Intranasal Ketamine for Anxiolysis in Pediatric Emergency Department Patients

Inclusion Criteria:

* Patients age 2 to 12 years who present to the ED
* Requiring intravenous access
* Requiring laceration repairs
* Requiring incision and drainage of abscesses
* Requiring digital nerve blocks
* Requiring radiological imaging
* Requiring bladder catheterization
* Requiring foreign body removal.

Exclusion Criteria:

* Vital sign abnormalities greater than 20% deviation from age-normalized ranges
* Altered mental status/delirium or intoxication
* Patient or patient's parent/guardian are unwilling to participate or provide informed consent
* Any allergy to ketamine or midazolam
* Patient is female with history of menarche
* Presence of chronic oxygen-dependent pulmonary disease, liver cirrhosis, or renal disease requiring dialysis
* Presence of ischemic heart disease, heart failure, or a history of unstable dysrhythmias
* Presence of intracranial mass or vascular lesion.
* Presence of a history of psychosis or hallucinations
* Weight greater than 100kg
* History of increased intracranial pressure/ hypertensive hydrocephalus within the last 3 months
* Non-English speaking/reading parent/guardian and/or patients
* Patient is acutely psychotic
* Provider feels that patient currently or likely will require chemical and/or physical restraints
* History of prolonged QT-interval
* Nasal trauma
* Epistaxis