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You are called emergently to evaluate a 10-year-old female in the emergency department. The patient was involved in an motor vehicle collision and has a suspected head injury. On exam, you find her minimally responsive to painful stimuli. Her pupils are unequal and are sluggish to light. In deciding to intubate this patient, which of the following medications should be avoided?

A. Fentanyl

B. Ketamine

C. Midazolam

D. Pentobarbital


Answer

The correct answer is B. Ketamine increases ICP and is therefore not recommended for patients with increased ICP. However, that being said, there is newer data emerging that ketamine is safe(er) than previously thought in patients with head injury, but the answer is still the same.

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