When a patient arrives in the emergency department in a state of extreme agitation or excited delirium, every second counts. In this episode, we explore the growing use of ketamine as a rapid intervention to control dangerous psychomotor agitation when traditional sedatives may act too slowly. Research shows ketamine can achieve adequate sedation far faster than medications like haloperidol, lorazepam, or midazolam, helping protect both patients and medical teams in high risk situations. But speed comes with tradeoffs, including a higher risk of complications such as hypoxia and the possible need for airway support. We unpack what the literature says about when ketamine may be appropriate and why careful cardiopulmonary monitoring is essential. Join us as we examine how clinicians balance urgency, safety, and evidence when managing one of the most challenging emergencies in acute care.