title: Ketamine for palliative sedation in the emergency department.
abstract: BACKGROUND
  Palliative sedation to treat severely distressing symptoms in those with a poor prognosis is well-accepted.
  
  
  OBJECTIVE
  We discuss palliative sedation in the Emergency Department and the use of ketamine.
  
  
  METHODS
  We present the case of a patient with angioedema of the tongue and severe respiratory distress. The patient's nursing home was unable to control her symptoms and she was transferred to the Emergency Department. The patient received fentanyl 50 μg i.v. and ketamine 50 mg i.v. every 5 min until adequate palliative sedation was achieved.
  
  
  CONCLUSIONS
  Ketamine can be considered for Emergency Department palliative sedation in selected patients. Identifying and caring for unmet palliative care needs is an important skill for Emergency Medicine.
authors.affiliation: Department of Medicine, Section of Emergency Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX 77030, USA.
authors.forename: Gil Z
authors.initials: GZ
authors.lastname: Shlamovitz
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsayem
authors.forename: Knox H
authors.initials: KH
authors.lastname: Todd
mesh_terms: D024362:Advance Directive Adherence; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000799:Angioedema / Q000150:complications; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D009735:Nursing Homes; D010166:Palliative Care; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy; D014060:Tongue Diseases / Q000150:complications
chemical_list: D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D005283:Fentanyl