title: Ketamine as a first-line treatment for severely agitated emergency department patients.
abstract: OBJECTIVE
  Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups.
  
  
  METHODS
  We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs.
  
  
  RESULTS
  106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups.
  
  
  CONCLUSIONS
  In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications.
authors.affiliation: Division of Emergency Medicine, University of Washington, Seattle, WA, USA. Electronic address: jeffridd@uw.edu.
authors.forename: Jeff
authors.initials: J
authors.lastname: Riddell
authors.affiliation: St. Louis University School of Medicine, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tran
authors.affiliation: Department of Emergency Medicine, University of California San Francisco - Fresno, Fresno, CA, USA.
authors.forename: Rimon
authors.initials: R
authors.lastname: Bengiamin
authors.affiliation: Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hendey
authors.affiliation: Department of Emergency Medicine, University of California San Francisco - Fresno, Fresno, CA, USA.
authors.forename: Patil
authors.initials: P
authors.lastname: Armenian
mesh_terms: D000293:Adolescent; D000328:Adult; D000778:Anesthetics, Dissociative / Q000008:administration & dosage*; D002140:California; D016292:Procedural Sedation / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy*; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine; D015742:Propofol
keywords: Agitation; Ketamine; Sedation