Ketamine for Pain Control After Severe Traumatic Injury

Inclusion Criteria: * Age 18-64 * ISS \>15 * Infusion can be started within 24 hrs of arrival to FMLH (time of injury irrelevant) * Admitted to Inpatient hospital trauma service (not Ortho/Plastics/Neurosurgery etc) Exclusion Criteria: * Age \<18 or \>64 * History of adverse reaction to ketamine therapy * Chronic opioid therapy defined as \> 3 weeks of \>30mg oral morphine equivalents per day * Current substance abuse with opioids including prescription and/or heroin * Intubation on arrival or need for urgent intubation on arrival * GCS \<13, significant traumatic brain injury, or suspicion of elevated intracranial pressure resulting in the patient's inability to communicate * History of psychosis * Active delirium * Glaucoma * Ischemic heart disease defined as active acute coronary syndrome * Severe, poorly controlled hypertension (SBP \>200) on more than two readings * Aortic Injury requiring HR and BP control * Concurrent use of monoamine oxidase inhibitors (MAOIs) * Pregnancy * Prisoners * Inability to start investigational drug infusion within 24 hours of arrival