Ketamine for palliative sedation in the Emergency Department

Background: Palliative sedation to treat severely distressing symptoms in those with a poor prognosis is well-accepted. Objective: We discuss palliative sedation in the Emergency Department and the use of ketamine. Case Report: We present the case of a patient with angioedema of the tongue and severe respiratory distress. The patient's nursing home was unable to control her symptoms and she was transferred to the Emergency Department. The patient received fentanyl 50 μg i.v. and ketamine 50 mg i.v. every 5 min until adequate palliative sedation was achieved. Conclusion: Ketamine can be considered for Emergency Department palliative sedation in selected patients. Identifying and caring for unmet palliative care needs is an important skill for Emergency Medicine.