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Analgesia must balance pain control with hemodynamic and respiratory safety. Ketamine, titrated IV/IO or administered IM/IN per local protocol, is frequently preferred in the tactical trauma setting because it provides potent analgesia and dissociation while generally preserving airway reflexes and maintaining or even supporting blood pressure through sympathetic stimulation. High-dose opioids risk respiratory depression and hypotension, which are detrimental in hemorrhagic shock. Benzodiazepines alone provide anxiolysis but poor analgesia and can depress respiration. NSAIDs are not appropriate initial therapy in acute trauma with potential bleeding risks and do not address severe pain rapidly. When using ketamine, monitor mental status, airway, and hemodynamics; consider adjuncts (e.g., ondansetron for nausea) and transition to multimodal analgesia as the casualty stabilizes and higher-echelon care becomes available.