Fentanyl

[1EMT-P]

Is Fentanyl the perfect analgesic for EMS? It has a very rapid onset when given IV. It can be easily titrated. It causes less hypotension, respiratory depression & sedation than both Meperidine & Morphine & It does not cause histamine release. Plus it doesn't seem to cause nausea.

[AZCEP]

Based on familiarity and cost, Morphine is my vote.

The hypotension and nausea are easily controlled with reducing the rate of administration. The blood pressure reduction is also quite useful for some patients. I also appreciate a bit longer duration of action than Fentanyl can provide with single dosing. The fact that if we eliminate morphine, we would not have anything to replace it currently, leaves me with voting for morphine.

Now, if we had enough Fentanyl to mix the infusion we would need, then maybe...

[sledogg1]

We use morphine and chase it with gravol prn...............but there seems to be a increase of allergic pts out there lately and the fentanyl would be great, its fast with less side effects. Morphine is a .01cent for 10.0mg what is fentanyl cost?

[Thunderchild145]

We used to carry morphine and nubain, but now we carry morphine and fentanyl. I like this combo of drugs because fentanyl is a great analgesic drug for EMS, but we still use morphine for ACS.

[Ridryder 911]

I would agree Morphine is the most safest and one that has the best all around desired effects that we should be aiming for. Fentyl, is a great analgesic but as AZCEP described a drip should be instituted for pain control. Personally, I have not seen much use for Nubain for trauma or cardiac, rather more used for migraine and obstetric type pain.

R/r 911

[1EMT-P]

Fentanyl has a better hemodynamic profile & a better side-effect profile than Morphine. It causes less histamine release, less hypotension, less nausea & vomiting, less respiratory depression & it's shorter acting than Morphine.

Fentanyl:

Onset Action: Immediate IV

Peak Effects: 3-5 Minutes

Duration: 30-60 Minutes

Usual Dose: 25-100mcg

[Dustdevil]

Anybody who thinks fentanyl causes less hypotension, respiratory depression, and sedation simply isn't giving enough of it. 8)

[Jess]

When i was in the hospital, thats all they gave me was Fentanyl and to me it caused just as much drowsiness, a drop in vitals, and nausea as some of the others. But everyone is different. Just thought I would share

[WelshMedic]

Hi all,

Is there such a thing as the perfect drug? Experience taught me that different drugs are preferable in different situations.

Morphine - a great drug, but causes nausea in majority of patients. It's use should be combined with an anti-ametic, preferably ondansetron (Zofran). The reality is that not many services carry Zofran because of the cost aspects - one dose costs $40.

Fentanyl - quick onset but misses the potency of true Morphine. Has less effects on hemodynamics, in my experience. (And i'm not mean with it either, Dust :wink: )

Alfentanyl (Rapifen) - a great drug and would be my first choice. However, very very potent and needs to be used with great care in larger doses.

Ketamine - not bad for short term sedation (although it's not true sedation, just disassociation) but they tend to wake up as mad as hatters if you don't give enough Versed with it. Other than that it can be useful in certain situations, such as entrapments where intubation is not an option.

Diclofenac (Voltarol) - NSAID - very good for musculo-skeletal pain, also useful in episodes of renal colic but obviously misses the sedative and euphoric effect of an opiate.

These are the drugs we have in EMS here in the Netherlands. It's not a bad choice, but again, it's not exhaustive. There are other options out there.

Carl.

[zippyRN]

Hi all,

Is there such a thing as the perfect drug? Experience taught me that different drugs are preferable in different situations.

Morphine - a great drug, but causes nausea in majority of patients. It's use should be combined with an anti-ametic, preferably ondansetron (Zofran). The reality is that not many services carry Zofran because of the cost aspects - one dose costs $40.

Ondansetron is off patent in the Uk now ... which bodes well for prices ...

Fentanyl - quick onset but misses the potency of true Morphine. Has less effects on hemodynamics, in my experience. (And i'm not mean with it either, Dust :wink: )

Alfentanyl (Rapifen) - a great drug and would be my first choice. However, very very potent and needs to be used with great care in larger doses.

alf is even shorter lived though

agree with your assessment of diclofenac as well - it's very good except IM when it;s evil - becasue it's 3ml of thick oily gloop