Acute painful conditions make-up a large proportion of pre-hospital transports in British
Columbia (BC) yet Basic Life Support (BLS) paramedics have limited options to provide
analgesia and therefore adequate and timely pain relief is often significantly delayed.
Inhaled nitrous oxide is commonly used as a pre-hospital analgesic and is considered "usual
care" for pre-hospital providers in BC, but its utility in severe pain is uncertain.
Moreover, nitrous oxide is limited in its effectiveness by a short duration of action,
nausea, vomiting, and the necessity for patient cooperation.
IN Ketamine has been shown to provide rapid, easily-administered, and well-tolerated
analgesia in many settings. The investigators believe that the addition of IN ketamine to
usual care with nitrous oxide inhalation for adults experiencing moderate to severe intensity
acute pain in the pre-hospital setting will result in improved pain severity, improved
patient-reported comfort, and improved patient satisfaction.