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/KiwiScot26 Jun 20 '25

If using it for procedural sedation in kids, I phrase the psychogenic stuff as part of my consent process. Standard phrase is something like “it tends to give people hallucinations as they emerge from it. These are relatively short lived and in kids are usually pleasant things, like raining chocolate drops or something. In the rare event that it seems very unpleasant we can give something else to sedate them a bit whilst ketamine washes out.” (Droperidol).

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u/Competitive-Young880 Jun 20 '25

If a kid was having bothersome ketamine reaction you’d reach for droperidol rather than midazolam? Not judging, just curious? And wondering why?

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u/KiwiScot26 Jun 20 '25

Fair question, and I think either OK. Based on personal experience they tolerate tiny dose of droperidol really well, and it’s stable both for resp and cardiovascular profile.

I think midaz also OK, but I’ve had a few obese kids over the years who prove real sensitive to it, then I’m bagging a fat kid for a few mins, rather than just letting them snooze 🤷‍♂️

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u/Goldy490 EM/CCM Attending Jun 20 '25

This is interesting, I don’t think it ever crossed my mind to use droperidol for this. I’m usually pretty hesitant to use antipsychotics in kids.

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u/Competitive-Young880 Jun 24 '25

As you should be. Especially when there are at least equally good, but I believe it would be more accurate to say better, agents available for the same thing. Midaz is what should be used here.