3 Years - 25 Years
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
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.