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Journal update monthly top five
  1. Clint Hendrikse1,
  2. Willem Stassen1,
  3. Roger Dickerson1,
  4. Wesley Craig1,
  5. Waseela Khan1,
  6. Anisa Jabeen Nasir Jafar2,3
  1. 1 Division of Emergency Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
  2. 2 Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, UK
  3. 3 Emergency Department, Royal Manchester Children’s Hospital, The University of Manchester, Manchester, UK
  1. Correspondence to Professor Clint Hendrikse, Division of Emergency Medicine, Department of Family, Community and Emergency Care, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa; clint.hendrikse{at}

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This month’s update is by the Division of Emergency Medicine, Faculty of Health Sciences, at the University of Cape Town, South Africa. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as:

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

Association of ketamine dosing with intubation and other adverse events in patients with behavioural emergencies by Sergot et al

Topic: behavioural emergencies

Outcome rating: worth a peek

Ketamine’s favourable safety profile, efficacy and quick time-to-adequate sedation has made it a popular pre-hospital choice for rapid tranquilisation/sedation. Evidence with regard to serious adverse events (SAEs) however varies substantially with reports of the need for intubation ranging from below 20% to nearly 60%. The association of SAEs with dose is also unknown. This retrospective study evaluated the dose-related risk of SAE, specifically the need for intubation, in prehospital adult patients with undifferentiated behavioural emergencies.1

From a database consisting of approximately 2000 emergency medical services (EMS) agencies in the USA, 2383 patient episodes involving ketamine for behavioural emergencies were reviewed. Patients were stratified into receiving ‘above’ (n=478) and ‘at/below’ (n=1 905) the maximum recommended dosing (2 mg/kg IV/IO or 5 mg/kg IM), and then matched using 1:1 propensity score matching based on patient and incident characteristics. Overall, 3.3% of patients required intubation, 36.8% any airway intervention and 0.4% developed cardiac arrest. High-dose ketamine was associated with a higher frequency of intubation and supraglottic airway placement (6.4% vs 3.3%, OR 2.0, 95% CI 1.0 to 3.9) and also with clinical improvement (92.5% vs 88.7%, OR 1.6, 95% CI 1.00 to 2.4). Overall, however both groups had similar rates of respiratory interventions.

This retrospective study was subject to multiple uncounted confounders—eg, knowing a higher …

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  • Twitter @Clint_EM, @willem_stassen, @rogerdickerson, @WaseelaKhan10

  • Contributors CH, WS, RD, WC and WK conducted the literature searches, selected the papers and drafted the summaries. AJNJ provided senior oversight and edited the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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