Dr. Roberts responds: I don't know why everyone is not using IM ketamine for rapid sedation of the undifferentiated acutely delirious patient in the ED. I agree that this is a paradigm shift, with clinical enlightenment of our colleagues mainly repressed by lack of understanding and reluctance to try something new or by a nervous nursing staff or a particularly critical anesthesiologist. I would encourage readers to study ketamine used in this scenario in a prospective manner, but in the meantime, Dr. DeBard's use agrees with my bias and seems ideal. I did reference an article where police subdued a suicidal jumper with IM ketamine, a nifty case report indeed. Getting EMS to replace the TASER with ketamine seems like a good idea, but getting shot (with an animal tranquilizer) rather than shocked might be a hard sell to all.