Ketamine Field Framing

Why This Matters

Many systems added ketamine for analgesia, DAI/RSI, or severe agitation. It is powerful and unforgiving when mis-applied. This lesson is framing only: indications themes, monitoring, and pitfalls — not a formulary.

Common EMS Contexts (Service-Dependent)

• Analgesia for severe pain when protocol includes ketamine.
• Sedation / behavioral pathways for extreme agitation when authorized.
• Airway induction agent in some RSI protocols — advanced training required.

Clinical Themes (Education)

• Dissociative anesthetic properties at higher ranges; analgesia at protocol analgesic ranges.
• Airway reflexes may be relatively preserved compared with some agents — still not an excuse to ignore airway.
• Emergence reactions, hypersalivation, laryngospasm risk discussions appear in training — know your system’s prep (suction ready).
• Hemodynamics often more stable than pure sympatholytic agents in teaching comparisons — still monitor BP.

Safety Habits

• Indication clear and protocol-approved.
• Weight-based math with second check.
• Continuous monitoring: SpO₂, EtCO₂ when available, ECG, BP.
• BVM and suction staged before administration for sedation-level uses.

Field Pitfalls

• Using ketamine for mild pain when simpler options fit protocol better.
• Under-monitoring after IM injection for agitation.
• Confusing analgesic vs induction dosing ranges — protocol only.

Practice

Read your service ketamine protocol line-by-line: indications, absolute cautions, monitoring. Related: Fentanyl, Dosing safety.

Sources & Further Study

• Your formulary and medical direction for ketamine.