Abstract
Procedural sedation and analgesia (PSA) is a core competency in emergency medicine (EM). As EM develops in low resource settings, it is incumbent upon the emergency medicine community to ensure that evidence based trainings are developed to enable providers in these setting to safely provide PSA. This will avert unnecessary delays and patient suffering from inadequate pain management and sedation during painful procedures. In addition to lack of providers trained in PSA, the other usual limiting factors in low resource settings are lack of proper monitoring equipment and supplemental oxygen. This makes ketamine the ideal choice for PSA in these settings. Ketamine is a dissociative anesthetic that has both amnestic and analgesic properties. Its effects do not fit into the typical continuum of sedation discussed for other agents. If administered properly, ketamine is associated with exceedingly low risk of respiratory depression or hemodynamic instability. Additionally, patients under ketamine anesthesia maintain protective airway reflexes. Ketamine has a long history of extensive use in low resource settings. However, ketamine can cause adverse events if used incorrectly or administered to an improperly selected patient. Practical pearls for ketamine use can be divided into patient selection, administration and rescue from adverse events. Patient selection:
Published Version
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