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It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement.
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Violent and agitated patients pose a serious challenge for emergency medical EMS personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the Ketamine im in adults choice of medication is not clear.
The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome ExDSis both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population.
We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine.
All patients were subsequently transported to the hospital before ketamine effects wore off. Ketamine may be safely and effectively used by trained paramedics following a specific protocol.
The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access.
It is not uncommon for paramedics and emergency medical technicians EMTs to be confronted with combative, violent and uncooperative patients. Moreover, a certain percentage of these individuals will go on to expire from sudden cardiac arrest.
Recently, a task force convened by the American College of Emergency Physicians has coined the phrase excited delirium syndrome ExDS to cover those patients with altered mental status who demonstrate severe agitation and combative or assaultive behavior.
The management of ExDS is also difficult and the associated mortality warrants further study. Many different medications can be given to effect sedation in the pre-hospital field including benzodiazepines, haloperidol and others.
Many of the medications commonly used are far from ideal in that their onset of action is not immediate, the intravenous IV route is often preferred and, when given in the higher dosages required to adequately sedate violent patients, negative hemodynamic and respiratory side effects can make their use Ketamine im in adults harmful for the
Ketamine im in adults. Previous feedback obtained from local paramedic experience revealed a perceived lack of timely efficacy with haloperidol and benzodiazepine use in the field.
The ideal medication, if one exists, would be given intramuscularly, have a near-immediate onset of action, a high efficacy rate even with the most violent and agitated patients, and have zero negative hemodynamic and respiratory side effects. Furthermore, it is well known that ketamine can cause an emergence reaction; therefore, midazolam was also to be administered to help avoid this potential reaction, but not for its sedative effects.
We retrospectively screened paramedic run sheets from January 1, through May 1, for cases where the ketamine protocol was used for complaints of violent, aggressive behavior secondary Ketamine im in adults a psychiatric or substance-abuse issue. Reviewing the run sheets generated from these encounters we R. Approval from the university Institutional Research Board was obtained to review those records. Ketamine im in adults.
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