Ketamine for RSI in Hemodynamically Unstable ED Patients

• Recall that ketamine acts as a sympathomimetic resulting in increases in heart rate, blood pressure, and ultimately cardiac output.
• Because of its rapid transport across the blood-brain barrier, its sympathomimetic effects, and lack of significant adverse effects, ketamine is recommended by many organizations as a first line agent for RSI in unstable patients.
• Important contraindications to ketamine include an acute coronary syndrome, aortic dissection, and acute heart failure.
• Take Home Point: Consider using ketamine the next time you need to intubate a hypotensive, critically ill ED patient.

References

Morris C, et al. Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent? Anaesthesia 2009; 64: 532-9.