Medication 7-373 - Fentanyl (Sublimaze)

CMH EMS & MIH Protocols

Scope of Practice:

• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• IM/SQ, IN, IO, IV,

Pharmacodynamics (class and mechanism of action):

• Narcotic analgesic (Binds to opiate receptors. Analgesia and sedation. Central nervous system depressant. Decreased sensitivity to Pain.).

Pharmacokinetics:

• Half-life: 3.5 hours.
• Onset time:
• IM: 7-15 minutes.
• IN: 5-15 minutes.
• IO/IV: 1-2 minutes.
• Peak action time:
• IM/IN: 20-30 minutes.
• IO/IV: 3-5 minutes.
• Duration of action:
• IM: 1-2 hours.
• IN: Unknown.
• IO/IV: 30-60 minutes.

• Peak	8	16	24	32	40	48	56	64	72	80	minutes
  Duration	8	16	24	32	40	48	56	64	72	80	minutes

Dosing:

• Refer to specific protocol(s) below for dose(s).

Indications:

• Protocol 2-044 - Airway: RSI.
• Protocol 2-220 - Chest Pain / Suspected Cardiac Event.
• Protocol 2-484 - Head Trauma.
• Protocol 2-660 - Pain Control.
• Equipment 8-288 - Endotracheal Tube.
• Equipment 8-486 - King Airway.
• Equipment 8-522 - Laryngeal Mask Airway (LMA).

Contraindications:

• Hypersensitivity.

Pregnancy Risk Factor:

• Category C
• Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. FDA requires a relatively large amount of high-quality data on a pharmaceutical for it to be defined as Pregnancy Category A. As a result of this, many drugs that would be considered Pregnancy Category A in other countries are allocated to Category C by the FDA.

Potential Incompatibilities:

• Medication 7-417 - Heparin.

Precautions and Adverse Effects:

• Respiratory depression may last longer than the analgesic effects.
• Narcan should be available.
• Give slowly, rapid injection could cause rigid chest syndrome (usually occurs when dose is greater than 200 mcg).
• Use with caution in Traumatic Brain Injury.
• May cause Bradycardia, respiratory depression, euphoria, hypotension, Nausea, Vomiting, dizziness, sedation, Tachycardia, palpitations, Hypertension, diaphoresis, syncope.
• There may be a possible beneficial effect in Pulmonary Edema.

Antidote:

• Medication 7-603 - Narcan.

Controlled Substance Information:

• Schedule II
• High potential for abuse. Abusing the drug can cause severe physical and mental addiction.
• DEA number: 9801.
• Narcotic: Yes.
• Street names: Apache, China Girls, China Town, China White, Dance Fever, Fent, Friend, Goodfellas, Great Bear, HeMan, Jackpot, King Ivory, Magic, Murder 8, Perc-A-Pop, Poison, Tango and Cash, TNT.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.