Intranasal Ketamine for Pain Control in Patients with Sickle Cell Disease and Vaso-occlusive Episode (VOE) in the PED

Inclusion Criteria: * History of Hemoglobin SS or SC disease * Age 3 years old to 25 years old presenting to the PED with vaso-occlusive with moderate-severe pain determined at triage as pain score (FACES or numeric rating scale) ≥ 5 * Parent or patient willing to provide consent/assent * English speaking Exclusion Criteria: * Patient with concern for more severe complications including acute chest, splenic sequestration, sepsis, stroke, non-VOC pain, asthma exacerbation * Allergy to ketamine * GCS\<15 * Obstructive nasal anatomy as per parent history * History of a psychiatric disorder * Pregnant patients will be excluded. Female patients \> 12 years old are routinely tested for pregnancy in our PED. Patients found to be pregnant will not be enrolled in study.