Ketamine

Question 1

Ketamine Intro

Answer 1

• Rapid acting dissociative anaesthetic
• IM onset: 5-10 minutes
• IV onset: 1 minute
• Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.

Question 2

Ketamine Indications

Answer 2

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

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

Combative Traumatic Brain Injury

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

Question 3

Ketamine Contra

Answer 3

• Hypersensitivity
• Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension
• Patients with delayed transfer of care (i.e. ‘ramped’)
• Disturbed and abnormal behaviour that are clearly not RASS 4 or where other sedative agents have already been administered (ASMA authority required)
• Rapid Tranquilsation ONLY: Age < 16 years old
• Age <1 Year of age

Question 4

Ketamine Precautions / Notes

Answer 4

• Caution in patients with stable psychiatric disorders such as Schizophrenia
• Caution in patients with hyperthyroidism or receiving thyroid replacement due to increased risk of hypertension and tachycardia
• Analgesia – IV Fentanyl minimum dose (age dependant as per CPG) should be given prior to IV Ketamine administration
• Analgesia for Non traumatic pain (IM / IV / IO) in opioid-dependent patients – consider SOC CSP consult

Question 5

Ketamine Special Considerations (Side Effects)

Answer 5

• 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 depression

Question 6

Ketamine Presentation

Answer 6

IV/IO/IM 200mg in 2mL