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/jubbyboi ED Attending Jun 20 '25

Sedated a 7 year old for fracture reduction 2 days ago and the nurse said “you’re gonna love this! A lot of people pay money to do this and you get it for free”… so I guess that’s an option.

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u/MrPBH ED Attending Jun 20 '25

Oh man, as an addiction doc and father that makes alarm bells go off in my head.

I think these kind of lines are a great way to relieve the tension and anxiety of an adult patient, but a bad message to kids. It's sending the message that this medicine can be used recreationally and that lots of people do it.

These statements might be true, but it's the wrong message for a seven year old.

I'd prefer a message that emphasizes A) this medicine is going to make it so it doesn't hurt when we fix your arm and you don't remember it, and B) it might be scary, but I promise if it is scary, it won't last forever.

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u/caffeinated_humanoid RN Jun 20 '25

I agree with you about glorifying the drug in that way. However, I avoid telling patients that they will not remember it. Ketamine doesn't reliably cause amnesia in my experience (but I also don't like to use it alone).

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u/Negative_Way8350 BSN Jun 20 '25

Patient's don't appear to have amnesia, but when asked about the procedure when back to baseline many express astonishment. Most ask if we've started yet and we're already done.

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

Yes, most shouldn't if they get an appropriate dose. "However, I had a patient who had previously received only ketamine and fentanyl for a colonoscopy. They remembered the whole procedure, but told me that they felt so disocciated that they were unable to move/speak, and was traumatized by the experience. Setting appropriate expectations is one of the most important things for a patient's experience. If they aren't going to be "out" or you can't assure that they won't remember anything, then I don't tell them that.