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Let’s “Take ’Em Down” With a Ketamine Blow Dart
DOI: http://dx.doi.org/10.1016/j.annemergmed.2016.01.002

Steven M. Green, MD
Gary Andolfatto, MD

Quote:Agitated, unpredictable, and violent patients. We all
see them. Fueled by some toxic combination of drug-
induced delirium, inebriated anger, paranoid delusions, or
pernicious personality, these erratic and dangerous patients
present an imminent threat to emergency department (ED)
staff and to themselves. They are legendary in their
imperviousness to pain and acts of superhuman strength.

Typically, these patients are grappled with by police
or hospital security staff and administered intramuscular
antipsychotics (with or without benzodiazepines). We then
stand back and count the agonizing minutes until it might
become safe to further assess and treat them. In dire
situations, we may be forced to give intramuscular
succinylcholine and crash intubate to achieve situational
control. In these scenarios, there are substantial risks to
staff of injury and body fluid exposure, and patients are
at risk of sudden death during the struggle.

In this issue, Isbister et al describe 49 adults with
acute behavioral disturbance who were sedated with
intramuscular ketamine. Yes, ketamine. During this study’s
peer review, an experienced reviewer reacted:
“This is just crazy.. [T]he last thing we need is for a bunch of residents
or docs to whack psych patients with ketamine in order
to ‘sedate’ them.”
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You'd have thought a rapid induction sedative/anaesthetic would be useful: etomidate maybe. Propofol. Ketamine takes a little longer to come on, so those might be worth a punt. That said, very interesting article. Always good when a reviewer reacts so badly.
Medicinal chemistry student, psychedelic explorer and collector of psychoactive substances ancient to novel.
Getting a lot of use and praise in medical circles right now. Good pacifier, maybe better painkiller than morphine, anaesthetic. Think it'll be a while before it hits mainstream though
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