Ketamine endorsed in official Australian policy for management of agitated ED patients!

my approach

Here is the updated official guideline from New South Wales health department!
Management of patients with Acute Severe Behavioural Disturbance in Emergency Departments

Key features:

  1. Droperidol is first and second line option if patient not able or unwilling to accept oral sedation
  2. Midazolam or ketamine are third line options
  3. Excellent section on de-escalation strategies/techniques
  4. The setting is for emergency departments with assumed sufficient trained staff to undertake physical restraint and close monitoring
  5. Sedation assessment tool is advocated as objective, validated measure of depth of sedation
  6. Capnopgraphy is not advocated but context of emergency department management of sedated patients needs to be considered here. Certainly in my opinion if ketamine is endorsed option then capnography is highly recommended.

Editors note: This is an excellent evidence based guideline for a difficult and challenging issue in emergency departments as well as for the general management of the undifferentiated acutely agitated patient. The Surviving Sedation guidelines 2015 that we have published is complementary and has many of the same features but is intended for a rural and remote context with less resources available and often requiring aeromedical transfer to higher level care.

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