IN Fentanyl and no IV

We have recently adopted new protocols that allow for our Paramedics to give Fentanyl IN in the field. We mainly use it for pediatric isolated orthopedic injuries. It really helps so you don't have to give the kiddo a needle stick. We also use it for adults but not nearly as much.
 
Christopher said:
How much were you giving? I've had great success with 1 mcg/kg in kids. I've not used it in enough adults to judge its adequacy in my own practice.
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0.5-2 mcg/kg to max single dose of 100 mcg q5 to a max total dose of 3 mcg/kg for pediatrics.

1-2 mcg/kg max single of 100 mcg q5 to a max of 300 mcg for adults.

Used it once on a kid and it worked like a charm, every time I've used it on an adult it didn't even touch them. I'm not a fan of IN fent in adults. Kids are another story.

You know what was a my favorite option though? Nitronox. They just took it away from us not too long ago :( That stuff works so well on kids and does a decent job on adults. Especially while you are working on IV access. I had a few peds ask if they could have the nitrous back because "it worked better than the shot you gave me".
 
Love the option of IN. We have had it in our protocols for a few years and I use that route a lot. More so than via iv.
 
We use it here as well as Versed and Narcan.

Versed works well on those combative pt's. Havent used narcan.

I have found that i need to double the dose for Fentanyl for it to work and i usually use about 25-50% more than an iv dose with versed.

I have found that when you tell them to Inhale as you give it that it doesn't work nearly as well. Just tell them to breathe normal. Not sure exactly why i suppose it allows more time for the medication to actually absorb in to the mucosal membranes.

Anyone else noticed this?
 
epipusher said:
Love the option of IN. We have had it in our protocols for a few years and I use that route a lot. More so than via iv.
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Maybe I'm doing it wrong?

Yet again today we blasted 55 kg grandma with 100 mcg, our max single dose, 50 mcg/nostril and it didn't touch her.

She was a tough stick, ended up with a 24g in her wrist and went IV after that but at that point I was driving. IV administration worked beautifully and had her from a 10/10 to a 4/10 with 75 mcg (50 then 25 as we were backing into the bay)

We also have the option for IN Versed and Narcan but I've never used either. Always gone IM or IV from my experiences with IN fentanyl.
 
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