PCP: Analgesia
Adult Patients with:
- Moderate to severe pain associated with fractures and dislocations
- Moderate to severe pain associated with burns or soft tissue trauma including crush injuries
- Moderate to severe pain associated with multisystem trauma
- Palliative Patients Requiring Analgesia for pain (See Associated Palliative CPG)
CliniCall can authorize PCPs to administer IN ketamine for:
- Moderate to severe pain in pediatric patients (Aged 5 - 12 years old) due to trauma, fractures, burns or soft tissue injury
- Moderate to severe non-traumatic back pain
- Moderate to severe pain associated with abdominal pain and renal colic
- Moderate to severe obstetrical or gynecological associated pain unrelieved by nitrous oxide
ACP: Analgesia
ACP: Induction of sedation prior to intubation
ACP: Procedural sedation
ACP: Severe agitation or excited delirium syndrome
PCP: Analgesia
Requires additional training and endorsement
- Intranasal
- 0.75 mg/kg (see intranasal ketamine dosing chart)
- May repeat 0.5 mg/kg after 20 minutes
- Maximum single dose 100 mg
- Contact CliniCall for additional dosing instructions
- See PR11: Intranasal Medication Administration procedure
ACP: Analgesia
- Intravenous/Intraosseous
- 0.3 mg/kg slow push
- May repeat 0.15 mg/kg after 5 minutes
- Maximum cumulative dose 0.6 mg/kg in 45 minutes
- Intramuscular
- 0.5 mg/kg
- May repeat 0.3 mg/kg after 45 minutes
ACP: Procedural Sedation
- Intravenous/Intraosseous
- 0.1 - 0.5 mg/kg slow push every 60 seconds to effect
- Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
- Titrate to effect
ACP: Anesthesia Induction
- Intravenous/Intraosseous: 2 mg/kg if shock index < 1
- Intravenous/Intraosseous: 1 mg/kg if shock index ≥ 1
ACP: Maintenance of Anesthesia
- ½ of required induction dose every 10-15 minutes as required
ACP: Excited Delirium
- Intramuscular
- 4-5 mg/kg bolus
- Maximum single/cumulative dose 500 mg. If appropriate sedation is not achieved, a call to Clinicall is required.
- Maximum volume of administration:
- Deltoid: 2 mL
- Lateral thigh: 4-5 mL
- Gluteal: 5 mL
Follow weight-based dosing (Page for Age)
PCP: Analgesia (Aged 5 - 12 years)
ACP: Analgesia (Aged > 6 months)
- Intravenous/Intraosseous
- 0.3 mg/kg slow push
- Maximum single dose 20 mg
- Repeat every 2-3 minutes to a total cumulative dose of 0.6 mg/kg
- Intramuscular
- 0.5 mg/kg
- May repeat 0.3 mg/kg after 45 minutes
- Intranasal
ACP: Procedural Sedation
- See adult dosing guidelines. Follow weight-based dosing regimen.
ACP: Excited Delirium
- CliniCall consult required for any patient under 12 years of age
- See adult dosing guidelines above
Ketamine is a non-competitive NMDA receptor antagonist that blocks glutamate. Low doses produce analgesia and modulate central sensitization, hyperalgesia, and opioid tolerance. Reduces polysynaptic spinal reflexes.