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EMR
EMT
AEMT
Paramedic
Extended
Ketamine (Ketalar)
Action
Onset
Dissociative anesthetic
Stimulates opioid receptors
IV 1 minute
IM 4-5 minutes
Indications
Pain Control (Adult and Ped)
Painful Procedures / Extrication
Excited Delirium
RSI
Adult Dose
Pain Control: 0.1-0.2 mg/kg IVP/IO/IM, Maximum 20mg
Painful Procedures/Extrication: 0.4 mg/kg IVP/IO/IM, Maximum 40mg
Excited Delirium: 5 mg/kg IM or 2 mg/kg IVP/IO if the line is already established
RSI: 2 mg/kg IVP/IO
Pediatric Dose
Pain Control: 0.2 mg/kg IVP/IO or 0.3mg/kg Nebulized or 2 mg/kg MAD
Contraindications
Hypersensitivity to the drug, schizophrenia, children < 2 months old.
Adverse Reactions
Cardiovascular: BP and pulse rate are frequently elevated following administration. Hypotension and
bradycardia have been observed, and arrhythmia has also occurred.
Gastrointestinal: Nausea, vomiting, increased salivation.
Neurological: Enhanced musculoskeletal tone may be manifested by tonic and clonic movements sometimes
resembling seizures. Nystagmus is common.
Respiratory: Although respiration is frequently stimulated, severe depression of the respiration or apnea may
occur following rapid IV administration of high doses. Laryngospasms and other forms of airway obstruction
have occurred, but can be managed via BVM.
Precautions
Resuscitative equipment should be ready for use. IV dose should be administered over 1 minute. More rapid
administration may result in respiratory depression or apnea and enhanced pressor response. Use caution in
chronic alcoholics and the acutely alcohol-intoxicated patient.
Considerations
Monitor vital signs frequently. Use caution with elderly and pediatric patients.
Ketamine (Ketalar
®
)