African Journal of Emergency Medicine (2011) 1, 81

African Federation for Emergency Medicine

African Journal of Emergency Medicine

www.afjem.comwww.sciencedirect.com

Ujuzi

Practical Pearl/ Perle Pratique

Eric Hodgson

Departments of Anaesthesia, Critical Care and Pain Management, Addington Hospital and Nelson R Mandela School ofMedicine, Ethekwini-Durban, KwaZulu-Natal, South Africa

Available online 28 July 2011

Ujuzi is intended to be a regular feature for colleagues toshare practical interventions, innovations and novelties that

have proved useful in the management of patients in theprehospital environment or Emergency Centre. You can letUjuzi know about your practical ideas by emailing

practicalpearl@afjem.com.

Intramuscular ketamine for sedation of patients in danger and/or

endangering others

Prehospital and emergency department staff are regularlyfaced with patients with acute confusion due to acute intoxica-

tion and/or metabolic disorders. These patients can hurt them-selves and those attempting to care for them.

A tragic example seen in KwaZulu-Natal (South Africa) re-

cently was a paramedic tending to a patient who had beenstabbed by an acutely psychotic patient who was subsequentlystabbed to death himself.

Safety can be improved in these cases by the judicious useof intramuscular ketamine.1 This dose provides profound dis-sociative sedation within 5 min. Ketamine is best administeredinto the deltoid muscle or anterior thigh. The highest concen-

E-mail addresses: practicalpearl@afjem.com, eric_hodgson@mweb.

co.za

2211-419X ª 2011 African Federation for Emergency Medicine.

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Peer review under responsibility of African Federation for Emergency

Medicine.

doi:10.1016/j.afjem.2011.07.008

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tration of ketamine available (100 mg/ml) is most appropriateand will allow administration of the required dose in less than

5 ml.The patient should be left alone as far as possible after

injection until sedation ensues.

� The first intervention after sedation arises should be appli-cation of a pulse oximeter. Saturation of >95% on roomair tends to exclude major metabolic disorders and favours

acute psychosis and/or intoxication.� Saturation of <95% warns the patient has more than psy-chosis and/or intoxication and needs to be evaluated for an

underlying medical disorder including cardiac, respiratory,renal or hepatic failure.

Reference

1. Roberts JR, Geeting GK. Ketamine for rapid tranquilization of

violent adult patients. J Trauma 2001;51(5):1008–10.