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FENTANYL
(Sublimaze)

Fentanyl

PACKAGED: 100 mcg/2 mL (50 mcg/ml) vial

LOCATION: Intermediate Pouch, Controlled Substance Pocket

INDICATIONS:
Suspected Cardiac Chest Pain, Trauma Emergencies, Extremity Fractures, Dislocations, Sprains, Frostbite, Abdominal Pain, Haz-Mat: Hydrofluoric Acid (Hf)

ADULT:
Fentanyl 100 mcg IN, repeat no sooner than 30 minutes.
Fentanyl administered up to 50 mcg slow IV/IO provided SBP > 100. 
Repeat Dose: May repeat up to 50 mcg after 5 minutes provided SBP > 100.
If unable to establish IV, Fentanyl  50 mcg IM; Repeat no sooner than 30 minutes and is only indicated when transport is greater than 30 minutes.

PEDI:

  • FENTANYL IS NOT TO BE ADMINISTERED TO ANYONE < 2 YEARS OF AGE.
  • For severe pain relief when the patient is conscious and alert, consider Fentanyl  1 mcg/kg, slow IV
    (
    max dose 50 mcg)  provided appropriate normal SBP. 
  • If unable to obtain IV, give Fentanyl  1 mcg/kg  IM (max dose 50 mcg) or Fentanyl  1 mcg/kg IN (max dose 100 mcg).
  • ¨May repeat Fentanyl  1 mcg/kg, slow IV after 5 minutes (max dose 50 mcg) if still in pain and appropriate SBP.
  • ¨Repeat dose of Fentanyl  1 mcg/kg IM (max dose 50 mcg, repeat no sooner than 30 minutes).

THERAPEUTIC ACTION:
Provides analgesia, reduces cardiac preload by increasing venous capacitance and decreasing afterload

CONTRAINDICATIONS:
Hypersensitivity to drug/class/components

PRECAUTIONS AND SIDE EFFECTS:
Apnea
CNS depression
Chest wall rigidity ("wooden chest syndrome") may occur preventing adequate chest wall excursion and ventilation.  This syndrome typically occurs with high doses (6-7 mcg/kg) or with rapid administration. Reversible with naloxone.
Bradycardia which may be transient.  Ensure adequate ventilation and oxygenation first.  Treat with atropine only after these have been ensured.  Use atropine only if the bradycardia is symptomatic and hemodynamically significant, and per the bradycardia protocol.
 
REQUIRES MCP:
ADULT: No
PEDI:  Yes for repeat doses
            Yes, for abdominal pain in peds