Wayne’s journey begins 30 minutes after a road traffic accident, with severe trauma, respiratory compromise and an unstable femoral fracture. This lecture focuses on recognising and managing acute pain in the true emergency patient, where rapid decisions can be life-saving. Participants will be guided through the assessment of traumatic pain and shock, interpretation of point-of-care diagnostics, and the development of safe, effective, and an discussion of opioid-free multimodal analgesic plans. Particular emphasis is placed on analgesic choices for patients with concurrent thoracic injury, and the practical use of pain scoring tools to guide real-time treatment adjustments.