DIlaudid

[croaker260]

Hey all, we are switching from fentanyl to Dilaudid due to a shortage of fentanyl availability. Go figure, huh?

Anyway, I have only used it a handful of times in the past so my personal experiences is limited. I was wondering is anyone else using it out there. How do you like it for pain control, how about for an adjunct in RSI?

Any other tips and tricks you would care to offer?

[ERDoc]

It works well for pain control but is easy to overdose since the doses are so low. Don't let your druggies know as they will be breaking into your ambulances to score.

[BAYAMedic]

In clinical's we pushed it like water in the ER's, Only pushed Morphine once for pain control, and twice for cardiac, and didn't push Fentanyl until I made it out to the field. So my limited experience with this med is partially based on my personal experience as a patient. Dilaudid Seemed to work a bit better on orthopedic pain than Fenanyl. It seems to fall into the "Rule of tens of Opioids" as well IE. 10mg MS = 100mcg Fentanyl = 1mg Dilaudid, IVP. Maybe I am just one of the sensitive ones, but Nausea did come but was relatively fleeting and dependent on how fast the dose was pushed, So might not be a bad idea to pre-treat with some Zofran. I haven't used it in a RSI situation, so I cannot comment on its effect that way.

If you have any voice in purchasing, I would ask for the 1mg/2mL Carpuject vs the 2mg/2mL for ease of dosing and a touch better control if you hit a bump in the road.

Fireman1037

[island emt]

Fentanyl shortages, got us Morphine back in the formulary

Now there's a MS shortage so they are looking at dilaudid.

next month dilaudid will be on the shortage list , then what?

The system is in trouble & that includes the hospitals.

Some of the others on the shortage list: Valium, rocuronium, vecuronium, glucogon, Saline flushes, D-50. And the list goes on & on.

Maybe we need to go way back into ancient medicine and just let the pt's smoke the opium pipe! just kidding folks!

But then I grew up in an age where mothers rubbed Paragoric on a babies gums. No wonder we slept welll as infants. :-}

[croaker260]

In clinical's we pushed it like water in the ER's, Only pushed Morphine once for pain control, and twice for cardiac, and didn't push Fentanyl until I made it out to the field. So my limited experience with this med is partially based on my personal experience as a patient. Dilaudid Seemed to work a bit better on orthopedic pain than Fenanyl. It seems to fall into the "Rule of tens of Opioids" as well IE. 10mg MS = 100mcg Fentanyl = 1mg Dilaudid, IVP. Maybe I am just one of the sensitive ones, but Nausea did come but was relatively fleeting and dependent on how fast the dose was pushed, So might not be a bad idea to pre-treat with some Zofran. I haven't used it in a RSI situation, so I cannot comment on its effect that way.

If you have any voice in purchasing, I would ask for the 1mg/2mL Carpuject vs the 2mg/2mL for ease of dosing and a touch better control if you hit a bump in the road.

Fireman1037

Good information , thanks. FWIW, We typically dilute our Fentanyl to 10 cc in a flush, so diluting the dilaudid wont be a big deal.

[Bieber]

Dilaudid was the first drug I ever pushed! Word to the wise, slow push! We carry fentanyl, but recently reduced our dose from 1 mcg/kg x2 to a straight 50-75 mcg x2 with no more diluting it, and we're getting morphine as soon as the medical society approves our new protocols (see, in the next era). Other than in clinicals, I haven't ever used dilaudid, so I don't have a great deal of experience with it, though we're feeling the hurt of this drug shortage too. We just recently switched from carrying the 100 mcg vials to 500 mcg vials of fentanyl because that's all we could find. Needless to say, we're wasting a lot of fentanyl right now.

Edited January 22, 2012 by Bieber

[Doczilla]

Dilaudid is a very effective narcotic pain medication. There is an added effect on the patient's sense of "well being", which I think is why so many drug seekers ask for it. The precautions about dilaudid are largely the same as any other opiate narcotic: respiratory depression, hypotension are possibilities. The duration of action is a good bit longer than morphine (6-8 hours as opposed to 2-4). Like any opiate, push slow. Typical initial dose for an adult in pain is 1 mg. For weight based dosing in pediatrics, 0.015 mg/kg.

'zilla

[Eydawn]

Whoa! I had no idea there were so many shortages currently until I pulled up http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050792.htm and started looking through.

What the heck? How does this happen? I truly don't understand, since there's such a huge profit in pharmaceutical markets, how some of the most used items in pharmacopeia suddenly go "short"- is it intentional, to drive up the price? If so, there's a HUGE ethics mess there...

Wendy

CO EMT-B

[Kiwiology]

Your drug shortage is because Kiwi can't break a glass ampoule properly .... so um goes through lots of them; oh and my finger is bleeding now, should I call the 911?

Hydromorphine is good stuff, the UK use it but nobody down this end of the plant does.

Edited January 22, 2012 by kiwimedic

[craig]

Your drug shortage is because Kiwi can't break a glass ampoule properly .... so um goes through lots of them; oh and my finger is bleeding now, should I call the 911?

Hydromorphine is good stuff, the UK use it but nobody down this end of the plant does.

dont you guys across the dutch have ampoule breakers in your kits...they are very inexpensive