For casualty in shock or respiratory distress, what is the initial Ketamine dose when given IV or IO?

• A. 10-20 mg
• B. 20-30 mg
• C. 30-40 mg
• D. 40-60 mg

Answer: (B)

Ketamine provides analgesia and sedation at low IV/IO doses while largely preserving airway reflexes and spontaneous breathing, which is especially helpful in someone who is in shock or has respiratory distress. The starting dose is typically around 0.3 mg/kg given IV or IO. For a typical adult, that dose translates to roughly 20–30 mg, which is why this amount is the designated initial range. This amount offers rapid pain relief and calming effects without heavy respiratory depression, and it can even help support blood pressure in hypovolemic patients due to its sympathetic-stimulating properties. If analgesia remains inadequate, small additional doses (titrated carefully) can be given, but higher initial doses (like 40–60 mg) increase the risk of adverse effects such as emergence phenomena, hypertension, or oversedation.