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