids and teach science? At Gallifrey One, naturally. Oh, there’s no pressure to being invited to teach at the world’s first and longest running Doctor Who convention? There’s zero stress to coming up with something kids from 7-17 and their parents will love doing together and not get bored. I was honored, I was thrilled, and I was a little terrified. A world class convention better have a world class magic hour.
Geodes and engines and polymer balls and hex nut orbits + a brilliant sense of humor x sonic screwdriver magic – pressure or testing = 100 people having an amazing time. We laughed, we smashed rocks to discover agates or crystal caverns. We formed copper coil monopolar engines and figured out which shapes spun the best. We bounced rubberized polymer balls off walls and desks. We spun pennies and hex nuts in orbit and contemplated the physics of love.
AND it was so good. Parents still parented but they got to see their children in a whole new light– the potential within them lit up with great questions, “Why do some engines spin clockwise vs. counterclockwise”, “Is it inertia that makes the pennies keep spinning”, “Why are some geodes solid and other’s hollow”. Children got to see their parents having fun and they saw that adults still can learn and have fun too.
We made all the science relate to The Doctor and how he can see beyond the surface. How he sees what could be or what is or how, with some knowledge, you can build something that will get you off a burning planet. We learned to reverse the flow of the ELECTRON polarity and how to appreciate laying eyes on something millions of years old that no one has ever seen before them. We learned without pressure, without testing, and we learned that when all else fails, you wave your sonic over it and start again.
My favorite part of every class were the smiles as kiddo after kiddo showed me–toothy grins agleam–the insides of their geodes. The second favorite part? The relaxed faces of moms and dads who got to stop being parents for 1 hour and be a lab partner. Sometime’s you need a break from parenting so you can see just how amazing your kids are, I think.
I gleaned some data and I’m looking forward to seeing if the children who want to be singers, dinosaur magicians, environmental scientists, astronauts, and math teachers grow up to follow their dreams. I am anxious to see if kids who never wanted to do anything with science may consider a field in engineering, math, science, or technology. My door is always open to them (and their parents) for feedback, mentoring, suggestions, and support.
As the night closed, I need to give a curtain call to my phenomenal assistants “Mistress” Monique Verschuur and “Doctor” Sawyer along with photographers and engineer F. Scotty Douglas and Judy Forbes. They were the team of companions every Doctor needs when she’s debating drinking the Everclear as opposed to making balls out of it. And Shaun Lyon, the center cog at the machine that is Gallifrey–thanks for letting us try something new, thanks for opening your doors to Sciencing With The Doctor. Every kid needs a dream, a sonic, a tiara, and the permission to blend fantasy with science. I’m already planning next year’s “In the Lab with Doctor Who” experiments.
Thank you.
A huge thanks to Monique Verschuur and Sawyer for their assistance during Sciencing With The Doctor, and a huge thanks to Judy Forbes and Scotty Douglas for their photography work!
