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Ketamine analgesia in shocked trauma — DIPIMC MCQ

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ModeratePharmacology (Pre-Hospital)Ketamine analgesia in shocked traumaDIPIMCDipIMC

A 28-year-old has significant haemorrhage from an open femoral injury and is hypotensive and in severe pain. You plan to provide analgesia before splinting and transfer. Which agent is most appropriate given his haemodynamic state?

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Correct answer: B — Ketamine, which preserves cardiovascular stability

Ketamine is well suited to analgesia in the shocked trauma patient because it tends to preserve sympathetic tone and cardiovascular stability, unlike opioids and sedatives that can precipitate hypotension; in sub-anaesthetic doses it provides effective pain relief. A large opioid bolus can worsen hypotension in a haemorrhaging patient, and propofol has no analgesic action while causing vasodilation and myocardial depression. Midazolam is a sedative with no analgesic effect. Pearl: titrate ketamine carefully and combine it with haemorrhage control and judicious blood or fluid, since analgesia does not substitute for resuscitation.

Reference: JRCALC Clinical Guidelines; Faculty of Pre-Hospital Care (RCSEd)