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Trench entrapment: is ketamine safe to use for sedation in head injury?
  1. Matthew Gunning,
  2. Zane Perkins,
  3. Tom Quinn
  1. Staffordshire Ambulance Service NHS Trust, Stafford, UK
  1. Dr Matthew Gunning, CareFlight Medical Services, 44 Eastern Ave, Bilinga 4225, Queensland, Australia; MattGunning{at}rcsed.ac.uk

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A 19-year-old man was buried when the walls of the trench he was digging collapsed. Bystanders exposed the head and chest, and called the emergency services. The paramedic applied a cervical collar. Primary survey revealed a patent airway, spontaneous respirations and saturations of 99% on oxygen. Good pulses were palpated bilaterally at 90 beats/min and intravenous (iv) access was secured. The Glasgow Coma Scale (GCS) was 3/15.

The patient began groaning in response to pain, and the GCS was revised to 4/15. Pupils were 3 mm in diameter, equal and reactive to light. The prehospital doctor administered ketamine 100 mg iv to aid extrication and the patient was secured onto a spinal board.

Once in the ambulance, the patient displayed decorticate posturing in response to pain (GCS 6/15). Secondary survey excluded obvious head injury. Surgical emphysema and bruising were noted on the right side of the chest, without flail segment. The trachea was central with good breath sounds …

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