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EMR
EMT
AEMT
Paramedic
Extended
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.
Fentanyl (Sublimaze
®
)