S Ketamine Mastery in Austere Care: S-Ketamine Dosing, Tricks, and TCCC Updates

S-Ketamine is now part of the TCCC pharmacopeia; you'd better understand how to use it. Dennis sits down with Pat — a veteran military anesthetist, former Danish Special Operations medical leader, and decades-long ketamine expert — for a deep dive into S-Ketamine. From its development and real-world use in austere environments (including Afghan war wounded and British Field Hospital MERT ops) to practical dosing, side effect management, and why it outperforms morphine in many trauma scenarios, this conversation delivers battle-tested wisdom for medics, PAs, nurses, and SOF operators.

Pat shares hands-on lessons from hospital, military, and austere settings: achieving the "thousand-yard stare," managing emergence phenomena, combining with regional anesthesia, IM/IN/rectal routes, and why ketamine shines for hemodynamically unstable patients, refractory asthma, and more. They also discuss training pitfalls, the value of hands-on experience (including vet collaboration ideas), and cultural differences in patient responses.

Key Takeaways:

• S-Ketamine is roughly twice as potent as racemic ketamine — use ~half the dose, but expect the same onset, duration, and side-effect profile (with potentially milder psych effects at mid-doses).

• Excellent for analgesia and procedural sedation in austere settings; superior hemodynamic stability compared to opioids in hypovolemic trauma patients.

• S-Ketamine is now included in the 2026 TCCC updates — critical knowledge for every combat medic and austere provider.

• Practical tips: titrate slowly IV, watch for nystagmus/thousand-yard stare, prepare for emergence with low-dose midazolam + patience, consider regional blocks to reduce opioid needs.

• Training emphasis: objective endpoints, patient monitoring, planning for side effects, and real-world experience over rote memorization.

Whether you're running a prolonged field care scenario, managing a screaming femur fracture, or preparing for the next deployment, this episode arms you with actionable strategies.

Subscribe, share with your team, and visit prolongedfieldcare.org for free resources, downloads, and more. PFC Coffee links in the description — fuel for the fight.

#ProlongedFieldCare #Ketamine #AustereMedicine #TCCC #SOFMedicine

Chapters:

• 00:00 Intro & Sponsors + Guest Welcome (Pat’s Background)

• 03:30 S-Ketamine vs Racemic Ketamine: Potency, Dosing, and Myths

• 08:45 Early Experiences – Afghan War Wounded & Mass Casualty Ketamine Sedation

• 14:20 Sedation Technique: Thousand-Yard Stare, Nystagmus, Airway Management, Atropine

• 20:10 Emergence Phenomena, Cultural Differences, and Midazolam Management

• 25:50 Battlefield Analgesia – Ketamine Superiority Over Morphine (Bastion Study)

• 30:40 Dosing Strategies: IV Titration, IM/IN/Rectal Routes, Bioavailability

• 37:15 Training Realities – Avoiding the “Middle Zone,” Objective Endpoints, Vet Collaboration

• 43:30 Regional Anesthesia + Ketamine Synergy (Chester Buckenmaier Influence)

• 47:20 Special Populations: Kids, Hemodynamically Unstable, Asthma, Head Trauma, Seizures

• 53:10 Practical Tips for New Providers, Mission Planning, and Austere Pearls

• 58:40 Closing Thoughts & Resources

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