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Fentanyl - 2008

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  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