Page 272 - ATP-P 11th Ed

STOP IV administration once pain control has been achieved or if disso-
ciative effects or nystagmus (rhythmic back-and-forth movement of the eyes)
noted.
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i. Ketamine (Ketalar ) 50mg IM in large muscle site (1mL total if concen-
tration 50mg/mL; ensure proper dilution). Repeat q30min unless dissociative
effects or nystagmus noted, then discontinue.
IV/IO ketamine (Ketalar ) must be diluted to a concentration of
50mg/mL or lower. Barbiturates and diazepam should NOT be mixed in
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SECTION 2 the same syringe with ketamine.
NOTE: If sedatives, opioids, or other adjuvant drugs (e.g., midazolam, fen-
tanyl) have been given, ketamine will normally be effective at smaller doses.
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ii. OR ketamine (Ketalar ) 20mg slow IV or IO once over 1 minute (0.4mL
total if concentration equals 50mg/ml; ensure dilution).
iii. Consider midazolam 0.03mg/kg IN/IV/IO (2–3mg for adults) as adjunct
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to ketamine (Ketalar ) sedation.
2. Treat per Nausea and Vomiting Protocol prn.
Disposition
1. Consider underlying cause to determine evacuation priority.
2. Patients receiving IV/IM opiates or ketamine should most likely be evacuated.

262 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 263