Intramuscular Ketamine for Suicidal Patients in the Evanston Hospital Emergency Department for Suicidal Distress

Inclusion Criteria for the dosing cohort: 1. Admitted to the Evanston Hospital ED and met criteria for SCS 2. Awaiting voluntary admission to the Evanston Hospital inpatient psychiatric unit 3. Above the age of 18. 4. Ability to provide written informed consent. Exclusion Criteria for dosing cohort: 1. Patients under the age of 18 2. Pregnant individuals (Individuals of child-bearing potential will be given a pregnancy test) 3. Active psychosis or carry a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder mixed, or bipolar disorder with a history of psychotic episodes 4. Individuals whose current ED visit was due to a suicide attempt defined by "actual attempt" on the C-SSRS and which resulted in a score greater than zero on the Lethality/Potential Lethality/Medical Damage C-SSRS questions. 5. Current substance use disorder or significant history of substance abuse 6. Unstable vital signs, including moderate or severe hypertension that is not controlled with medication 7. History of an adverse reaction to ketamine or esketamine 8. Any condition that, in the clinical opinion of the investigator, impairs capacity to provide informed consent (including but not limited to: seizure disorders, psychiatric conditions, neurological conditions, intellectual disabilities, neurodegenerative disorders, renal impairment, hepatic impairment, bleeding disorders, cardiovascular disease, pulmonary disease, or recent history of stroke, aneurysm, or malignancy). 9. Any condition that, in the clinical opinion of the investigator contraindicates intramuscular injections (including but not limited to: current medications, current or recent infection, neuromuscular conditions, skin conditions, bleeding disorders, cardiovascular disease, ror recent myocardial infarction). 10. Any condition that, in the clinical opinion of the investigator that contraindicates ketamine (including but not limited to: seizure disorders, psychiatric conditions, neurological conditions, intellectual disabilities, neurodegenerative disorders, renal impairment, hepatic impairment, bleeding disorders, cardiovascular disease, pulmonary disease, or recent history of stroke, aneurysm, or malignancy). Inclusion Criteria for Chart Review Cohort: 1. Admitted to the Evanston Hospital ED 2. Assessed for Suicidal Ideation by the Crisis Team 3. Over the age of 18 Exclusion Criteria for Chart Review Cohort: 1. Pregnant individuals 2. Individuals who were participants in the Dosing Cohort