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Analgesia in shocked trauma — DipIMC MCQ

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ModeratePre-hospital PharmacologyAnalgesia in shocked traumaDipIMC

A 28-year-old man has an open tibial fracture and severe pain. He is hypotensive from suspected bleeding and has a reduced level of consciousness. What is the most appropriate immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Prioritise haemorrhage control and cautious analgesia titrated to physiology

Analgesia is important, but in shocked trauma it must be titrated carefully alongside haemorrhage control and airway assessment. Large opioid boluses can worsen hypotension and ventilation. Entonox is inappropriate in reduced consciousness because of airway and cooperation concerns. The pearl is that pain relief should be compassionate and physiologically safe.

Reference: JRCALC Guidelines 2025; NICE Major Trauma NG39