How should I manage pain in a patient presenting with major trauma before transfer to secondary care?

For a patient presenting with major trauma before transfer to secondary care, pain management should begin with regular pain assessment using a scale appropriate for their age, developmental stage, and cognitive function NICE NG39. Medications should be offered to control pain in the acute phase NICE NG39.

Intravenous morphine is the first-line analgesic, and the dose should be adjusted to achieve adequate pain relief NICE NG39. If intravenous access has not been established, the intranasal route for atomised delivery of diamorphine or ketamine can be considered NICE NG39. It is important to note that in February 2016, this was an off-label use of intranasal diamorphine and intranasal ketamine NICE NG39. Ketamine in analgesic doses can be considered as a second-line agent NICE NG39.