Ketamine in the Field

Why this matters

Ketamine is for the job the protocol names. That job is pain, severe agitation, or induction. Those are different dose ranges. Do not swap them.

This lesson names which job the drug is doing, and what to watch. It is not a dose card. The card has the amount.

Clinical sequence

1. Name the pathway. Analgesia, severe agitation, or induction. They are not interchangeable.
2. Confirm kilograms. Have a second person check the math. Your protocol sets milligrams per kilogram. This site does not publish that number.
3. Have suction and a bag-valve mask ready before a sedation-level dose. Do not leave the patient face-down.
4. Turn monitoring on: oxygen saturation, waveform capnography when you have it, ECG, and blood pressure. Reassess as you would after a dissociative drug, because that is what you gave.

Common EMS Uses

• Analgesia for severe pain when the protocol includes ketamine.
• Severe agitation when you are authorized. Do not use the outdated label excited delirium as a diagnosis.
• Induction for intubation in some rapid-sequence protocols. That requires advanced training.

What Ketamine Does

• At higher ranges it is a dissociative anesthetic. The patient is disconnected, not asleep the way a benzodiazepine makes someone asleep. At protocol pain ranges it is an analgesic. Those ranges belong to the protocol. They are not orders from this site.
• Airway reflexes may look more preserved than with some other sedatives. That is not a reason to ignore the airway.
• Watch for agitation as it wears off, extra saliva, and laryngospasm. Know how your system prepares. Keep suction ready.
• Blood pressure often holds up better than with drugs that mainly drop sympathetic tone. Still check the blood pressure. Ketamine is not free of blood-pressure effects.

Safety Habits

• The indication is clear and approved by protocol.
• Weight-based math, with a second check.
• Continuous monitoring: oxygen saturation, waveform capnography when available, ECG, and blood pressure.
• A bag-valve mask and suction are ready before a sedation-level dose.

Common errors

• Using ketamine for mild pain when simpler options fit the protocol better.
• Under-monitoring after an intramuscular dose for agitation.
• Mixing an analgesia dose range with an induction dose range. The protocol owns both ranges. This site does not.

Practice

Related: Fentanyl, Dosing safety.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

• Evidence-Based Guidelines for Prehospital Pain Management (Lindbeck et al., PEC 2023) — A conditional recommendation that intravenous ketamine or intravenous opioids are both acceptable for severe pain. That is not permission to mix dose ranges.
• NAEMSP and partner organizations: restraint of agitated or combative patients (2021) — Ketamine is one option among protocol drugs. Watch the patient continuously after chemical restraint. Do not leave the patient face-down or hobbled.
• NASEMSO National Model EMS Clinical Guidelines (2022) — Model EMS language. Your protocol sets the indication.
• Analgesia, dissociation or sedation, and induction ranges are not interchangeable. Use only the indication and the monitoring your protocol lists.