b'Exploring the Many Uses of KetamineBy Chris Walsh (MS IV, Sidney Kimmel Medical College)intubation. Rapid sequence intubation,have been exhausted prior to their although commonly performed, is notarrival. In such patients, ketamine offers without risk, among the greatest of whicha promising non-opioid alternative to are hypoxia, acidosis, and hypotension3.acute pain management. Ketamine can Ketamine, however, provides improvedbe used in the emergency department hemodynamic stability when comparedin sub-dissociative doses (either to other agents, in addition to offeringthrough IV push, short infusions, or longer duration of action, analgesia,continuous infusions) without the need amnesia, and sedation3. Decidingfor monitoring, and has been shown to when and how to intubate a patientdecrease the need for post-ketamine is something that I will confront as aanalgesia5,6. This is an exciting modality resident, and having an option of usingthat could improve patient satisfaction a medication like ketamine can mitigatewithout contributing to the over-Chris Walsh some risks associated with such aprescribing of opioid pain medications.(MS IV, Sidney Kimmel Medical College) procedure, calming my own nerves whileExploring novel uses for medications performing it.that have been around for decades is Throughout my rotations, its useAcutely agitated patients are notquite an exciting aspect of medicine, and was almost ubiquitous, whether onuncommon to the emergency department,the possibilities for ketamine are just Neurology, Internal Medicine, Anesthesiaand as many of us know, they sometimesbeginning. In my future practice, I hope or in Emergency Medicine, ketaminerequire chemical restraint. I have seen thisto learn more and discover new uses for always seemed to find its way into theachieved with haloperidol, droperidol,existing medications and lean into the art discussion of treatment plans. In this briefand benzodiazepines depending on theof medicine that makes this profession so article, I will discuss a few of the manyseverity of the situation. I learned thatrewarding.uses for ketamine, specifically as it relatesketamine could offer us another choice, to the management of patients in thegiven that it has properties to maintain emergency department.hemodynamic stability while inducingReferences1. Li, Linda, and Phillip E. Vlisides. "Ketamine: 50 Years ofKetamine was originally introduced todissociation to calm agitated patients.2.Modulating the Mind." PubMed Central, 29 Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/. Accessed 27 clinical medicine as an anesthetic in theIn a prospective single-institution study,Sept. 2023.1960s, with the first paper publishedpatients who received ketamine to treat2. Lin, Justin, et al. "Efficacy of Ketamine for Initial Controlof Acute Agitation in the Emergency Department: A about it in 19661. It exists as two distinctacute agitation achieved sedation moreRandomized Study." PubMed, 11 Apr. 2020, https://pubmed.isomers and is marketed as a racemicreliably at the 5- and 15-minute mark andncbi.nlm.nih.gov/32340820/. Accessed 27 Sept. 2023.3. Merelman, A. H., Perlmutter, M. C., & Strayer, R. J. (2019, mixture1. It is soluble in both waterhad a shorter median time to sedationApril 26). Alternatives to Rapid Sequence Intubation: and lipids, lending to its ability to becompared to patients treated with aContemporary Airway Management with Ketamine. PubMed Central. Retrieved September 27, 2023, from administered via IV, IM, oral, nasal,combination of haloperidol/lorazepam2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526883/rectal, subcutaneous, and epiduralThis provides a useful alternative in4. Mion, Georges, and Thierry Villevieille. "Ketamine Pharmacology: An Update (Pharmacodynamics and routes1. While ketamines predominantthe management of agitated patients,Molecular Aspects, Recent Findings)." PubMed Central, mechanism of action is antagonism ofalthough I would like to find additional10 Apr. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC6493357/. Accessed 27 Sept. 2023.NMDA receptors, it also has clinicallystudies to support this finding.5. Motov, S., Drapkin, J., Likourezos, A., Doros, J., Monfort, R., & significant effects at a wide range ofMarshall, J. (2018, June 20). Sub-dissociative dose ketamine Lastly, pain management in theadministration for managing pain in the emergency glutamate-independent receptors,emergency department is a complicateddepartment. PubMed Central. Retrieved September 27, lending to its large treatment profile4.2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/task, especially amid the ongoing opioidPMC6117536/Now, lets talk about ketamines use in theepidemic. For patients presenting to6. Bang, S. (2021, January 24). Sub-Dissociative Dose Ketamine Emergency Department! in the Emergency Department. ACEP: Pain Management the Emergency Department who haveand Addiction Medicine Section. Retrieved September 27, 2023, from https://www.acep.org/painmanagement/In my experience within the Emergencyneeds related to pain management,newsroom/jan2021/sub-dissociative-dose-ketamine-in-the-Department, many of the discussionsover-the-counter options, such asemergency-department about ketamine were related toibuprofen and acetaminophen may PACEP News | Fall 2023 9'