# Ketamine

OCEMS analgesia for eligible patients age 15 and older; pediatric exclusion is explicit.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/ketamine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- PR-70 excludes pregnancy, ketamine allergy, psychosis history, and GCS below 14.
- Concurrent alcohol/drug intoxication is a relative contraindication: the source allows consideration only after base contact when intoxication is not significant and the patient is not lethargic or otherwise impaired.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2)
- [PR-70 — Ketamine Analgesia](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/PR-70%20ketamine%2010-2025.pdf)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)

## Use in OCEMS

- PR-70 addresses moderate–severe pain (4–10) when fentanyl is not a safe or appropriate choice. Examples include opioid intolerance/refusal, hypotension, or concern about airway/ventilatory status.
- This is the analgesia procedure, not a field dissociative-sedation or pediatric ketamine protocol.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| IV — preferred when practical | 0.1 mg/kg slowly over 1–2 minutes, maximum 10 mg. May repeat once after 15 minutes. |
| IM | 0.5 mg/kg, maximum 50 mg. May repeat once after 15 minutes. |
| IN | 1 mg/kg, maximum 100 mg. The procedure does not list an IN repeat dose. |

## Pediatric

- Age younger than 15 is a contraindication in PR-70. No pediatric analgesia dose is supplied by this OCEMS procedure or I-20.
- Do not extrapolate these doses to a child. Use an authorized pediatric analgesia pathway and base direction.

## Pediatric dosing availability

- PR-70 excludes patients younger than 15. No OCEMS pediatric analgesia dose is provided.
| Weight | OCEMS pediatric dose |
| --- | --- |
| Any weight | No general pediatric dose under the cited source; follow the applicable order / medical direction. |

## Preparation & reassessment

- Concentration is determined by the provider agency; confirm route-appropriate stock before drawing up the dose.
- Record weight, indication, pain before/after, intoxication assessment, response, and ongoing vital signs, SpO₂, consciousness, and cardiac rhythm. Watch for dissociation, tachycardia, or hypertension.