Ketamine

Question 1

Ketamine: Introduction

Answer 1

Rapid acting dissociative anaesthetic

Use of a sedative agent should never be considered routine. Adopt a high threshold to offer or administer

Question 2

Ketamine: Indication

Answer 2

IV: Second line agent for severe pain of a traumatic origin post IV Fentanyl administration. ASMA consult needed if IV Fentanyl minimum dose (age dependant as per CPG) has not been given prior to IV Ketamine administration

IM: First line agent for severe pain of a traumatic origin should other means of administering pain medication not be available

Combative Traumatic Brain Injury

(RASS 4) First line agent for severely DAB where there is an immediate risk to safety and rapid tranquillisation is required and no other sedative medications have already been administered to this patient

Question 3

Ketamine: Contraindications

Answer 3

1) Hypersensitivity

2) Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension

3) Patients with delayed transfer of care (ramped)

4) DAB that are clearly not RASS 4 or where other sedative agents have already been administered (ASMA authority required)

5) Rapid Tranquilisation ONLY: Age <16 years old

6) Age <1 years old

Question 4

Ketamine: Considerations

Answer 4

BREHTT

Blood pressure and pulse frequently elevated

Random purposeless movements, muscle twitching and rash are common

Hypersalivation

Emergence reactions (10%)

Transient laryngospasm

Transient apnoea or respiratory distress

Question 5

Ketamine: Precautions

Answer 5

Caution with psychiatric disorders - Schizophrenia
Caution with hypothyroidism
IV Fent minimum dose required
For non-traumatic pain consider CSP consult

Question 6

Ketamine: Precautions

Answer 6

Psychiatric disorders (schizophrenia)
Hypothyroidism
IV Fent minimum dose
Analgesia for opioid dependant patients