ABSTRACTS
Safety of Prehospital Ketamine Sedation for Pediatric Behavioral AgitationAuthor: Casey Patrick, MD | | Associate Authors: Kevin Crocker, Jordan Hanks, Robert Dickson
Introduction EMS use of ketamine for severe agitation in adults is commonplace and well-studied. Minimal data, however, exists on the safety of prehospital ketamine for behavioral agitation management in the pediatric population. Objective To assess the safety of ketamine sedation in agitated pediatric patients with a primary behavioral complaint from a single, high-volume, ground-based EMS agency Methods This is a retrospective observational study of the 60 pediatric patients treated with dissociative ketamine (4 mg/kg IM or 2 mg/kg IV) for sedation management of severe behavioral agitation over a 5-year period. Data were obtained from both EMS electronic medical records and complete Zoll monitor data review. Inclusion criteria required the patient to be younger than 18 years old, have received dissociative dose ketamine, and the ketamine indication to have been for behavioral agitation sedation management. Zoll monitor data were used to augment and validate EMS clinician documentation. Descriptive statistics are calculated to evaluate key demographic parameters and EMS management, including vital signs before and after ketamine administration, route and doses of ketamine administered, paramedic primary impression, advanced airway technique(s) used, and incidence of vomiting post-ketamine administration. Results During the study period, the median patient age was 16 (9–17) years with a White, male predominance, 67% (40/60) and 72% (43/60), respectively. Paramedic primary impressions were 73% (44/60) behavioral, 18% (11/60) overdose, and 8% (5/60) altered mental status. Fifty-six percent of patients (101/180) were missing at least pulse, systolic blood pressure, or oxygen saturation prior to ketamine administration, which was primarily given via intramuscular route (88%, 53/60). Eighty percent (48/50) required a single ketamine dose. Significant side effects included hypoxia (O2 sat < 90% post-ketamine) in 25% (15/60) and hypercarbia (EtCO2 > 50 post-ketamine) in 12% (7/60). However, only 5% (3/60) required bag-valve mask initiation and 3% (2/60) endotracheal intubation. No episodes of post-ketamine hypotension were reported, and only one episode of vomiting. Conclusion In this sample of EMS ketamine use for sedation management of behavioral pediatric agitation, both hypoxia and hypercarbia did occur, but rarely required advanced airway progression. Further evaluation with larger and and more geographically diverse sample sizes is needed for generalizability to other systems.
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