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  Background: Up to 20% of CVAs involve posterior circulation Most commonly missed Posterior strokes not well identified on the usual screening tools Anatomy:     Symtoms: dizziness off balance sensation vision is blurry, oscillating or jumping bilateral leg weakness and / or numbness hemiparesis with motion disturbances on non-hemiparetic side facial symptoms Signs: ataxia (finger to nose / heel to shin / truncal) ataxia when standing (Romberg) or walking locked-in syndrome nystagmus bilateral horizontal gaze palsy internuclear ophthalmoplegia: vertical and rotatory nystagmus visual field defects Vertebral Artery Dissection: sudden rotational force minor trauma, childbirth, sexual intercourse, coughing, sneezing, Chiropractic high velocity manipulation 60%-90% alsoRead More →

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Ketamine is being used with increasing frequency in the prehospital setting for sedation of the agitated patient. Ketamine received some bad press in the summer of 2018 which resulted in putting the prehospital study of the use of ketamine in agitated patients on hold in Minneanapolis, MN. With increased use, we wanted to provide a succint review of ketamine and its use specifically for sedation. This is different than using ketamine for analgesia, which we will discuss in an upcoming episode.  Ketamine Fast Facts:  Developed as an anesthetic Dissociative agent Both amnestic and analgesic properties Administer IM, IV, IO, IN Dose: 1-2 mg/kg IV/IO; 4-5Read More →