Scheduled Intranasal Ketamine

Inclusion Criteria: * Patient between aged 18-80 years, present following a traumatic incident, rate pain \> 5 on the numeric rating scale (NSR), and require admission to the hospital. Exclusion Criteria: * \- Patients that arrive at facility intubated * Patients that received Ketamine in the field * Patients less than 18 years old or greater than 80 years * Pregnant or breast-feeding females * Hemodynamic instability defined as need for vasoactive drugs or Systolic blood pressure \>180 * Weight less than 80 pounds or greater than 300 pounds * Glasgow Coma Scale less than 15 * Current acute head injury resulting in unconsciousness * Current or history of eye injury * Current or history of seizures * Facial or nasal fractures that require nasal precautions * Current or history of intracranial hypertension * History of Schizophrenia * BAC (Blood Alcohol Content) greater than 0.08 * Current alcohol abuse * Current drug abuse or positive drug screen * Chronic pain or patients on pain contracts * Inability to assess pain intensity * Contraindications or allergies to the treatment * Patients with hepatic insufficiency * Prisoners * Nursing home residents * Urine drug screen positive for illicit drugs or medications not on their home medication list. * BAC \> 0.08 * Positive pregnancy test