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 ². Medications should be offered to control pain in the acute phase ².

Intravenous morphine is the first-line analgesic, and the dose should be adjusted to achieve adequate pain relief ². If intravenous access has not been established, the intranasal route for atomised delivery of diamorphine or ketamine can be considered ². It is important to note that in February 2016, this was an off-label use of intranasal diamorphine and intranasal ketamine ². Ketamine in analgesic doses can be considered as a second-line agent ².