• Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, and Jeffrey D Ho.
• Minnesota Poison Control System, Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, United States. Electronic address: jon.cole@hcmed.org.
• Am J Emerg Med. 2018 May 1; 36 (5): 789-796.

ObjectiveWe investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation.MethodsThis was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality.ResultsForty-nine patients were enrolled. Median age was 29years (range 18-66); 76% (37/49) were male. Median time to adequate sedation was 4.2min (95% CI: 2.5-5.9, range 1-25min) and 90% (44/49) had adequate sedation prehospital. Seven patients (14%) received a second sedative prehospital. Intubation occurred in 57% (28/49) of patients. Mechanical ventilation lasted <24h in 82% (23/28) of patients, and <48h in 96% (27/28) of patients. A single physician intubated 36% (10/28) of the patients. Complications related to ketamine included hypersalivation (n=9, 18%), vomiting (n=3, 6%), and emergence reaction (n=2, 4%). One patient died from complications of septic shock on hospital day 29, likely unrelated to ketamine.ConclusionsIn patients with prehospital profound agitation, ketamine provides rapid effective sedation when used as a primary therapy. Intubation was common but accompanied by a short duration of mechanical ventilation and appears to have been subject to individual physician practice variation.Copyright © 2017 Elsevier Inc. All rights reserved.

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