Intranasal Ketamine Versus Subcutaneous Ketamine for Treatment of Post-traumatic Acute Pain in the Emergency Department ( INVESCK )

Inclusion Criteria: * • Patients who presented to the ED with acute limb trauma pain with a visual analgesic scale (VAS) of 5 or more on a standard 11 point (0-10). * Pain was considered traumatic if it is reported as appearing immediately after the trauma and no anterior pain was described in the same limb. Exclusion Criteria: * Pregnancy/Breastfeeding * altered mental status (GCS\<15) * Allergy to ketamine or morphine * Weight less than 40 kg or greater than 100kg * Unstable vital signs (systolic blood pressure \<90 or \> 180mmHg, pulse rate\<50 or \>150bpm, and respiration rate \<10 or \>30 breath/min) * Medical history of acute head or eye injury * Medical history of seizure * Medical history of intracranial hypertension, * Medical history of chronic pain, * Medical history of severe renal or hepatic insufficiency. * Medical history of glaucoma * Alcohol or drug abuse * Psychiatric illness, * Recent (4 hours before) analgesic agent use.