Nubain or Stadol

[1EMT-P]

Do any of you carry either Nubain and/or Stadol?

[Pelotari]

Yes, as strange as it may sound, we DO carry Nubain (Nalbuphine). Mainly due to the fact that morphine is not available in Mexico -not even intra-hospital and Nubain has similar analgesic effects.

However, we don't use it as an opioid antagonist.

[Dustdevil]

I am not sure what the purpose of your question is. It would be helpful to know if you are just taking a statistical survey, or if you are looking for some feedback on field usage. I'll go ahead and chime in, in case you wanted usage feedback.

I am not currently in the field, so I can't speak for what is currently being done here. However, when I left the field, we were carrying both Nubain and Stadol (as well as Morphine, Demerol, and Versed) and I had great luck with both. It is all about choosing the right drug for the patient. So long as this is done appropriately, both have great efficacy. I used them mostly on isolated musculoskeletal injuries. Especially fx hips and the like. I have used Stadol myself and I can assure you it worked well on the worst pain I ever had in my life. However, at the upper limits of dosage, the side-effects can be unpredictable. Patient A receiving 2mg may experience relief with no significant side-effects, while Patient B gets completely and unarousably knocked out by the same 2mg. And occasionally, 2mg will send you into a full-blown hallucinogenic "bad trip" that requires patient restraints. And, unlike with narcotics, you are left with no antidote when you have a side effect with Nubain or Stadol.

[Nate]

We have Nubain, it is okay. I'm not a big fan of it.

[Beagle189]

My service carries Nubain. We carry it as a pain control med for pt's that are allergic to Morphine. MS being the preferred Pain control med by our Medicl Control Doc's.

One thing I want to pass on about Nubain - Its a narcotic agonist. If your pt is using Narctics for any reason and Nubain is given - be prepared for a possible withdrawal type reaction.

[Ridryder 911]

Neither nor would I suggest any service to carry it as well. There are better analgesics to use without the major side effects.

R/r 911

[Spock]

I think fentanyl is the best opioid for prehospital use. It has rapid onset and short duration. If you have long transport times you can give fentanyl and morphine together. The fentanyl will be "wearing off" when the morphine kicks in. Any of the agonist/antagonist drugs are lousy analgesics. I only use nubain in the hospital when I have a patient slow to emerge from anesthesia and I think the cause is too much opioid. It doesn't happen often because I work at a level 1 trauma center in the city and most of our patients are not narcotic naive.

Our prehospital pain protocol was recently changed to include fentanyl and we are having very good results. With morphine we say a reduction in pain from 8 to 5 on the ten scale while fentanyl is showing a reduction of 8 to 3 with many patients at ZERO pain upon arrival at the hospital (we have short transport times). I've given it three times since we implemented it in January but all three were in combination with versed to put a patient down for intubation. Not what the medical directors had in mind when they agreed to add fentanyl but it was certainly on my mind when I proposed the protocol change!

Live long and prosper.

Spock

[1EMT-P]

I was talking with a friend of mine from Maine and he told me that they were using Fentanyl, O2, Nitro & ASA ( F.O.N.A. ) for chest pain.

[Spock]

1-EMT-P--

I'm curious to know what kind of results they are getting using fentanyl for chest pain. In the operating room we use fentanyl as an induction agent for patients undergoing open heart surgery because of its hemodynamic stability. 1000mcg of fentanyl along with 5mg of versed and anybody is asleep and not breathing. My question about chest pain arises from the position statement on prehospital pain management issued by the National Assoc. of EMS Physicians. Among other things they stated that morphine is still the analgesic of choice for chest pain. If you talk to your buddy in Maine any time soon see if you can find out.

Thanks.

Live long and prosper.

Spock