title: Ketamine use for acute agitation in the emergency department.
abstract: BACKGROUND
  Emergency physicians regularly encounter agitated patients. In extremely agitated and violent patients, the onset of many traditional medications is relatively slow and often requires additional medication. Ketamine is frequently used in emergency departments (EDs) for procedural sedation and intubation, but has recently been suggested as a treatment for acute agitation.
  
  
  OBJECTIVE
  We sought to examine the use of ketamine in the treatment of acute agitation in an ED setting, including vital sign changes as a result of this medication.
  
  
  METHODS
  This is a structured review of an historical cohort of patients over 7 years at two university EDs. Patients were included if they received ketamine as treatment for acute agitation. Abstracted data included age, vital signs including hypoxia, any additional medications for agitation, and alcohol/drug intoxication.
  
  
  RESULTS
  Ketamine was administered for agitation on 32 visits involving 27 patients. Preadministration systolic blood pressure was 131 ± 20 mm Hg, with an average postadministration increase of 17 ± 25 mm Hg. The average baseline heart rate was 98 ± 23 beats/min, with an average increase of 8 ± 17 beats/min. No patients became hypoxic; 62.5% of patients required additional calming medication. Alcohol or drug intoxication was present in 40.6% of patients.
  
  
  CONCLUSIONS
  We found ketamine was used rarely, but had few major adverse effects on vital signs even in a population with 21.9% alcohol intoxication. However, a high proportion (62.5%) of patients required additional pharmacologic treatment for agitation, implying that administering ketamine is useful only for initial control of severe agitation.
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California.
authors.forename: Austin B
authors.initials: AB
authors.lastname: Hopper
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California; Department of Emergency Medicine, University of California, San Diego, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California; Department of Emergency Medicine, University of California, San Diego, San Diego, California.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Campillo
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California; Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, Arizona.
authors.forename: Timothy
authors.initials: T
authors.lastname: Davie
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of California, San Diego, San Diego, California; Department of Emergency Medicine, University of California, San Diego, San Diego, California.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000374:Aggression / Q000187:drug effects*; D000435:Alcoholic Intoxication / Q000150:complications; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D062787:Drug Overdose / Q000150:complications; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000150:complications / Q000188:drug therapy*; D019233:Retreatment; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D007649:Ketamine
keywords: aggression; agitation; control; ketamine; vital signs