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Achieving prehospital analgesia
  1. Nick Castle,
  2. Raveen Naidoo
  1. Durban University of Technology, Republic of South Africa
  1. Correspondence to Nick Castle, Emergency Department, Frimley Park Hospital, Portsmouth Road, Camberley, Surrey GU16 7UJ, UK; castle.nicholas{at}

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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 …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.