Can I only give Fentanyl if my patient doesn’t qualify for Morphine?
Answer: No. This was a common question during our CME teaching this year (2018). In the pre-course module, it was mentioned to consider Fentanyl when the patient has an allergy to Morphine. However, it can be used at the discretion and clinical acumen of the paramedic. Remember that the contraindications are allergy or sensitivity, treatment of headache, treatment of chronic pain, if SBP drops by one-third or more of its initial value after fentanyl is administered, or for suspected ischemic chest pain (refer to Cardiac Ischemia Medical Directive: which indicates Morphine only). Note that these contraindications are mirrored by Morphine. Indications for use include Age 1 years*, Unaltered LOA, Severe pain and Normotension.
*Although, recall that a BHP patch is required for authorization and dosage verification before administering morphine or fentanyl for children < 12 years-old under the new AUXILIARY Analgesia Medical Directive
Clinical Considerations:
Remember to exercise caution when using narcotics in opioid naïve patients and patients 65 years old as they may be sensitive to dosages.
Also, remember to consider starting with low doses. When higher doses of fentanyl (50-75mcg) are given intravenously for severe pain, consider administering medication in small aliquots q 3 minutes until desired effect or max. single dose is reached to avoid nausea and vomiting.