IM Ketamine Is Not a Good First-Line Option for Severely Agitated Patients

We have previously expressed some hesitance about use of ketamine as a first-line choice for sedation in agitated patients (NEJM JW Emerg Med Apr 2017 and Am J Emerg Med 2017; 35:1000). In a prospective observational study, investigators assessed outcomes for a case series of 49 patients with severe agitation who received 5 mg/kg intramuscular (IM) ketamine for sedation in the prehospital setting.

Adequate sedation was achieved in a median time of 4.2 minutes and by 90% of patients. Of the 49 patients, 57% were intubated in the emergency department (ED), and of these, 36% were intubated by a single physician. Among intubated patients, the indication for intubation was “Airway Unprotected NOS” for 36%.