Fentanyl suckers

[Jon]

Anything will eventually end up on the streets... Duragesic patches, Morphine, etc... it just costs money.

I just looked at the wikipedia page... it says that 90-99% of the first 1/2 of 2006's scripts for Actiq were for off-label use (not for breakthough cancer pain).

 

[fma08]

We use them for peds pain control as well. I think the "sucker" part starts them on their way and settles them down for the drug to take effect.

Far better than coming at them with needles right away. Makes IV access MUCH easier on all concerned, especially the parents seeing their child settled down.

I have seen them for adults, but usually the needle anxiety is not as great for them. Notice I said 'Usually'


I would still advise starting a lock with these patients..

Just an opinion

lock would be good.... specially when ya gotta give the narcan when they quit breathing lol

 

[Ridryder911]

lock would be good.... specially when ya gotta give the narcan when they quit breathing lol

I realize that you were joking but: If that was the case, you were the idiot and overdosed them. Await, for the med to take affect then start your line. The main reason of administering the Fentanyl lollipop. Like I described, the strength is based upon weight, as well it does not have the s/e associated alike other analgesics, with length of time. Just monitor their breathing, and if they do stop, ventilate them and allow the med to wear off (since your the culprit).

Too many medics rush to give Narcan nowadays. If you give Narcan, now they cannot treat the pain with regular opioid medications.

R/r 911

 

[fma08]

I realize that you were joking but: If that was the case, you were the idiot and overdosed them. Await, for the med to take affect then start your line. The main reason of administering the Fentanyl lollipop. Like I described, the strength is based upon weight, as well it does not have the s/e associated alike other analgesics, with length of time. Just monitor their breathing, and if they do stop, ventilate them and allow the med to wear off (since your the culprit).

Too many medics rush to give Narcan nowadays. If you give Narcan, now they cannot treat the pain with regular opioid medications.

R/r 911

obviously don't let that happen in the first place, my service carries fentanyl and it is pretty awesome about not having much of the side effects of other narcs, and while i don't think that too many medics rush to give narcan, i think they are too... text book about giving a certain dose. if a pt is in resp. distress/failure due to a narcotic overdose, narcan should be titrated to restore the pt's breathing ability, not completely reverse the effect of any opiates in the pt's system. and we can look at that on both ends of the spectrum (and i may be running into different scenarios than you since i'm doing mostly field work and you are in a critical care unit). A. coming across a pt who is not breathing due to recreational drug use. ABC's, 02, IV, monitor, and narcan titrated to effect, i.e., the pt starts breathing on their own. Now, if we were to give a "standard" dose and completely block all effects of the opiate, pt wakes up and becomes highly agitated at us for ruining their several hundred dollar high that they just had thus creating an unsafe scene. On the other end of the spectrum, pt is on fentanyl or other opiate of pain control due to... terminal cancer or whatever. pt is overdosed on opiate, and stops breathing, give narcan titrated again to effect of pt able to breath on their own (with good perfusion and all that) but not to block out the needed pain relief of narcotic therapy. Again, working streets and the area i'm in i run into scenario A. more often so the patient is the idiot for making him/herself stop breathing into the first place.

 

[Airway Junkie]

Its about time some tasty treats got put on the rigs!

 

[fma08]

for sure, fentanyl works great, we dont have the PO version though, just IV

 

[Ridryder911]

obviously don't let that happen in the first place, my service carries fentanyl and it is pretty awesome about not having much of the side effects of other narcs, and while i don't think that too many medics rush to give narcan, i think they are too... text book about giving a certain dose. if a pt is in resp. distress/failure due to a narcotic overdose, narcan should be titrated to restore the pt's breathing ability, not completely reverse the effect of any opiates in the pt's system. and we can look at that on both ends of the spectrum (and i may be running into different scenarios than you since i'm doing mostly field work and you are in a critical care unit). A. coming across a pt who is not breathing due to recreational drug use. ABC's, 02, IV, monitor, and narcan titrated to effect, i.e., the pt starts breathing on their own. Now, if we were to give a "standard" dose and completely block all effects of the opiate, pt wakes up and becomes highly agitated at us for ruining their several hundred dollar high that they just had thus creating an unsafe scene. On the other end of the spectrum, pt is on fentanyl or other opiate of pain control due to... terminal cancer or whatever. pt is overdosed on opiate, and stops breathing, give narcan titrated again to effect of pt able to breath on their own (with good perfusion and all that) but not to block out the needed pain relief of narcotic therapy. Again, working streets and the area i'm in i run into scenario A. more often so the patient is the idiot for making him/herself stop breathing into the first place.

My point was that the dosage of Fentanyl lollipop is minute in comparison, as well as they are used as transient analgesic. Yes, I work part time in a unit/ED but in the field full time. I do see more and more medics not using Narcan appropriately. In fact, if you explorer some you will find many EMS Medical Directors removing it from the formulary.

I agree you with on your description and intent and purpose of when and how Narcan is supposed to be administered. The problem is when attempting to administer another analgesic, either a different derivative or increasing dosage. Not that it cannot be achieved, just another hurdle to overcome by some that do not understand pain management and analgesics.

R/r 911