In the situation when intravenous access is not readily available or unobtainable, or when
prehospital delays to obtain intravenous access are not warranted, sub-dissociative dose
ketamine can be administered via intranasal (IN) route. The data supporting IN is not set on
the optimum intranasal dose (range 0.75-1 mg/kg) and frequencies of administration. In
addition, IN administration of SDK for adult patients in the ED requires a highly
concentrated solution that is not routinely stock in the ED. Hence, another non-invasive
route exists such as nebulization via a Breath-Actuated Nebulizer which allows a controlled
patient-initiated delivery of analgesics in titratable fashion.
Nebulized administration of ketamine however, has only been studied in the areas of acute
postoperative pain management, cancer palliation, and status asthmaticus therapy (ref). To
our knowledge, there are no prospective randomized trials that evaluated a role of nebulized
SDK role in managing acute pain due to extremity trauma in the prehospital arena.
We aim to evaluate analgesic efficacy and safety of sub-dissociative dose ketamine
administered prehospital via breath-actuated nebulizer at 1.0 mg/kg for patients with acute
traumatic extremity injuries.