Ketamine: Safe Until It's Not - A Terrifying Trip to the K-Hole.

Abstract

On a daily basis we, as emergency medicine providers, discuss drugs and their side effect profiles. We often survey our colleagues regarding rare reported phenomena that have not been previously encountered. In my short emergency medicine career, I've heard the praises of ketamine thousands of times over: “Ketamine is safe and effective.” “You can never give too much ketamine.” “You can theoretically get an emergence reaction, but I haven't seen it.” I will be the first to admit that I used ketamine for nearly every procedural sedation that I performed—until my little adventure to the K-hole. What you're about to read acutely magnifies a mantra that I'm sure many of us heard throughout medical school: “The right patient, the right medication, the right dose, the right route.” Of the many lessons to be learned, mine was in my approach to resident education regarding sedation. All drugs can be unsafe. The rare side effects that “we'll never see” certainly happen—we know this. Comments on Medication Safety in the Emergency Department After a Trip to the K-HoleJournal of Emergency MedicineVol. 59Issue 2PreviewWe read with fascination the account of an emergency physician having experienced a severe adverse reaction after receiving intravenous (IV) ketamine for procedural sedation (1). We commend Dr Simon for sharing her traumatic episode. Her account serves as a vivid reminder that ketamine, despite popularity among emergency medicine providers, carries a unique toxicity profile. Nonetheless, we contend that the title of the commentary may be misleading and create undue stigmatization against a tool with a record of dependability and cardiorespiratory safety for procedural sedation (2). Full-Text PDF