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Rapid Tranquilisation (RT) in the ED

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Ketamine in RT

Up to Rapid Tranquilisation (RT) in the ED
November 22. 2018
Matt King

I've almost finished writing a guideline for my Trust for RT

After seeking support from my ED Consultant colleagues, one agent they felt would be really beneficial to include is ketamine

Obviously has its benefits, and a good summary of this is written in RCEM's guidance in addition to some of the drawbacks:

"Ketamine has many properties that make it a useful sedative agent in the management of ABD. It has a very rapid onset of action when administered IV or IM and has a wide therapeutic window producing consistent effects at predictable doses. Ketamine protects airway reflexes and increasing doses lead to more prolonged duration of sedation whilst rarely affecting respiratory drive

However, ketamine does inhibit the reuptake of catecholamines leading to the potential for sympathomimetic side effects such as an increase in heart rate, blood pressure, cardiac output and myocardial oxygen consumption. There is, therefore, the theoretical risk of worsening any cardiovascular instability present in ABD. Ketamine may be associated with unpleasant emergence phenomenon, although this is readily managed by the administration of benzodiazepines"

RCEM also provides a helpful dosing table in this guidance. However from searching various sources for dosing information in RT, there seems to be a wide variety of dosing. Does anyone have any consensus or information regarding "safe" dosing of ketamine for RT purposes?

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