I had the opportunity to respond to questions submitted to me by my institution's peer review committee regarding my care of an agitated, violent patient who received ketamine to control violent behavior and permit evaluation. This was an interesting and complex case. The patient was taken to the emergency department (ED) by paramedics after he jumped from a bridge approximately 30 feet into a river. He presented with mild hypothermia and moderate hypertension and was initially cooperative with the evaluations, including radiological testing and blood draws. After returning from the radiology department (where computed tomography scans proved negative for serious injury), this large, muscular patient leaped from his bed, threatened violence to multiple staff members, exited his room suddenly to attack a staff member, and was tackled to the ground.
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- Acute pulmonary edema associated with ketamine-induced hypertension during procedural sedation in the ED.Am J Emerg Med. 2017; 35: 522.e521-522.e524
- Hypertension and pulmonary oedema associated with ketamine administration in a patient with a history of substance abuse.Can J Anaesth. 1993; 40: 160-164
- A physiologic analysis of cardiopulmonary responses to ketamine anesthesia in noncardiac patients.Anesth Analg. 1977; 56: 813-816
- Ketamine use for acute agitation in the emergency department.J Emerg Med. 2015; 48: 712-719
- Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update.Ann Emerg Med. 2011; 57: 449-461
- A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients.Acad Emerg Med. 2000; 7: 228-235
- Myth: ketamine should not be used as an induction agent for intubation in patients with head injury.CJEM. 2010; 12: 154-157
- Ketamine for rapid sequence induction in patients with head injury in the emergency department.Emerg Med Australas. 2006; 18: 37-44
- When used for sedation, does ketamine increase intracranial pressure more than fentanyl or sufentanil?.Ann Emerg Med. 2015; 65: 55-56
- Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension.J Neurosurg Pediatr. 2009; 4: 40-46
- The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review.Ann Emerg Med. 2015; 65: 43-51.e42
- Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients.Ann Emerg Med. 2017; 69: 24-33.e22
- Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil.Crit Care Med. 2003; 31: 711-717
- Effects of ketamine in normal and schizophrenic volunteers.Neuropsychopharmacology. 2001; 25: 455-467
- Subanesthetic doses of ketamine stimulate psychosis in schizophrenia.Neuropsychopharmacology. 1995; 13: 9-19
- A prospective study of ketamine versus haloperidol for severe prehospital agitation.Clin Toxicol (Phila). 2016; 54: 556-562
- Ketamine as a first-line treatment for severely agitated emergency department patients.Am J Emerg Med. 2017; 35: 1000-1004
- A meta-analysis of the risk of acute extrapyramidal symptoms with intramuscular antipsychotics for the treatment of agitation.J Clin Psychiatry. 2008; 69: 1869-1879
- Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department.Ann Emerg Med. 2016; 67: 581-587
- Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department.Ann Emerg Med. 2017; 69: 480-498
Published online: March 20, 2018
Accepted: December 26, 2017
Received in revised form: December 22, 2017
Received: December 5, 2017
Reprints are not available from the authors.
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