For more information, visit JEMS.com/rs and enter 12.
weight isn’t possible.
What about the TBI patient who isn’t combative? Apart from obtaining control of the
patient, the priorities remain the same: maintaining MAP, preventing hypoxia and hyperventilation, and mitigating increases in ICP.
The high therapeutic index, and support of
MAP and respiratory drive without increasing
ICP makes ketamine an ideal choice for TBI.
The success of this patient’s care wasn’t only
due to the use of ketamine, but strong basic
skills with an effective and timely executed
plan. Understanding how medication choices
fit into your patient care plan is essential for
Ketamine should be a strong consideration
in a care strategy requiring any or all of the
following: analgesia, hemodynamic stability,
sedation, combative patients with or without
head injuries, and when both patient and crew
safety is a concern. The versatility and safety
profile of ketamine makes it a reliable tool in
the prehospital environment.
The history of ketamine is just another
example how weakly supported dogma has
limited the use of a safe, reliable, inexpensive medication. As field providers, we must
also remember that it isn’t always about the
resources you have available, it’s about your
resourcefulness and making what needs to
happen for your patient happen safely. JEMS
1. Spaite DW, Bobrow BJ, Stolz U, et al. Evaluation of the impact of
implementing the emergency medical services traumatic brain
injury guidelines in Arizona: The Excellence in Prehospital Injury Care
(EPIC) study methodology. Acad Emerg Med. 2014;21( 7):818–830.
2. Bar-Joseph G, Guilburd Y, Tamir A, et al. Effectiveness of ketamine
in decreasing intracranial pressure in children with intracranial
hypertension. J Neurosurg Pediatr. 2009; 4( 1): 40–46.
3. Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used
as an induction agent for intubation in patients with head injury.
CJEM. 2010; 12( 2):154–157.
4. Hughes S. (Nov. 30, 2011.) Is ketamine a viable induction agent
for the trauma patient with potential brain injury.
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5. Chi JH, Knudson MM, Vassar MJ, et al. Prehospital hypoxia affects
outcome in patients with traumatic brain injury: A prospective
multicenter study. J Trauma. 2006; 61( 5):1134–1141.
6. Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res.
2014; 8( 3):283–290.
7. Zeiler FA, Teitelbaum J, West M, et al. The ketamine effect on ICP
in traumatic brain injury. Neurocrit Care. 2014;21( 1):163–173.
8. Vallerand AH, Sanoski CA, Deglin JH: Davis’s drug guide for nurses,
15th edition. F.A. Davis Company: Philadelphia, 2016.
9. Murray MJ(Ed.): Faust’s anesthesiology review, 4th edition.Elsevier
Saunders: Philadelphia, p. 166, 2015.
Bradley Kitts, NRP, FP-C, is an active flight paramedic for Humboldt General Hospital Med X Air One in Winnemucca, Nev. He
can be contacted at firstname.lastname@example.org.
Jerad Eldred, MS II, is a medical student at the University of New
Mexico, and a former Special Forces Medical Sergeant. He can be
reached at email@example.com
Jenifer Belcher Jones, RN, CCRN, CFRN, is a flight nurse and
critical care nurse in the Southwest U. S. She can be reached at
Ryan Hodnick, DO, NRP, FAWM, is an EMS physician and critical
care paramedic for multiple ground and air EMS agencies throughout the Southwest U.S. He’s also an active flight crew member.