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.