How many services use Fentanyl instead of Morphine for Cardiac Chest Pain?

[philslat]

Thanks guys

I will give the fentanyl a go in my next acs patient

One more question we also give intranasal fentanyl and I've been very disappointed as have nearly all my colleagues with its lack of effect with adults although it's very good with paediatric pain

What are your experiences with IN fentanyl for adult pain relief ?

 

[Peak]

Our pediatric IN dosing is typically 2-3mcg/kg, we just aren't going to approach the same level with adults. Kids are also typically more opioid naive and generally have a more profound effect from most medications, although I think there is a lot of psychological reasons that play into this as well.

I also think the atomizers aren't the most useful thing in the world and the biggest draw for kids is that it is needle free, I'd honestly just rather give most drugs IM than IN in adults if we can't get rapid IV access.

 

[photog]

0.1mcg/kg, 100mcg per dose max, max total of 200mcg.

100 mcg would require a 1000 kg patient with 0.1 mcg/kg dosing. You propably meant 1 mcg/kg?

Our protocol is 1,5 mcg/kg with fentanyl (second dose half of that). For cardiac chest pain we start with morphine 4 mg and repeat it until pain is tolerable or NRS < 4. No upper limit. (One vial is 20 mg and I very rarely have to open a second one.) Very old or fragile patients get 2 mg doses repeatedly.

We also have the option for s-ketamine for non-cardiac pain management. Typically starting with 12,5 mg i.v. or 25 mg i.m.

 

[NPO]

100 mcg would require a 1000 kg patient with 0.1 mcg/kg dosing. You propably meant 1 mcg/kg?

Our protocol is 1,5 mcg/kg with fentanyl (second dose half of that). For cardiac chest pain we start with morphine 4 mg and repeat it until pain is tolerable or NRS < 4. No upper limit. (One vial is 20 mg and I very rarely have to open a second one.) Very old or fragile patients get 2 mg doses repeatedly.

We also have the option for s-ketamine for non-cardiac pain management. Typically starting with 12,5 mg i.v. or 25 mg i.m.

[emoji23] haha yes, thank you. 1mcg/kg.

 

[Tigger]

I also think the atomizers aren't the most useful thing in the world and the biggest draw for kids is that it is needle free, I'd honestly just rather give most drugs IM than IN in adults if we can't get rapid IV access.

Exactly, to me there is less question about the efficacy of IM analgesia. My luck with IN fentanyl or versed in kids has been borderline at best although it usually does calm them down enough to make getting an IV less of a struggle.

 

[Hamish]

We carry both but our guidelines state that Morphine is preferred in the treatment of cardiac chest pain (after administrating Aspirin and GTN).