r/emergencymedicine • u/rainbowsforeverrr • Jun 20 '25

Advice Ketamine-- how to prepare patients?

Hi folks, ER nurse here. I'm curious how you talk to patients about ketamine admin for procedures or for intractable pain relief. I give it fairly often but I still haven't found the right way to prepare patients (or parents of littles) for the psychotropic effects. I've never used ketamine personally, but it seems to be a very intense experience that ought to be part of the informed consent conversation. What is our ethical obligation?

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u/FraeshFeesh Pharmacist Jun 20 '25

One interesting thing about ketamine is that a patients experience can actually change depending on their feelings leading up to a procedure. If I’m in the room during a sedation I usually try to have a patient recall a good memory/experience, really anything that has the potential to prevent an emergence reaction is worth it in my book.

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u/rainbowsforeverrr Jun 20 '25

I try to do this too, to set the scene for a positive experience

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u/Firemedic623 Paramedic Jun 20 '25

I always do this in the field as well and it has worked well for my patients.

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u/Tiradia Paramedic Jun 20 '25

200% this! As I’m drawing the meds up I tell em to find a happy memory and think back on it. As I’m pushing the meds I tell them to keep that memory in mind and just let go they are safe and in good hands. Never had a bad emergence. If I have the time though I’ll make a quick drip and give it over 10 mins usually helps as well.

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u/HockeyandTrauma Trauma Team - BSN Jun 20 '25

I've done this with kids too. I ask them what they'd like to dream about, and then as I'm giving it I have them recall that.

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u/turdally BSN Jun 20 '25

Omg, that is SUCH a good idea. I’m gonna use that with adults too. Im always making awkward convo as patients are being sedated, “soooo…what do you do for fun?”

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u/FastZombieHitler Jun 20 '25

lol. I do my propofol slowly in 5ml syringes (thanks Dr Levitan!) and chit chat as it goes in to get a gauge of how it’s affecting them. I know when they’re about to get to the sweet spot when the secrets comes out. Normal small talk, sudden smile and admission of various drug use in the 60’s, out, zap, eyes open and conversation resumes.

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u/metforminforevery1 ED Attending Jun 20 '25

Yeah same. And now that it’s summer, I ask them about their favorite summer things or trips and they usually talk about the beach and Disneyland and visiting cousins and stuff. The kids never seem to have bad trips. The adults I tell them to picture their favorite vacation or dream vacation. Usually the bad trips are the traumas who are on some substance and there’s not a lot of time to talk them down anyway

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u/_meshy Jun 23 '25

This is a thing in the psychedelic community. It's called set and setting and is how people try to avoid bad trips. I've never had to worry about it much with katamine though.

https://en.m.wikipedia.org/wiki/Set_and_setting

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u/ellafisher17 RN Jun 23 '25

Totally agree with you. I've seen way smoother recoveries when we take a sec to set the mood before pushing ketamine. That good memory trick really works anything to steer the trip in a chill direction is worth it.