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Fentanyl is similar to Morphine and Meperidine in its respiratory effects, except that respiration of healthy individuals returns to normal more quickly after Fentanyl. The agent exhibits little hypnotic activity and histamine release rarely occurs. Preferentially use inter-nasal (IN) via MAD for those where IV access may be difficult to obtain in a timely fashion(ie. extremity burns /injuries) or not indicated for chief complaint (ie. stable dental or back pain). After each drug dosage administration, (divide equally between nostrils.

- Reassess the patients pain
- Note adequacy of ventilation and perfusion
- Assess vital signs

- For relief of moderate to severe pain
-Pain from acute myocardial infarction
-Pain associated with isolated extremity fracture, renal colic or burns

-Contraindicated if systolic blood pressure is less than 90 mmhg
-Volume depletion or hypotension
-Head trauma
-Acute alcoholism
-Depressed ventilatory function (eg.: COPD,cor pulmonale. emphysema and acute asthma)

- CNS: sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, dizziness, psychic dependence and mood changes.
- Cardiovascular: circulatory depression, peripheral circulatory collapse and cardiac arrest have occurred after rapid administration.
- Ortostatic hypo-tension and fainting may occur if the patient stands up following the injection.
-GI; Nausea and vomiting, constipation and urinary retention.
-Respiratory: respiratory depression, bronchoconstriction and decreased cough reflex.

DOSAGE: monitor oxygen saturation and end-tidal CO2

-100mcg increments every 3-5 minutes to a maximum of 200mcg IN, IM, IO.
- IV dose is 1 mcg/kg (slow IV increments every 3-5 minutes, maximum initial dose of 100 mcg, titrated to pain and BP remains above 100 mmhg.
-Second dose: if needed, not to exceed a maximum total dose of 200mcg IV, IN, IO, IM.
-If Fentanyl was initially given IN and an IV is the established, them one IV dose of 50 mcg. can be given if needed.

- 0.5 mcg/kg (maximum of 25mcg (SLOW IV); repeat once after 5 minutes as needed (max of 50 mcg total dose) or IN 1.5mcg/kg (max 100mcg)

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