[TriageRN_34]

This is actually a question of my huband who is a paramedic. The local paremdics/emts want to know about a new protocol they have, and I don't blame them! They are trying to replace morphine on the ambulances with Fentanyl. Many fear that it doesn't have the MONA potential for MI...but someone says it does (Hubby was on the phone and couldn't elaborate..but asked me to post this for comment).

Now...my hospital does not use Fentanyl unless in patch form..and I will find out why (we use morphine IV or Dilaudid IV..then I try to get my ortho pts on po quickly when tolerated for longer effects and antispasmotics). So I don't deal with cardiac effects as much...but as I recall..fentanyl never was mentioned as cardiac???

Anyone have insight?

[jmgrn65]

We only use Fentanyl for pain control in PACU, except as a patch or epidural. I don't have any knowledge of it being used elswhere.

[TriageRN_34]

Yah me neither..that seemed very odd to me..thanks...keep the answers comming folks..this just makes me say 'HUH!?"

[RunnerRN]

As far as I know, Fentanyl doesn't have the afterload reduction capability that Morphine does.....but I may be wrong (and I'm too lazy to look it up right now)

[TazziRN]

We use it for IV sedation for procedures.

Just asked my doc, he said it could work but it would be much shorter acting so would not be as effective.

[Reno1978]

From my experience as a student, fentanyl is used often with versed for procedural sedation. Other than that, I've only seen it used in patch form post-op.

Looking it up in my drug book, it has the same mode of action as morphine - both bind to opiate receptors in the CNS to alter pain sensation and provide general depression of the CNS.

[angeRN6297]

We use Fentanyl now in our PCA pumps instead of demerol...

[babynurselsa]

Some of my favorite ER docs like Fentanyl for pain. BUT I have never had it ordered fo cardiac pain. They still rely on Morphine.
Let us know what you find out

[willie03]

I just recerted for ACLS and Morphine is still the drug of choice, after NTG, for cardiac pain.

We use PCA Fentanyl on my unit for postop pain sometimes, like when a patient is allergic to Morphine. And the patches are good for chronic and cancer pain.

[Sweetooth EMT-P, RN]

We use Fentanyl in NH on the ambulance, however we also carry morphine. I use fentanyl for patients with orthopedic injuries and for patients having an MI involving the right ventricle.
Fentanyl does reduce stimulation of cardiac muscle through the beta receptors although I do not know the exact mechanism of this. Fentanyl does not have the same effects on vasculature that morphine does because it does not cause a release of histamine. Studies also show giving patients doses of narcotics often masks the severity of their pain and increases overall mortality in ACS. There really is no need to give a narcotic for vascular dilation when we give nitroglycerin SL and in my service we can even hang IV NTG in the ambulance or put on paste. We also give lopressor which has been shown to decrease mortality by about 30%. The only true value of narcotics in teh MI patient may be to help with sympathetic stimulation secondary to the anxiety one would have, which fenatly does, and since it does not cause the vascular dialtion that morphine does it is much safer for those patients who can easily be killed by NTG and other drugs that reduce preload and afterload such as those having a right V. MI.
Ok I am getting of the soap box now.

Swtooth