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Fri Aug 3 02:24:23 BST 2007

Oh, I just get the willies when someone says "I've used X drug Y times and so it's safe".  I've heard about people using ketamine safely in head trauma, and so I'm fairly certain that it doesn't ROUTINELY cause significant increases in ICP. But how many times have I seen the phrase: "Ketamine is contraindicated in head trauma because it causes increases in ICP"?  Suppose the incidence of this is .1%. Has any one person used it safely in 1000 patients with head trauma?  All you need is 1 case and you don't have a leg to stand on.  There are just too many other drugs to use in RSI in patients with head trauma.  There is no reason to use ketamine when the preponderance of the world's literature says it isn't safe.

  Neil Mullen MD, FACEP, FAAP
  Madigan Army Medical Center
  Tacoma, WA

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ketamine in head injured patients