May 2022 Virtual Journal Club – Rapid Agitation Control with Ketamine in the ED: A Blinded, Randomised Controlled Trial

Author: Richard Grimwood, Mike Penn, Callum Shaw / Editor: Rajesh Chatha, Robert Hirst / Codes: / Published: 19/05/2022

Happy TERNsday! Welcome to April 2022s Virtual Journal Club module. The team for this months virtual journal club is made up of Emergency Medicine trainees of different grades from the North East region. 

Are you interested in writing a module? We are looking to recruit regional Teams around the country to write future modules. Email us on


  1. The Royal College of Emergency Medicine Best Practice Guideline Guidelines for the Management of Excited Delirium / Acute Behavioural Disturbance (ABD). 2016.
  2. American College of Emergency Physicians White Paper Report on Excited Delirium Syndrome. September 2009. 
  3. Vilke GM, Payne-James J, Karch SB. Excited delirium (ExDS): Redefining an old diagnosis. Journal of Forensic and Legal Medicine 2012; 19:7-11. doi: 10.1016/j.jflm.2011.10.006.
  4. National Institute for Health and Care Excellence. Violence and aggression: short-term management in mental health, health and community settings. NICE guideline [NG10]. 28 May 2015.
  5. Vilke GM, DEBard ML, Chan TC, et al. Excited Delirium Syndrome (EXDS): Defining based on a review of the literature. Journal of Emergency Medicine 2012; 43(5): 897-905. doi: 10.1016/j.jemermed.2011.02.017.
  6. Korczak V, Kirby A, Gunja N. Chemical agents for the sedation of agitated patients in the ED: a systematic review. Am J Emerg Med. 2016 Dec; 34(12): 2426-2431. doi: 10.1016/j.ajem.2016.09.025.
  7. Yap CYL, Taylor DM, Kong DCM, Knott JC, Taylor SE; Sedation for Acute Agitation in Emergency Department Patients: Targeting Adverse Events (SIESTA) Collaborative Study Group. Risk Factors for Sedation-related Events During Acute Agitation Management in the Emergency Department. Acad Emerg Med. 2019 Oct; 26(10):1135-1143. doi: 10.1111/acem.13826. 
  8. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011 May; 57(5):449-61. doi: 10.1016/j.annemergmed.2010.11.030. 
  9. Cole JB, Moore JC, Nystrom PC, Orozco BS, Stellpflug SJ, et al. A prospective study of ketamine versus haloperidol for severe prehospital agitation. Clin Toxicol (Phila). 2016 Aug; 54(7):556-62. doi: 10.1080/15563650.2016.1177652. 
  10. Mo H, Campbell MJ, Fertel BS, et al. Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience. West J Emerg Med. 2020 Jan 27; 21(2):272-281. doi: 10.5811/westjem.2019.10.43067. 
  11. Riddell J, Tran A, Bengiamin R, Hendey GW, Armenian P. Ketamine as a first-line treatment for severely agitated emergency department patients. Am J Emerg Med. 2017 Jul; 35(7):1000-1004.
  12. Lin J, Figuerado Y, Montgomery A, et al. Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study. Am J Emerg Med. 2021 Jun; 44:306-311. doi: 10.1016/j.ajem.2020.04.013. 
  13. Barbic D, Andolfatto G, Grunau B, et al. Rapid Agitation Control With Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial. Ann Emerg Med. 2021 Dec; 78(6):788-795. doi: 10.1016/j.annemergmed.2021.05.023

Leave a Reply