You are the ICU fellow on call overnight at a tertiary care hospital. At approximately 2 AM, you receive a call from the emergency department (ED) with a consult. The ED resident gives you the following details: Mrs P is a 67 year old woman who presented recently with acute dyspnea and severe pain focused around an area of extensive erythema on her left arm. She has apulse rate of 115, respiratory rate 45 breaths per minute, temperature 39°C, blood pressure 95/65 mm Hg, and O2 saturation 68% on room air. The resident also notes areas of dark and yellowish tissue surrounding her left elbow, which are suspected to be necrotic. She is currently receiving 100% O2 via a high flow mask and fluid resuscitation via two peripheral IVs. She is experiencing severe pain, which she rates as 10/10, but is otherwise stable. You agree to have this patient transferred to your care. While she is on the way up you remind yourself of the key components of pain management in the critically ill patient.