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/caffeinated_humanoid RN Jun 20 '25 edited Jun 20 '25

Helping a conscious patient achieve a calm state of mind before initiating the ketamine is huge. Allowing for a single dose of a benzo to take effect (such as 1-2 mg of versed) is quite helpful.

Dimming lights and familiar music help, but creating a calm environment is difficult in the ER, especially if they are sharing a room or accompanied by anxious family members. This is where a bit of artificial relaxation goes a long way.

Anecdotal - but I have started dozens of ketamine drips for awake patients / used ketamine for conscious sedation for many others. I don't like using ketamine alone - for conscious sedation for a reduction or something similar I'd prefer versed + ketamine or propofol + ketamine with ketamine being the second agent administered.

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u/windisfun Jun 20 '25

I got ketamine and propofol when they reduced my open tib/fib fracture. Sent me on a trip I'll never forget! It was an out of body experience.

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u/ThisGremlin Jun 20 '25

This. I've been on both ends of this and what people forget is that you can absolutely still hear and see things whilst drugged up your brain just can't make sense of them. A calm environment, dimmed lights, supportive family members and asking them to think of a good memory (plus ,~2mg benzo) makes a world of difference.