We present the case of a 32-year-old male (78 kg, 179 cm), without drug allergies, with a history of inguinal herniorrhaphy and without any treatment, military, who during his working day suffered a crushing after an unexpected fall from a metal structure weighing approximately 1,500 kg. He was evacuated by land ambulance with advanced life support capability to the Hospital Universitario Central de la Defensa "Gómez Ulla" without loss of consciousness and with both respiratory and haemodynamic stability.
In the Emergency Department, a secondary assessment was carried out, a blood sample was taken (CPK 2.295 U/l and myoglobin 469 ng/ml with the rest of the haemogram, biochemistry and haemostasis parameters within normal limits), a chest X-ray compatible with mild pulmonary contusion without pelvic rib fractures and cervical and abdominopelvic CT scan showing a fracture of the left ischiopubic branch without displacement, 10 mm diastasis in the upper portion of the right sacroiliac joint with small bony avulsion of the superomedial iliac border, and decreased thickness of the intersomatic spaces at L4-L5 and L5-S1 accompanied by small diffuse disc prominence at L4-L5.

Diagnosed as polycontused, he was admitted to the Intensive Care Unit with GCS of 15 points, symmetrical reactive pupils, without neurological focality, with good respiratory dynamics, oxygen saturation within the normal range, perfused, normotensive and normocardiac, without signs of peritoneal irritation and absence of macroscopic haematuria, so that after 24 hours it was decided to discharge him to the hospital ward.
On the hospital ward, the patient evolved satisfactorily, with a blood test on the sixth day of admission showing elevated liver enzymes (GOT 134 U/l, GPT 91 U/l, BT 1.2 mg/dl, BD 0.5 mg/dl) which was diagnosed by the Gastroenterology Department as probable acute toxic hepatopathy without liver failure, not accompanied by hepatomegaly or jaundice.
Fifteen days after the accident and after clinical improvement and recovery of normal laboratory values, the patient was discharged from hospital with the recommendation of periodic check-ups by the Traumatology Department.
During his admission, the patient presented pain of variable intensity (VAS 2/10, 3/10, 7/10 and 1/10 during his stay in the emergency room, ICU, hospital ward and at discharge, respectively), with stabbing characteristics, located in the right thoracic region, right pelvis and buttocks, non-radiating, which increased with sitting and decreased in the supine position without causing vegetative symptomatology. She slept satisfactorily and slept without interruption for approximately 8 hours a day. She presented slight dysthymia, probably due to not being able to be with her family living in Colombia.
The analgesic treatment administered during the evacuation to the hospital was: fentanyl 100 µg, in the ICU: paracetamol 1 g/8 h i.v. and dexketoprofen-tromethamol 50 mg/8 h i.v., during the first 6 days in the ward: paracetamol 1 g/8 h i.v. and dexketoprofen-tromethamol 50 mg/8 h i.v. and finally until discharge: dexketoprofen-tromethamol 50mg/8 h i.v. and fentanyl 400 µg transmucosal 30 minutes before any potentially painful movement (showering, standing x-ray...).

