Hey folks Scott Weingard here and this is the MCrit podcast. Today a topic I have seen messed up so many times by both trainees and experienced attending level emergencyshund intensive care doctors and it is the use or

avoidance of the use of ketamine for the patient with severe agitation. I see so many people choosing to use this agent at times

it's inappropriate and then when it is appropriate they use it they use it

incorrectly and I've been planning to do this episode for a while, but then I heard the recent

MRAP piece by Frenemy of the show and my buddy Ruben Strayer, who did such a wonderful job of encompassing all of the ideas that were floating around my

head that I'm like I don't need to do this I need to get Rubin to come on the show and

do this so why don't we start off with a 60 second excerpt of the actual MRAP piece and hopefully my buddies in

MRAP won't get pissed that I'm putting 60 seconds at their show here and I am doing it to say how wonderful

MRAP is so check out the whole episode if you have M-R-R-P, but here's 60 seconds to introduce us.

You can think of agitation in three levels of severity.

There is what I call the agitated but cooperative patients who don't cause us much trouble. I'm not going to say anything else about that group.

The vast majority of patients who strike an emergency clinician as agitated fall into the group I call disruptive without danger.

These patients include just about everyone who comes in intoxicated or with decompensated

psychiatric illness and requires calming medications.

And we've been providing calming medications to these patients for decades very effectively.

The classic cocktail is 5 milligrams Halaparadol and 2 milligrams Larazepan, I am.

You can do better than that with Droparidol, Madazolam, Alansapine, but you don't have to do better than that.

You can carry on with five and two, which takes a while to work because Adam and

poorly absorbed I am and Halaparadol slow acting, but it's fine because these patients are

disruptive, but there's no danger.

There is a third group of patients with agitation and in most departments you will see them

rarely, but this is the most important group.

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