Along with droperidol and dexamethasone, ketamine is on my short list of favorite medications for use in the Emergency Department. As this correspondence from authors at Highland Hospital summarizes, it's a floor wax and a dessert topping:
- Use as peri-procedural pain control/anxiolytic to assist with subcutaneous infiltrative local anesthesia.
- Use as adjunctive pain control in patients who are failing high-dose narcotics.
- Use as pain control/anxiolytic in patients with significant supratentorial comorbidities.
These authors state "In clinical practice, chronic pain, psychologic distress,
and behavioral disorders frequently overlap", and I couldn't agree more. Sub-disassociative doses of ketamine (0.1 to 0.3 mg/kg) have an excellent safety profile and represent an ideal option for multiple common clinical situations in the ED.
If your ED restricts the use of ketamine, you need to make that stop.
"Emerging applications of low-dose ketamine for pain
management in the ED"