Nebulized Ketamine Used for Managing Ankle Fracture in the Prehospital Emergency Setting: A Case Report.

Acute traumatic limb injury is a common complaint of patients presenting to the emergency department (ED). Ketamine is an effective analgesic administered via intravenous (IV), intranasal (IN), intramuscular (IM), and nebulized routes in the ED. It has also been used in the prehospital setting via IV, IM, and IN routes. Recent studies have proposed the prehospital use of nebulized ketamine via breath-actuated nebulizer (BAN) as a noninvasive and effective method of analgesic delivery, as well as an alternative to opioid analgesia. We present a case of a patient with right ankle fracture after a 12-foot fall who subsequently received 0.75 milligrams per kilogram of nebulized ketamine via BAN in the prehospital setting. The patient reported improvement of pain from 8/10 to 3/10 on the pain scale without need for additional pain medication during prehospital transport. This report supports the use of nebulized ketamine via BAN in the prehospital setting for acute traumatic limb injuries. The use of nebulized ketamine via BAN in the prehospital setting may be an effective analgesic option for the management of patients with acute traumatic limb injuries, particularly in those with difficult IV access, where mucosal atomization devices are not accessible, or where opioid-sparing treatments are preferable.

急性创伤性肢体损伤是急诊科（ED）就诊患者常见的病症。氯胺酮是一种有效的镇痛药，在急诊科可通过静脉（IV）、鼻内（IN）、肌肉内（IM）和雾化途径给药。它也已通过静脉、肌肉内和鼻内途径用于院前环境。近期研究提出，通过呼吸驱动雾化器（BAN）在院前使用雾化氯胺酮是一种无创且有效的镇痛给药方法，也是阿片类镇痛药的一种替代选择。 我们介绍一例患者，该患者从12英尺高处坠落导致右脚踝骨折，随后在院前环境中通过BAN接受了每千克0.75毫克的雾化氯胺酮。患者报告疼痛程度从疼痛量表的8/10改善到3/10，在院前转运过程中无需额外的止痛药。本报告支持在院前环境中对急性创伤性肢体损伤使用通过BAN的雾化氯胺酮。 在院前环境中通过BAN使用雾化氯胺酮可能是治疗急性创伤性肢体损伤患者的一种有效镇痛选择，特别是对于那些静脉通路困难、无法使用黏膜雾化装置或更倾向于阿片类药物节约治疗的患者。