Pain Management

Question 1

Why is pain management important in trauma care?

Answer 1

Reduces stress, improves outcomes, and increases cooperation.

Question 2

What are the primary goals of pain management in tactical medicine?

Answer 2

Relieve suffering, maintain function, and prevent complications.

Question 3

What are common pain medications used in tactical medicine?

Answer 3

Ketamine, fentanyl, paracetamol, and NSAIDs.

Question 4

What pain relief is recommended for mild pain in TCCC?

Answer 4

Tylenol (paracetamol) and/or Meloxicam.

Question 5

What is the TCCC-recommended combo for mild to moderate pain?

Answer 5

650 mg Tylenol PO q8h + 15 mg Meloxicam PO daily.

Question 6

What is the preferred pain relief for moderate to severe pain with no shock?

Answer 6

Fentanyl (OTFC 800 mcg) or IV morphine.

Question 7

What is the dose of fentanyl lollipop (OTFC) in TCCC?

Answer 7

800 mcg, can repeat once in 15 minutes if needed.

Question 8

What is the preferred analgesic in casualties at risk for shock?

Answer 8

Ketamine.

Question 9

What dose of ketamine is used for pain in TCCC?

Answer 9

50 mg IM/IN or 20 mg IV/IO slow push.

Question 10

Why is ketamine preferred in hypotensive patients?

Answer 10

It maintains airway reflexes and does not suppress respiration.

Question 11

What is the risk of using morphine in trauma patients?

Answer 11

Respiratory depression and hypotension.

Question 12

What pain medication has dissociative properties?

Answer 12

Ketamine.

Question 13

How does ketamine work?

Answer 13

NMDA receptor antagonist, produces analgesia and dissociation.

Question 14

What are common side effects of ketamine?

Answer 14

Hallucinations, hypertension, increased salivation.

Question 15

What is the benefit of OTFC over IV opioids in the field?

Answer 15

Easy to administer, no IV access required.

Question 16

What are contraindications to ketamine?

Answer 16

Significant psychiatric illness or penetrating eye injury (relative).

Question 17

When should pain be reassessed in trauma care?

Answer 17

Regularly after any intervention or medication.

Question 18

What is the role of non-pharmacological pain management?

Answer 18

Positioning, splinting, reassurance, and distraction.

Question 19

What is the maximum daily dose of acetaminophen?

Answer 19

4,000 mg in 24 hours.

Question 20

Why are NSAIDs used cautiously in trauma?

Answer 20

They can affect platelet function and kidney perfusion.

Question 21

What is the onset time for oral acetaminophen?

Answer 21

30–60 minutes.

Question 22

What is the duration of action for fentanyl OTFC?

Answer 22

30–60 minutes.

Question 23

Why is monitoring essential with opioids?

Answer 23

To detect respiratory depression or sedation.

Question 24

What tool can be used to assess pain in conscious patients?

Answer 24

Numeric pain scale (0–10).

Question 25

How should pain be assessed in unconscious patients?

Answer 25

Observe for grimacing, movement, or vital sign changes.

Question 26

What is an alternative route for ketamine if IV is not available?

Answer 26

Intramuscular or intranasal.

Question 27

How is pain managed in a casualty with a penetrating chest injury?

Answer 27

Ketamine preferred to avoid respiratory depression.

Question 28

What are signs of opioid overdose?

Answer 28

Pinpoint pupils, respiratory depression, unconsciousness.

Question 29

What drug is used to reverse opioid overdose?

Answer 29

Naloxone (Narcan).

Question 30

What is the dose of naloxone for opioid reversal?

Answer 30

0.4–2 mg IV/IM/IN every 2–3 minutes as needed.

Question 31

What is the benefit of using multimodal pain therapy?

Answer 31

Enhanced relief with reduced side effects.

Question 32

What adjuncts may be useful for musculoskeletal trauma?

Answer 32

Splinting and immobilization.

Question 33

What is the preferred pain management for a burn casualty?

Answer 33

Opioids like morphine or fentanyl, or ketamine.

Question 34

When is it appropriate to escalate pain treatment?

Answer 34

If pain persists despite initial treatment.

Question 35

What does the acronym TCCC stand for?

Answer 35

Tactical Combat Casualty Care.

Question 36

What non-opioid is recommended by TCCC for all levels of pain?

Answer 36

Acetaminophen (Tylenol).

Question 37

What role does hydration play in pain management?

Answer 37

Supports kidney function and helps reduce discomfort.

Question 38

Why should sedation level be monitored with ketamine?

Answer 38

To avoid over-sedation and maintain airway control.

Question 39

What is a key consideration for pain relief in mass casualty settings?

Answer 39

Use fast-acting and easily administered options.

Question 40

What should be documented after giving pain medication?

Answer 40

Drug, dose, time, route, effect, and vital signs.

Question 41

What can be used for pain in patients with shell fragment wounds?

Answer 41

OTFC, ketamine, and non-opioid adjuncts.

Question 42

When might oral pain meds be preferred in the field?

Answer 42

When IV access is unavailable and patient can tolerate PO intake.

Question 43

What is an advantage of IN (intranasal) ketamine?

Answer 43

Fast absorption, no IV needed.

Question 44

How should a fentanyl lollipop be administered?

Answer 44

Placed between cheek and gum, not chewed or swallowed.

Question 45

Why is it important to monitor for ketamine emergence reactions?

Answer 45

They can cause confusion or agitation post-administration.

Question 46

What medication class should be avoided in patients with head injury?

Answer 46

Excessive opioids due to respiratory depression risk.

Question 47

What is the role of reassessment in pain management?

Answer 47

Ensure effectiveness and monitor for side effects.

Question 48

How can pain interfere with tactical casualty care?

Answer 48

Reduces mobility, cooperation, and increases stress response.