Ketamine is a versatile medication with an emerging role for the treatment of numerous psychiatric conditions, including treatment resistant depression. Current psychiatry guidelines for its intravenous administration to treat depression recommend regular blood pressure monitoring and an aggressive approach to potential transient hypertensive episodes induced by ketamine infusions. While this approach is aimed at ensuring patient safety, it should be updated to align with best practice guidelines in the management of hypertension. This review defines and summarizes the currently recommended approach to the hypertensive emergency, the asymptomatic hypertensive urgency, and discusses their relevance to intravenous ketamine therapy. With an updated protocol informed by these best practice guidelines, ketamine treatment for depression may be more accessible to facilitate psychiatric treatment.
The number of older Canadians is growing rapidly and many will continue to drive to meet their transportation needs. Most older drivers are safe drivers; however, with advancing age, some develop medical conditions and associated impairment that may affect their driving ability. Often these medical conditions are first recognized when they seek emergency care. In this cross-sectional study, we collected data on a sample of 92 older drivers (57 males and 35 females) aged >= 70 years, who were treated in an urban emergency department (ED) for acute illness or injuries. We asked about their perceived driving ability, driving habits, and transportation needs. About one third of respondents had never taken public transit in the past year. Most drove for grocery shopping, visiting family and friends, and medical appointments. Sixty eight drivers also agreed to take tests for cognitive ability, visual acuity and reaction time. All 68 drivers passed vision screening and no drivers showed severe cognitive impairment. However, ten drivers (10/68, 14.7%) failed the Trail Making Test B test and 14 drivers (14/68, 20.6%) had slow reaction time according to a ruler drop test. Medical chart review revealed that close to 40 percent were taking sedating medications that could impair driving and 20 percent had a discharge diagnosis of a medical condition that could potentially affect their driving. In conclusion, many ED older drivers depend on driving to meet their mobility needs. Screening tests and medical chart review suggest that some of these drivers may have conditions that could affect their ability to drive safely.
