Volume 12, Issue 7: Ketamine in prehospital sedation – ‘you’ve got to be ket-ting me’

Ketamine in prehospital sedation – ‘you’ve got to be ket-ting me’

It is a drizzly Friday evening when a call comes through for an 18-year-old male injured while playing football. On arrival you find that he heard his ankle crack quite audibly and is now in extreme pain. His ankle needs urgent manipulation, but you have not done this before and you are a long way from the ambulance – what do you do now?

CPD benefit

Many injuries present with a time-critical aspect and a difficult extrication. This article uses a case study featuring a complicated fracture with dislocation, critical skin and difficult extrication to discuss the factors to consider when requesting additional support from critical care paramedics trained in limb manipulation under procedural sedation. The article also discusses the use of ketamine, a dissociative anaesthetic that has multiple roles in the prehospital setting and can be administered by critical care paramedics and doctors. The key effects of ketamine are highlighted, and how clinicians can prepare the patient in cases where ketamine may need to be considered. This can improve the outcome for such patients and alleviate the pain in a difficult extrication.