Altitude contributes to a wide variety of physiological changes within the body. Changes that disrupt the amount of oxygen delivered to the cells, altering the acid-base balance, resulting in abnormalities like skip breathing, hypercapnia and hypoxia. All issues that are uncommon breathing ambient air. As more and more adventurous thrillseeking individuals travel to high elevations, it becomes more paramount for medical providers to understand these effects. With special attention on the pharmacodynamics of drugs in a lower oxygen environment. Traumatic patients are of special interest at altitude because they require constant monitoring as well as proper resource management. Within every provider trauma protocol is pain management of the patient. Adverse side effects can always present from improper dosing of opioid narcotics, however lower partial pressures of O2 amplify these concerns. Concerns mainly associated with the depression of the respiratory drive. Thus, increasing the risk of administering narcotics at altitude. Ketamine can successfully accommodate the need for analgesia at altitude, while eliminating the serious potential for CNS depression. This article seeks to educate and promote the usage of ketamine in high-altitude traumatic patients. The end goal is the confidence needed to avoid errors of omission rather commission in any austere environment.