Page 165 - PJ MED OPS Handbook 8th Ed

• Other Notes:
○ Ketamine should not be injected intravenously without proper dilution. It is recom-
mended the drug be diluted with an equal volume of normal saline.
○ If pre-loading ketamine in syringe for care under fire or CASEVAC missions, ensure to label
syringe with time/date and dosage and ensure to discard any unused medications after
24 hours.
○ Ketamine is not compatible with Lactated Ringers. For infusion, mix with normal saline or
PlasmaLyte A.

Ketorolac (Toradol )
®
GROUNDING medication for Air Force personnel on flight status
• Description: analgesic, non-steroidal anti-inflammatory drug (NSAID), inhibits platelet function
• Indications: mild to moderate pain due to musculoskeletal injury (most common during pa-
trol); as a base-line pain med during prolonged field care for patients with no active bleeding.
• Adult dose: 15mg IV/IM. May be repeated q6hr for up to 72 hours.
• Pediatric dose: adolescents 13–16 years and children 2–12 years: 1mg/kg IM to a maximum
of 15mg or 0.5mg/kg IV to a maximum of 15mg
Contraindications: aspirin allergy, history of severe asthma, history of bleeding, not to be
used chronically in combat zone due to anti-coagulant effects, ACTIVE COMBATANTS/OPER-
ATORS, kidney failure, pregnancy
• Side-effects: prolonged bleeding time, tinnitus, edema, peptic ulcer, gastritis

Levetiracetam (Keppra )
®
• Description: antiseizure (antiepileptic)
• Indications: Treatment of persistent or recurrent seizure in conjunction with midazolam.
Prohylaxis for casualties with depressed skull fracture or penetrating brain injury.
• Dose:
○ Loading: 2g for standard adult dose (or 20mg/kg) IV or IM loading dose over 10 minutes
○ Maintenance: 1g IV q12hr over 15 minutes
Contraindications: pregnancy
• Side-effects: weakness, suicidal tendencies, pancreatitis, diplopia, anxiety, amnesia, cough
• Adverse Reactions: 13% of adults report psychiatric reactions

Lidocaine HCl (Xylocaine )
®
Aviation personnel are grounded for 12 hours after the use of local anesthesia and until
symptoms have resolved enough to allow safe performance of duties.
• Description: local anesthetic
CAUTION: PJs are supplied lidocaine without epinephrine. In some theaters, lidocaine solu-
tions contain 1:10,000 epinephrine may be supplied. This causes intense vasoconstriction
and prolongs the duration of the anesthesia. These solutions are identified by a red label or
red lettering on the label.

Chapter 9. Pararescue Drug Formulary n 163