Indications

1) Acute Traumatic pain (e.g., fractures, lacerations, dislocations, burns)

2) Acute non-traumatic pain (e.g., abdominal, flank, back, headache)

3) Chronic pain conditions

4) Analgesic resistant pain

5) Sickle cell pain crisis [34]

Contraindications

1) Schizophrenia/psychosis

2) Age <3 months or >75 years

3) Pregnant/breastfeeding

4) Hypersensitivity to ketamine

5) Active chest pain, ischemia, acute heart failure (HF)

6) Advanced liver disease

7) Unstable Vitals:

a) Systolic Blood pressure <90 or >180

b) Heart rate <50 or >150

c) Respiratory rate <10 or >30 [21]

Medication Adminstration

1) The medication must be administered by a registered nurse [21]

Dosing

1) 0.3 mg/kg of ketamine slow intravenous push over 5 minutes

a) May repeat dose as needed every 30 minutes [21]

Monitoring

1) Document pain level and vital signs prior to administration

2) All patients to be monitored using continuous pulse oximetry and telemetry

Reassess pain level and vital signs 30 minutes after administration [33]

Management of Adverse Reactions

1) Nausea/vomiting: anti-emetic per physician order

2) Respiratory: repositioning, supplemental oxygen, suction, bag-valve mask

Agitation, hallucinations: maintain calm quite environment, dim lighting, benzodiazepine [33]

Discharge

1) The patient should be observed at least 60 minutes beyond final drug administration and until patient attains pretreatment levels of verbalization and awareness, and purposeful neuromuscular activity seems reasonable

2) Patient should be advised that they may experience ataxia for hours and that family observation is warranted

3) Patient should be advised to avoid driving a motor vehicle upon discharge for at least 8 hours

a) An effort will be made to provide safe transportations, and/or the patient will be held in the ED until safe discharge can be made [33]