Little has been published regarding intravenous (IV) ketamine for burn wound care in adult patients. Ketamine may serve as a safe alternative to provide conscious sedation and limit opioid administration to patients. The purpose of this study was to characterize IV ketamine use during burn wound care and establish its potential role as a safe adjunct to opioid and benzodiazepine medications. This is a retrospective review of adult patients admitted to a regional burn center who received IV ketamine for burn wound care. Patient demographics, medications, and ketamine-related side effects including hypertension and dysphoric reactions were recorded. Cardiopulmonary complications were also tracked. Thirty-six patients met inclusion criteria; 50 total cases were performed. The median patient age was 37 [IQR 28 – 55] years with a median burn size of 9.5 [IQR 4.0 – 52] %TBSA. The median ketamine dose administered was 1.2 [IQR 0.8 – 2.1] mg/kg. IV midazolam was administered in almost all cases (98%) at a median dose of 3.0 [IQR 2.0 – 5.0] mg. Opioids were administered in 13 of 50 cases (26%) at a median morphine equivalent dose of 10 [IQR 5.0 – 18] mg. In 46 cases (92%), patients denied unpleasant recall of medication. Dysphoric reactions were observed in 3 cases (6%). Ketamine-induced hypertension occurred in 3 cases (6%) and all immediately responded to IV labetalol. There were no cardiopulmonary complications. These findings suggest IV ketamine provides a safe analgesia and sedative option for burn wound care. Given these findings, IV ketamine for burn wound care warrants further study.

Providing adequate analgesia during burn wound care is essential to patient-centered care. Both oral and intravenous (IV) ketamine are often used for analgesia and sedation. Ketamine may improve analgesia and decrease opioid requirements for burn wound care. Oral ketamine wafers and tablets have been used as a safe alternative internationally but are unavailable in the United States. The purpose of this study was to compare opioid usage and patient satisfaction scores in patients with and without the use of oral injectable ketamine for burn wound care, with each patient serving as their own control. Ketamine, opioid, and benzodiazepine dosages recorded during dressing changes were compared to dressing changes without ketamine use that occurred before and after ketamine-associated sessions in each patient. Fourteen patients received oral ketamine at a median (interquartile range [IQR]) dose of 2.5 (2.2-2.7) mg/kg. Ketamine use significantly decreased opioid requirements when compared to wound care sessions that did not use ketamine both before (50 [IQR: 30-75] mg vs 75 [IQR: 46–91] mg median IV morphine equivalents, P = .0097) and after (50 [IQR: 30-75] mg vs 63 [IQR: 50-96] mg median IV morphine equivalents, P = .0042) the ketamine-associated sessions. One patient experienced hallucinations, and no adverse events were observed. Hence, oral administration of injectable ketamine was associated with a decrease in opioid requirements during dressing changes. Additionally, ketamine use improved patient satisfaction (P = .0034). Preliminary data suggest this promising analgesia method is safe and effective for burn wound care.

The United States Fire Administration (USFA) provides high-quality data for firefighter deaths (FFDs), but until now these data have not been analyzed for temporal trends. This analysis explores FFDs between 1990 and 2016 to determine high-risk groups for outreach and training. Mortality rates were calculated using USFA information compared against the total number of deaths per year. Rates were compared between 1990–2009 (early period) and 2010–2016 (recent period). Multinomial logistic regression was used to determine predictors of death in firefighters (FFs) by age group (≤45 and >45 years old) and by work status (career vs volunteer). Analysis of 3159 FFDs revealed a decline in crude-rate mortality between 1990–2009 and 2010–2016 (47.4 vs 35 FF deaths per million, P < .0001). FFs of ≤45 years old were less likely to die in the 2010s than in the 1990s–2000s (13.7 vs 24.7 FF deaths per million, P = .0002). Trauma-related deaths decreased (13.1 vs 8.1, P = .0003), whereas CV-related deaths remained constant (19.4 vs 19.5, P = .24). Regression analysis determined that volunteer FFs were more likely to die from burns (OR 1.7, CI: 1.2–2.4, P < .0001) and trauma (OR 1.8, CI: 1.5–2.2, P < .0001) than career FFs. Younger FFs were also more likely to die from burns (OR 10.4, CI: 6.9–15.6, P < .0001) and trauma (OR 6.5, CI: 5.4–7.8, P < .0001). Although overall FFDs were lower after 2010, younger and volunteer FFs saw an increase in burn and trauma-related mortality. Cardiovascular-related fatalities were consistent throughout the study. Future research should continue to make use of high-standard data to track FFDs and efficacy of interventions.