Ketamine vs. MorphineMorphine or Ketamine for Analgesia

Inclusion Criteria:

1. Age 6 to < 18 years old
2. Chief complaint includes abdominal pain OR isolated long-bone extremity fracture (suspected or proven)
3. Self-reported pain score of ≥ 6/10
4. Requires IV morphine for analgesia as determined by the treating physician

Exclusion Criteria:

1. Weighs more than 81.9 kg
2. Known allergy/contraindication to morphine or ketamine
3. Antecedent receipt of ketamine related to presenting complaint
4. Inability to use self-report measures of pain or questionnaires
5. Chronic disease associated with pain
6. Chronic pain conditions requiring use of opioids as an outpatient
7. Abnormal vital signs at baseline, defined as oxygen saturation <92% and/or low respiratory rate and/or low heart rate and/or low blood pressure per age
8. Altered mental state (e.g., GCS < 14 or clinical intoxication)
9. Known history of schizophrenia, liver or kidney problems, or osteogenesis imperfecta
10. Concern for open fracture, neurovascular compromise, or compartment syndrome
11. Injuries in addition to the extremity injury (e.g., head, neck, abdomen)
12. Known or reported pregnancy
13. Patients who are breastfeeding
14. Patient or parent/guardian does not speak English or Spanish
15. Patient previously enrolled in this study
16. Known significant or uncontrolled cardiovascular disease
17. Known increased intracranial pressure and/or elevated intraocular pressure
18. Currently taking or having used a monoamine oxidase inhibitor within 14 days
19. Wards of state, foster children, or children in custody