High-Dose Ketamine Sedation of an Agitated Patient During Air Medical Transport

Reicher, David

doi:10.1016/j.amj.2015.10.009

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…Management of the patient presenting with undifferentiated, acute behavioural disturbance is complicated and challenging in highly resourced settings, but in remote communities additional layers of complexity increase this challenge . These relate to available resources, access to healthcare and the safety of the patient, public and staff involved.…”

Section: Introductionmentioning

confidence: 99%

“…These relate to available resources, access to healthcare and the safety of the patient, public and staff involved. Furthermore, the remote area nurse or medical practitioner may not have the access to the requisite skill set to safely manage the acutely disturbed patient, which may include the administration of sedation or advanced airway management/ventilation . Transportation to a regional or tertiary centre with a higher level clinical and in‐patient facility is often required for either mandatory assessment and/or treatment under the Mental Health Act, or the further assessment and treatment of medical conditions presenting as behavioural disturbance.…”

Section: Introductionmentioning

confidence: 99%

“…Transportation to a regional or tertiary centre with a higher level clinical and in‐patient facility is often required for either mandatory assessment and/or treatment under the Mental Health Act, or the further assessment and treatment of medical conditions presenting as behavioural disturbance. The vast distances of outback Australia require a retrieval team to balance the resource access, allocation and safety of remote communities with the recognised risks to both patients and crew of aeromedical retrieval …”

Section: Introductionmentioning

confidence: 99%

“…Few studies, limited to case series, have explored the role, effectiveness and safety of ketamine in the aeromedical retrieval of the patient with acute behavioural disturbance, mainly psychosis . So far, few adverse effects have been recorded . A landmark study by Le Cong et al .…”

Section: Introductionmentioning

confidence: 99%

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Impact of a ketamine sedation protocol on intubation rates and undesirable outcomes in the transport of patients with acute behavioural disturbance

Shahtahmasebi

Johnson

Shahtahmasebi³

2019

Emerg Medicine Australasia

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Objectives To identify the effects of the introduction of a ketamine sedation protocol on the rates of intubation and adverse events associated with retrieval of patients with acute behavioural disturbance. Transport of patients with acute behavioural disturbance poses clinical and logistical management difficulties, as well as risks. Remote Australian communities are separated by vast distances. Risks to aircraft and crew, and patient and community must be balanced. Ketamine has received increasing attention in recent years for pre‐hospital sedation of behaviourally disturbed patients, predominantly with psychiatric illness. This paper explores the benefits and suitability of ketamine in undifferentiated presentations, using data from the retrieval service in Alice Springs, Australia. Methods A pre‐ and post‐intervention study was carried out. The intervention was the introduction of a ketamine sedation protocol. Pre‐intervention data was collected retrospectively, pre‐2015 and post‐intervention data prospectively from 2015 onwards. Prospective data, rather than only including confirmed psychiatric cases as in previously published series, will provide a powerful message for pre‐hospital and retrieval practice. Group variables were created to compare the incidence of adverse events. Results The introduction of a ketamine protocol significantly reduced rates of intubation. The incidence of adverse events was strongly associated with the method of sedation (P = 0.000, confidence interval −0.56, −0.22), with significantly lower rates with ketamine (P < 0.0001). Conclusion The introduction of a ketamine protocol is associated with a decrease in intubation, and accordingly, a decrease in adverse events, though it is not without its risks. Further analysis is required to establish the likely cost saving to health systems.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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