A Comparison Study of Two Different Methods of Administration: Intranasal versus Intramuscular for Pediatric Procedural Sedation and Analgesia

PURPOSE: To compare the efficacy of ketamine between intranasal (IN) administration and intramuscular (IM) injection for pediatric procedural sedation and analgesia (PPSA). METHODS: A prospective study was conducted during 3 months. Ketamine was given by IN or IM route before primary repair of facial laceration for procedural sedation. The administration dose was 8 mg/kg for IN and 4 mg/kg for IM. We evaluated resistance scale on administration, sedation scale, satisfaction of physician and parents. RESULTS: One hundred children were enrolled into this study. IN administration was given to 50 children, and IM injection to 50 children each. In the IN group, 75%(36 of 50) showed severe resistance, whereas only 34%(17 of 50) showed severe resistance and 50%(25 of 50) showed mild resistance in IM group. Successful rate of sedation after initial administration was 82%(41 of 50) in IM group and 34% in IN group. Satisfaction of physicians and parents was high in IM injection group. CONCLUSION: Intranasal administration of Ketamine is less effective and provides lower satisfaction than intramuscular injection for procedural sedation of pediatric patients in the emergency department.

Bullet Embolism

When a bullet hits the body, it generally follows a straight path, and there may or may not be an exit wound. Sometimes the bullet loses its kinetic energy within a blood vessel and thus it embolizes into the cardiovascular system, either in the systemic circulation or the pulmonary circulation and we call this phenomenon a "Bullet" embolism. A thirty-five years old man with a gun shot injury on his abdomen came to hospital. There was an entry site, but no exit site. According to his plain X-ray, there was no bullet in his abdomen. Instead, the bullet was located on the right ventricle of the heart. Because there was no injury on his diaphragm and heart, we concluded that the bullet got into a blood vessel and it ran through the venous system into the heart.