German EMT

hi to all. Here in Germany we use both, MSI and Fentanyl on our Emergency Physician Units. We actually only use MSI in myocardiac-infarction(hope I'm spelling right) due to its pre-load reduction. Fentanyl is used in every other situations were pain-relief is needed. We use a initial dose of 0.2mg Fenta. There is also now a big discussion about Ketanest here. Schould be used in cerebral-bleeding because it lowers cerebral pressure and the patient won't have breathing-depression (good for multiple trauma). The problem is that the dosage is hard to handle and patiant needs simmultain Midazolam to prevent him from nightmares.