Inhaled vs IV Opioid Dosing for the Initial Treatment of Severe Acute Pain in the Emergency Department

Inclusion Criteria:

• Age ≥ 18 and <75 years old;

• EVA ≥ 70/100 or EN ≥ 7/10;

• Patient who received clear information from the investigator and read and signed theconsent form;

• Patient affiliated with, or beneficiary of a social security category;

• For women: O of childbearing age: effective contraception (oral contraception, intrauterine device oruse of condoms) O menopausal status (amenorrhoea less than 12 months before the inclusionvisit) O objectivized sterility (diagnosis or surgically)

Exclusion Criteria:

• Chronic pain (> 3 months)

• Taking opioids longer than 10 days (including "weak" opioids tramadol and / orcodeine);

• Taking Rifampicin;

• Impaired ability to discern, cognitive impairment;

• Morphine-related contraindications: O Obstructive chronic obstructive or restrictive respiratory failure known or suspectedcompensated or not, O Hypersensitivity to the active substance or to any of the excipients,O Severe hepatocellular insufficiency (known or suspected), O Chronic renal failure knownor suspected, O Uncontrolled epilepsy, O Cranial trauma (intracranial hypertension), OAssociations with buprenorphine, nalbuphine, pentazocine and naltrexone

• Active drug history or practice (s);

• Evidence of reduced fracture or dislocation in emergency rooms;

• Suspected occlusive syndrome

• SaO2 <95%;

• FR <12 / min;

• Glasgow <15 or other alertness disorders;

• HR heart rate <50 bpm and / or Auriculo-Ventricular block (PR XML File Identifier:zR6XOYKSEQ9GjQHghP8c465EwF0= Page 15/30 interval> 200 ms);

• Arterial hypotension with systolic blood pressure TA syst <100 mm Hg;

• Pregnant or nursing

• Persons deprived of their liberty by an administrative or judicial decision, a personplaced under the safeguard of justice, guardianship;

• Patients with poor comprehension of spoken or written French;

• Patients participating in another interventional clinical study;

• Contra-indication related to the use of saline solution

• Contra-indications related to the use of aerosol: O Necessity to access the face O Allergy known to plastic