Ketamine

Question 1

When is it preferable to dose ketamine?

Answer 1

Early in the treatment episode, prior to establishing intravenous access for opioid administration or IN fentanyl

This ensures effective pain management and reduces the need for additional interventions.

Question 2

What should be administered before sublingual ketamine if feasible?

Answer 2

Oral paracetamol

This combination may enhance analgesic effects.

Question 3

Why are emergence reactions and dissociative effects unlikely with this ketamine formulation?

Answer 3

Due to lower peak plasma concentrations compared to IV ketamine

This formulation is designed to minimize these side effects.

Question 4

How must the sublingual tablet be removed from the blister pack?

Answer 4

Using the dedicated tear strip and NOT pushed through foil

This prevents breaking the tablets.

Question 5

What condition allows fractured tablets to be safely administered?

Answer 5

If they are not crumbled

Crumbled tablets may lead to improper dosing.

Question 6

What happens to the absorption of incorrectly administered sublingual tablets?

Answer 6

It is lower, especially if the tablet is swallowed

Proper administration is crucial for effective dosing.

Question 7

What are notable adverse effects of sublingual ketamine?

Answer 7

• Dizziness
• Feeling abnormal
• Drowsiness

These effects may vary in intensity among patients.

Question 8

How should IV/IO ketamine be prepared for administration?

Answer 8

Dilute as per medication calculator and inject bolus slowly (over 2 - 3 min)

This method ensures proper dosing and minimizes side effects.

Question 9

What is the onset of action for IV/IO ketamine?

Answer 9

2 - 5 minutes

Quick onset is beneficial in emergency settings.

Question 10

What is the duration of action for a bolus of IV/IO ketamine?

Answer 10

30 - 40 minutes

This duration is suitable for managing acute pain.

Question 11

What are notable adverse effects of IV/IO ketamine?

Answer 11

• Dysphoria and emergence reactions
• Apnoea (usually within first 2 to 3 mins of administration)
• Nausea and vomiting
• Tachycardia and hypertension
• Laryngospasm
• Purposeless movements
• Hypersalivation

Awareness of these effects is important for monitoring patients.

Question 12

True or False: Sedation may be appropriate for patients in extremis.

Answer 12

False

Caution is required as sedation could worsen the patient’s condition.