As a result of the altered level of consciousness risk with ketamine, casualties should be disarmed after being treated, regardless of the route of administration. Additionally, you should document a mental status exam using the AVPU method prior to administering ketamine and use caution in casualties with eye injuries or mild TBI as ketamine may make it difficult to perform a neurologic exam or determine if the casualty is decompensating. 

Monitor airway, breathing, and circulation closely in casualties who have received ketamine. If respirations are reduced, reposition the casualty into a “sniffing position.” If that fails, provide ventilatory support with a bag-valve-mask or mouth-to-mask ventilations.

As the dose-related effect of ketamine transitions from analgesia to anesthesia, nystagmus (a rhythmic back-and-forth movement of the eyes) emerges as a side effect, and the appearance of nystagmus is an end-point indicator. Additionally, control of the pain is another end-point.

Ketamine has been used widely as an anesthetic agent but is also a very effective analgesic in doses that are lower than the usual anesthesia doses. Its clinical effects are very rapid (within one minute of IV administration and within 5 minutes of IM administration). 

Ketamine offers prehospital providers the ability to relieve pain without the potential adverse effects of opioids. Unlike the opioid agents, ketamine causes a mild increase in heart rate and perhaps a slight rise in blood pressure, which makes its use in trauma settings advantageous for casualties in hemorrhagic shock. Additionally, respirations are not normally affected and it is unique among anesthetics because the pharyngeal-laryngeal reflexes are maintained.