In which situation should you administer 4 mg/kg of ketamine IM?

Administering 4 mg/kg of ketamine intramuscularly is particularly indicated in situations where a patient is exhibiting violent behavior, especially as a result of stimulant use. Ketamine serves as a sedative agent that acts quickly, providing effective sedation and dissociation, which allows for the safe and controlled management of a potentially dangerous situation.

In cases of agitation or violent behavior, particularly when it's linked to the influence of stimulants, it is crucial to rapidly control the patient's movements to protect both the patient and responders from harm. Ketamine’s rapid onset and the fact that it can be administered intramuscularly make it a practical choice in emergency settings where intravenous access may not be readily available.

Other situations mentioned, such as assessing blood glucose levels or managing respiratory distress, are not appropriate settings for the administration of ketamine. Evaluating blood glucose levels does not require sedation, and respiratory distress needs immediate intervention aimed at restoring adequate ventilation, rather than sedation. While severe pain is often treated with analgesics, ketamine's use in pain management scenarios typically involves specific dosing and is not indicated at that dosage or route unless as part of a more complex pain management protocol.