The provision of analgesia to patients in pain is a fundamental necessity of emergency department practice and is usually accomplished using IV opioids. However, significant barriers exist to the provision of timely analgesia by the IV route.

The use of the IN route for medication delivery provides an efficient and relatively painless mode of analgesia delivery. As well, ketamine is well-known to be an effective analgesic and to preserve cardiorespiratory function thus removing the necessity of physiologic monitoring that is obligatory when using opioids. The use of ketamine by the IN route provides a rapid, easy-administered and well-tolerated method for providing analgesia in the ED setting.

Inclusion Criteria:

• age 6 years or greater
• moderate or severe pain (VAS >=50mm)

Exclusion Criteria:

• history of allergy or intolerance to ketamine
• structural or functional nasal occlusion
• inability to understand the VAS
• Glasgow Coma Scale < 15
• Systolic BP > 180
• History of schizophrenia
• Clinical necessity for immediate IV access as judged by the treating physician