Ketamine & Crisis Response Plan for Suicidal Ideation in the ED

Inclusion Criteria:

• Adult men and women between the ages of 18 and 70 presenting to the EmergencyDepartment with acute suicidal ideation.

• Patient cleared for admission to the University Hospital inpatient psychiatric unit.

• Decision to admit the patient to the inpatient unit or psychiatric stabilizationunit made prior to consent to prevent study procedures from complicating orinfluencing the disposition and treatment as usual for suicidal patients reportingto the ED.

• Individuals presenting to the ED for other complaints but found to have suicidalideation necessitating admission will also be eligible.

• Able to read and write English.

Exclusion Criteria:

• Serious mental illness with active and significant signs of psychosis, mania,hallucinations, paranoia, agitation, and drug-induced or other toxidromic symptoms.

• Acute intoxication with clinically significant symptoms (as defined by the attendingclinician's assessment of patients' clinical sobriety).

• The patient is not capable of understanding the research procedures and providinginformed consent for themselves.

• Lack of reliable means to be available for follow-up assessments (e.g, workingmobile phone).

• Persistent resting blood pressure lower than 90/60 or higher than 180/110, orpersistent resting heart rate lower than 45 beats/minute or higher than 120beats/minute.

• Injuries requiring procedural sedation.

• Pregnancy or breast feeding.

• Known hypersensitivity to ketamine.

• Legal or illegal use of ketamine in the previous 90 days.

• End-stage or severe cardiovascular (e.g., ACS or decompensated heart failure),liver, or kidney disease.

• Patient is a prisoner.

• Patient is physically restrained or actively under custody of law enforcement. Oncea patient is no longer under custody of law enforcement or physically restrained,the patient may be considered eligible and may consent to voluntary enrollment inthe study.