What pain medication should be provided to a casualty with moderate to severe pain who is also in shock?

For a casualty experiencing moderate to severe pain while also in shock, the appropriate pain management option is ketamine. This is primarily due to ketamine's unique characteristics as an analgesic and sedative that can effectively manage pain without causing significant respiratory depression, which is particularly crucial in a shock scenario where the patient’s physiological stability is compromised.

Ketamine is also advantageous because it provides rapid pain relief and can be administered intravenously or intramuscularly. Additionally, it has dissociative effects, allowing for better management of anxiety and discomfort, which can be particularly beneficial in traumatized patients or those in severe distress.

Given that patients in shock may have altered physiological responses, using a medication that can be safely administered without extensive monitoring requirements, as needed with other opioids like morphine and fentanyl, makes ketamine a preferred choice. These opioids may have respiratory depressant effects, and their use may require more careful evaluation of the patient's ability to maintain adequate ventilation, which is critical in shock management.

While ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can relieve pain, it is not suitable for severe pain treatment and might not provide adequate analgesia in such acute situations.