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Respiratory arrest following intramuscular ketamine injection in a 4-year-old child
1Department of Emergency Medicine, North Carolina Baptist Hospital, Winston-Salem.
Insights
A child experienced apnea after ketamine sedation for ear foreign body removal. This highlights the critical need for airway management preparedness during pediatric sedation.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Otolaryngology
Background:
- Foreign body insertion into the pediatric ear canal is a common emergency department presentation.
- Sedation is often required for the safe removal of pediatric ear foreign bodies.
Observation:
- A 4-year-old boy developed apnea following intramuscular ketamine administration for ear foreign body removal.
- The patient experienced transient respiratory arrest without signs of laryngospasm or excessive secretions.
Findings:
- Ketamine sedation, while effective for foreign body removal, carries a risk of respiratory depression, including apnea.
- Prompt recognition and monitoring are crucial for managing adverse respiratory events during procedural sedation.
Implications:
- This case underscores the importance of vigilant monitoring and readiness for airway intervention during ketamine sedation in children.
- Healthcare providers should be prepared for potential airway complications, even with seemingly minor procedures.
Abstract:
A healthy 4-year-old boy presented to the pediatric emergency department after inserting a black-eyed pea into his right external ear canal. Initial attempts at removal of this foreign body were unsuccessful, resulting in patient agitation. After administration of intramuscular ketamine for sedation, the patient was observed to experience one ineffective respiration followed by a period of apnea. No excessive oropharyngeal secretions or laryngospasm were noted. Spontaneous respirations resumed after 40 seconds, and the child recovered with no apparent ill effects. This case illustrates the need for adequate monitoring and preparation for emergency airway management when using ketamine for sedation in the ED.