• Ketamine
• paramedic
• sedation
• End-tidal C02
• analgesia/pain control
• emergency ambulance systems
• nursing
• pre-hospital

We were dispatched to a road traffic collision which was 40 min from the nearest receiving hospital. On arrival, we noted an adult patient who had been extricated from their car after a T-bone collision.

1. Clear

2. Resp 32, Spo₂ 100% on 40% O₂

3. BP 130/95 & pulse 100

4. GCS 15

Primary survey found no head or chest injuries but an obvious fracture of the femur with associated severe pain preventing the application of a traction splint. We elected to use ketamine 0.25 mg/kg (15 mg based on an estimated weight of 60 kg) to obtain pain relief and a state of conscious sedation (sedated, maintaining own airway but responding to verbal commands).1 In less than 5 min, our patient was more comfortable and sedated, but rousable, allowing application of the traction splint. A pain score could not be recorded, as our patient did not speak English or Zulu, but, during transfer to hospital, our patient …