The dosages for analgesia are: 

As Combat Medics, you may need to be prepared to administer ketamine through several different routes, to include intranasal, intramuscular, intravenous, or intraosseous. Combat Paramedics and providers also are trained to manage intravenous or intraosseous infusions for prolonged analgesia relief and higher doses for sedation. Again, the unit medical director will ultimately determine who can perform which procedures and the protocols that will be followed.

The steps in delivering ketamine will vary based on the route of administration, and later in this module, we will review those in more detail. 

In the 3rd option for analgesia in the TCCC Guidelines, when the casualty is in moderate to severe pain and/or is in shock or respiratory distress or at significant risk of developing either condition, ketamine is the medication of choice. Additionally, for casualties who do not respond to standard fentanyl treatment and are not in shock or respiratory distress, ketamine has been shown to provide effective relief as an adjunctive treatment. It is safe to give ketamine to a casualty who has previously received a narcotic.

The only absolute contraindications to ketamine use are age less than 3 years and a history of schizophrenia, which are not considerations in deployed combat forces. So, unless a casualty has a known allergy to ketamine, it should be used if clinically indicated.