There is an especially good study of pediatric patients that showed the same results, Mr. Hayes observed. “Not only didn’t ketamine elevate ICP, but it decreased it by 30 percent,” he said.

Ketamine can also be used as an analgesia. Mr. Hayes suggests not using a full dose for a patient in shock. For patients in severe alcohol withdrawal ketamine has been found to significantly lower the use of benzodiazepines. It can be effective for treating severely agitated patients or those suffering from excited delirium. It works quickly, but can be associated with a significant increase in intubation. Mr. Hayes suggests using a half dose—4-5 mg/kg by intramuscular injection—repeated after five minutes, if needed.

Treatment levels are not enough to cause delirium commonly associated with ketamine use, Mr. Hayes noted. It is contraindicated for infants less than three months old and patients with known or suspected schizophrenia.

Unfortunately, ketamine comes in three separate concentrations, causing a potential complication in the ED. Bar code scanners help avoid overmedication issues.

Given recent studies, emergency physicians should reconsider TXA and ketamine, concluded Mr. Hayes.

Teresa McCallion is a freelance medical writer based in Washington State.