1 / 20

Fentanyl - 2008

Fentanyl - 2008. Southeastern Massachusetts EMS Council. What is the Right Agent??. A medication with rapid onset of action Easily titrated to effect A medication with short half life Rapidly metabolized for the exam in the Emergency Department A medication that is easily dosed

lalo
Download Presentation

Fentanyl - 2008

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fentanyl - 2008 Southeastern Massachusetts EMS Council

  2. What is the Right Agent?? • A medication with rapid onset of action • Easily titrated to effect • A medication with short half life • Rapidly metabolized for the exam in the Emergency Department • A medication that is easily dosed • 1 microgram per kilogram

  3. Sedative Medication Indications • Decrease anxiety and causes amnesia for certain procedures • Cardioversion • Minor surgical procedures • Pre-operative • Conscious sedation for some procedures • Cardioversion • Medication facilitated intubation

  4. Sedative Medication • Sedative • A medication that causes a soothing or tranquilizing effect • A sedative can be…. • General • Local • Nervous System • Vascular System

  5. Sedative Medication • Sedation • The state of being calm • The active process of calming • Psychological – verbal interaction • Chemical Agents

  6. Sedation • Psychological • Verbal interaction • Active listening • Calming soothing voice • Reassurance • Confidence • Understanding

  7. Sedation • Chemical agents • Benzodiazepines • Barbiturates • Sedative/hypnotics • Amnestics • Antipsychotic • TCA’ss • Dissociative anesthetics

  8. Sedation with Medication • Humane • Safe in trained hands • Decreases CNS response • Decreases anxiety • May cause therapeutic hypnosis • Causes amnesia • Decreases seizure activity • Decreases ICP • Decreases oxygen demand

  9. Fentanyl Basics • First synthesized in Belgium in the 1950’s for anesthesia • Trade Name “Sublimaze” • It is a potent synthetic narcotic with properties similar to those of morphine • Chemically unrelated to morphine, but 50 to 100 times more potent • Duration of action is considerably shorter than morphine – from 30 to 60 minutes

  10. Fentanyl Benefits • Used in the EMS environment for… • Pain management • Sedation • Fewer negative effects than morphine on… • Blood pressure • Respiratory effort • Less incidents of nausea and vomiting!!!

  11. Fentanyl Concerns • Fentanyl is the most diverted medication in the medical community! • It has an increasing street value! • It has a very high potential for habituation

  12. Fentanyl Overview • Class: • Narcotic analgesic • Indications: • Adjunctive agent for MFI and for moderate to severe pain • Dose: • 1 mcg/kg slow IVP, IM, or intranasal

  13. Fentanyl Pharmacokinetics • Absorption • Immediate onset by IV. • +/- 8 minutes by IM • Peak effects in 3-5 minutes • Duration of effects 30 to 60 minutes • Distribution • Widespread • Metabolism • Hepatic • Elimination • Urine

  14. Contraindications & Interactions • Contraindications • Patients who are on MAO inhibitors • Myasthenia Gravis • Use with caution: • Head injuries • Elderly, debilitated • COPD • Interactions • Alcohol and other CNS depressants • Anti-depressants

  15. Sedation Euphoria Dizziness Diaphoresis Delirium Hypotension Bradycardia Nausea Vomiting Laryngospasm Respiratory depression Adverse/Side Effects

  16. Considerations • Parenteral dose may be given diluted or undiluted • Administer IV over 1 to 2 minutes • Protect from light • Closely monitor vital signs • Respiratory depression may out last the analgesic effect • Effects may be reversed by naloxon (Narcan®)

  17. Fentanyl – In Summary • Fentanyl is a potent analgesic • Dose is 1 mcg/kg • Reversal agent is Narcan®

  18. Fentanyl Is Used in What Protocols? • 1.2 Atrial Fibrillation (Cardioversion) • Paramedic S.O./ Medical Control Option • 1.3 Atrial Flutter (Cardioversion) • Paramedic S.O./Medical Control Option • 1.5 Acute Coronary Syndrome (Pain) • Paramedic S.O./Medical Control Option • 1.9 Supraventricular Tachycardia (Cardioversion) • Paramedic S.O./Medical Control Option

  19. Fentanyl Is Used in What Protocols? • 1.11 Ventricular Tachycardia with Pulses (Cardioversion) • Paramedic S.O. • 3.7 Hypertensive Crisis • Medical Control Option • 3.14 Adult Pain Management (Pain) • Paramedic S.O./Medical Control Option • 4.2 Burns/Inhalation Injuries (Pain) • Medical Control Option

  20. Fentanyl Is Used in What Protocols? • 5.9 Pediatric Supraventricular Tachycardia (Cardioversion) • Medical Control Option • 5.13 Pediatric Pain Management (Pain) • Paramedic S.O./Medical Control Option

More Related