2016 Trumbull Protocol Book

Fentanyl (Sublimaze) Fentanyl (Sublimaze ® )

Action

Onset

Narcotic analgesic

Immediate Maximal analgesic and respiratory effect may take several minutes

Indications Pain Control

Adult Dose 1 mcg/kg IV/IO/MAD 3 mcg/kg IV/IO/MAD maximum 300 mg for patients who are opioid tolerant (cancer, chronic pain, etc) 0.5 mcg/kg IV/IO/MAD for frail elderly patients Remember 1 mL maximum per nostril via MAD route

Pediatric Dose Do not use.

Contraindications Known intolerance or hypersensitivity to the drug. Use caution in BP < 100mmHg and have a plan to maintain BP. Respiratory rate < 14 bpm. Oxygen saturation < 90% and/or significant respiratory depression.

Adverse Reactions Respiratory: Respiratory depression, apnea, laryngospasm Cardiovascular: bradycardia, hypotension, hypertension CNS: Dizziness, blurred vision

Gastrointestinal: nausea and vomiting Other: muscle rigidity, diaphoresis

Precautions Use caution in patients with head injuries and elevated ICP. Use caution with bradycardia, COPD, and decreased respiratory reserve patients, as well as patients already on narcotics. Fentanyl should be reduced in frail elderly patients. Use caution in patients with elevated BP. Fentanyl in high doses (> 2-3 mcg/kg) can result in “stiff chest” with inability to ventilate patient. Stiff chest is treated with a paralytic during RSI. Considerations Studies show that fentanyl is very hemodynamically neutral compared to other narcotic analgesics. If the patient is in pain, even post trauma or abdominal pain, please provide pain relief. Prepare to manage the blood pressure after administration.

203

EMR

EMT

AEMT

Paramedic

Extended