Is Ketamine an Effective Sedative in the Acutely Agitated Patient in the Prehospital Setting?
AffiliationThe University of Arizona College of Medicine – Phoenix
MeSH SubjectsEmergency Medicine
MetadataShow full item record
PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractExcited Delirium Syndrome: disorder characterized by hallucinations, aggressive and peculiar behaviors, a catecholaminergic surge and secondary risk for sudden cardiac death (Gerold, 2015). The development of sedatives and antipsychotics lead to a decreased incidence until the 1980s. With increasing use of stimulants such as cocaine and methamphetamines, the rates of “undetermined cause of death” has increased in patients exhibiting acute agitated delirium who were in police custody. Patients in this state may be in danger of avoidable death. Emergent medical treatment may prevent death in these patients as suggested by a retrospective review of deceased patients; indicating a need for sedation that minimizes the use of physical restraint and sedates the patient chemically. Ketamine, which functions as a noncompetitive antagonist to NMDA receptors and releases of glutamate, is an option for chemical sedation. The safety profile is ideal as it has a wide therapeutic index and does not act on opioid or GABA receptors. This study asks if Phoenix Fire Department paramedics assessments indicate that IV/IM ketamine administration to patients with Excited Delirium Syndrome is more effective at sedation than Midazolam alone for prehospital transport to an acute care facility?