During assessment of a patient with suspected injuries who cannot reliably report pain, what is the recommended approach to pain evaluation?

• A. Do not assess pain until imaging is completed.
• B. Pain assessment is unnecessary in RSI.
• C. Assume pain is present based on MOI and injuries identified.
• D. Use a standard pain scale only if the patient can communicate.

Answer: (C)

When a patient can’t reliably report pain, rely on what you know from the mechanism of injury and the physical exam to judge likely pain and guide treatment. Inferring that pain is present from MOI and observed injuries allows you to initiate analgesia promptly and adjust it as you gather more information, using nonverbal cues (grimacing, restlessness, agitation) and vital signs to monitor response.

This approach avoids waiting for imaging or for the patient to communicate, and it recognizes that standard pain scales aren’t usable when communication is impaired. It also counters the idea that pain assessment isn’t needed in critical scenarios, since addressing pain is important for comfort, hemodynamic stability, and overall care.