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Prehospital sedation with ketamine vs. midazolam: Repeat sedation, intubation, and hospital outcomes

      Emergency medical service (EMS) providers often encounter acutely agitated patients who can pose serious threats to themselves, bystanders, and EMS, Fire, and Law Enforcement personnel [
      • Maguire B.J.
      • Smith S.
      Injuries and fatalities among emergency medical technicians and paramedics in the United States.
      ]. Severe, acute, undifferentiated agitation can be a symptom of drug ingestion or underlying medical or psychiatric disorders, and not all agitated patients respond similarly to chemical sedation [
      • Pajonk F.G.
      • Schmitt P.
      • Biedler A.
      • Richter J.C.
      • Meyer W.
      • Luiz T.
      • et al.
      Psychiatric emergencies in prehospital emergency medical systems: a prospective comparison of two urban settings.
      ]. Conventionally, paramedics treat agitated patients in the prehospital settings with benzodiazepines to calm the patient sufficiently to complete medical assessment and care. Adverse effects from benzodiazepines including respiratory depression, hypotension, and the need for advanced airway management leave agencies seeking alternative solutions [
      • Isenberg D.L.
      • Jacobs D.
      Prehospital agitation and sedation trial (PhAST): a randomized control trial of intramuscular haloperidol versus intramuscular midazolam for the sedation of the agitated or violent patient in the prehospital environment.
      ].
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