FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Moderate–severe pain (4–10) when the PR-070 analgesia criteria are met; this is not general procedural-sedation authority.
Contraindications & local exclusions
- OCEMS PR-070: psychosis history, pregnancy, ketamine allergy, age below 15, or GCS below 14. Alcohol/drug intoxication is a relative contraindication: limited non-significant intoxication may be authorized after base contact. The injection label also excludes patients for whom a significant BP rise would be a serious hazard.
Precautions
- Monitor consciousness, BP, pulse oximetry and rhythm; dissociation, tachycardia, hypertension and respiratory depression can occur. Use the analgesic route-specific instructions, not an anesthetic-induction regimen.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- PR-70 excludes pregnancy, ketamine allergy, psychosis history, and GCS below 14.
- Concurrent alcohol or drug intoxication is a relative contraindication. Consider treatment only after base contact confirms the intoxication is not significant and the patient is not lethargic or otherwise impaired.
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 OCEMS pediatric dose is listed; follow the applicable order or 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.
UNDERSTAND THE CARE
Why the indication cannot be borrowed from another ketamine use
Ketamine is described here for the local analgesia procedure. Knowledge of another jurisdiction’s sedation or airway use does not expand this guide’s authority. Check the patient’s age, clinical eligibility and exclusions against the cited procedure before choosing a dose.
Applying the guidance
The actual preparation and administration method must match the local analgesia instructions. Keep the concentration and intended dose visible and record prior pain treatment. Continue assessing pain, consciousness, ventilation and perfusion after administration. The purpose of reassessment is to describe both symptom relief and whether the patient tolerates the intervention.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Eligibility
- Local analgesia indication and age 15+.
- Exclusions
- Use the complete PR-70 conditions.
- Preparation
- Correct concentration and administration method.
- Response
- Pain, consciousness, ventilation and perfusion.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Apply the route-specific repeat rule
The procedure describes separate IV, IM and IN analgesia regimens. Read the repeat instruction attached to the selected route rather than carrying one route’s permission into another. The IV and IM rows include a permitted repeat; the IN row does not supply an IN repeat dose. Persistent pain alone does not fill that missing instruction.
Before treatment, explain why fentanyl is not safe or appropriate for this patient and document the relevant PR-70 eligibility assessment. The relative intoxication provision is conditional and requires the stated base-hospital process; a patient being awake is not a substitute for the complete assessment.
For example, after IN treatment a patient still reports substantial pain. Reassess pain, consciousness, ventilation and perfusion, retain the dose and administration time, and use the applicable medical-direction process for further care. Do not convert the persistent symptom into an improvised repeat or sedation regimen. At handoff, identify analgesia as the purpose and name the route actually used.
Source: Ketamine Analgesia.