Ketamine

Question 1

** Ketamine**
Drug Class

Answer 1

Anaesthetic, Analgesia– Rapid acting dissociative anaesthetic

Question 2

** Ketamine**
Onset

Answer 2

IV - 1 minute
IM - 5 - 10mins

Question 3

** Ketamine **
Indications

Answer 3

• • IV: Second line agent for severe pain of traumatic origin post 200mcg Fentanyl administration
    *IM:First line agent for severe pain of traumatic origin if other pain administration unavailable
• Combative Traumatic Brain Injury
• First line agent for severely disturbed or abnormal behaviour (RASS 4) and no other sedatives given.
• CPR Induced Consciousness (CPRIC) where patient movement or other features are interfering with cardiac arrest management

Question 4

** Ketamine**
Contraindications

Answer 4

• Hypersensitivity to ketamine
• Active cardiovascular disease

Question 5

**Ketamine **
Analgesia
Dose

Answer 5

Adult: IM

(pre-hospital only):
* Initial dose: 1 mg/kg
* repeat at 5 minute intervals – 0.5 mg/kg
* Concentration: 200 mg/2 ml = 100 mg/ml

Adult:IV/IO
(Dilute 200 mg in 2 ml with 18 ml NaCl 0.9% to produce 10 mg/1 ml)

• (pre-hospital only):*
• Initial dose: 5 - 20 mg titrated to effect over at least 1 minute
• repeat at 5 minute intervals: 5 - 10 mg titrated to effect

Paediatric: IM

(pre-hospital only):
Initial dose: 1 mg/kg;
repeat at 5 minute intervals: 0.5 mg/kg;
Concentration: 200 mg/2 ml = 100 mg/ml

Paediatric: IV / IO
(Dilute 200 mg in 2 ml with 18 ml NaCl 0.9% to produce 10 mg/1 ml)

(pre-hospital only):
* 0.1 mg/kg administered over at least 1 minute titrated to effect
* Repeat at 5 minute intervals as required

Question 6

**Ketamine **
Disturbed Abnormal behaviour
(Rass 4)
Dose

Answer 6

Adult 16 or over IM:

Initial dose (agreed ideal body weight):

• 2 mg/kg
  (Max bolus dose 200 mg) in moderate to severe alcohol intoxication.
• 4 mg/kg max bolus dose of 400 mg in nil to mild alcohol intoxication.

IV access obtained as soon as practicable:

• 0.5 mg/kg repeated every 5 - 10 minutes ONLY IF REQUIRED

(Dilute 200 mg in 2 ml with 18 ml NaCl 0.9% to produce 10 mg/1 ml)

Question 7

**Ketamine **
Combative Traumatic Brain Injury
Dose

Answer 7

IM:
Initial dose (agreed ideal body weight):

2 mg/kg
(max bolus of 200 mg )

IV access obtained as soon as practicable:

IV /IO:
0.5 mg/kg repeated every 5-10 minutes IF REQUIRED

(Dilute 200 mg in 2 ml with 18 ml NaCl 0.9% to produce 10 mg/1 ml)

Question 8

**Ketamine **
CPR Induced Consciousness (CPRIC)
Dose

Answer 8

IV/IO:

0.3 - 0.5 mg/kg, repeated once only at 5-10 minutes if required

Question 9

Ketamine
Side Effects

Answer 9

Dissociation and trance like state
Transient hypertonicty and nystagmus
Disinhibition
Emergence reactions
Hypertension
Tachycardia
Depresion of consciousness
Hypersalivation
Nausea AND/OR Vomitting
Laryngospasm
Respiratory Depression (rare)