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Induction Agent Haemodynamic Instability Trauma — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaInduction Agent Haemodynamic Instability TraumaFRCA Final

A 30-year-old man sustains blast injuries in an explosion with bilateral above-knee traumatic amputations and extensive burns. He is haemodynamically unstable. What is the most appropriate induction agent for emergency surgery?

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Correct answer: A — Ketamine 1-2 mg/kg

Ketamine is the induction agent of choice in haemodynamically unstable trauma patients. Its sympathomimetic properties maintain blood pressure, heart rate, and cardiac output through central stimulation of the sympathetic nervous system. It also provides potent analgesia. All other agents (propofol, thiopental, etomidate) cause dose-dependent cardiovascular depression. In severely hypovolaemic patients, even ketamine's sympathomimetic effect may be insufficient (catecholamine stores may be depleted), and doses should be reduced. Ketamine may increase intracranial pressure and should be used cautiously in TBI.

Reference: ATLS – 2018 – 10th edition; RCOA – 2023 – Trauma anaesthesia module