Should Ketamine Be Contraindicated for Patients with Traumatic Brain Injury?

Is ketamine safe for head-injured patients?
You're called to rendezvous with an ALS unit at an altitude of 8,300 feet in the mountains. On board is an altered male in his 50s or 60s who was witnessed crashing his motorcycle at highway speeds on a windy mountain road.
On arrival, you find your patient altered and extremely combative. No vital signs or blood sugar are obtained secondary to the patient's combative state. He's noncompliant with a non-rebreather mask and pulls it off.
The patient wasn't wearing a helmet and is only wearing jeans with a T-shirt. He's noted to have multiple abrasions to his right flank, forehead and a deformity to the right clavicle. He's otherwise moving all of his extremities with normal strength, but isn't making any sense and won't cooperate with any commands. You score his Glasgow coma scale (GCS) as 10.
The transport will take 40 minutes by flight over remote mountainous terrain at elevations above 11,000 feet in an unpressurized cabin to the nearest trauma center. You and your partner decide the patient will need to be intubated for airway protection and to facilitate both patient and crew safety during transport.
Your initial priority becomes behavioral control to attain IV access and vital signs. You and your partner briefly discuss safe sedation options to gain behavioral control. The options are benzodiazepines, midazolam (Versed) and lorazepam (Ativan), or ketamine.
Your safety, as well as the patient's safety, is your number one priorit...

Source: JEMS Patient Care - February 12, 2018 Category: Emergency Medicine Authors: Bradley Kitts, NRP, FP-C Tags: Trauma Patient Care Source Type: news