Pain management in hypotensive patients

Published

Specializes in Emergency Nursing.

Case one, I had a septic guy come in who took pain meds regularly for back pain. He was in so much pain but I had to hold off on giving him IV dilaudid because his pressure was in the 60s-80s. I had to explain this situation to the family who thought I was being cruel by witholding the meds. They kept saying, who cares about his pressure, he's in so much pain! I know! But he NEEDS A BLOOD PRESSURE!

Case two, old lady circling the drain with ischemic bowel.... needs immediate surgery. In lots of pain... end up giving her fentanyl and she holds her existing pressure fo 80s systolic.

So.... Is fentanyl the go to?

I've read it doesn't have the same histamine release as morphine/dilaudid. What do you guys see used at your facilities in this situation?

Up Vote Up Vote ×
Specializes in ER.

Fentanyl doesn't dump blood pressure like the other narcotics. That's why it's used in recovery.

Up Vote Up Vote ×
Specializes in ER/Trauma.

I felt horrible for a young CA patient that was in constant pain but I was having a difficult time managing it because his BP was in the toilet. Watching his very loving family watch him suffer just made it worse! :(

But he was so polite and understanding about the situation!

Haunts me to this day...

Up Vote Up Vote ×
Fentanyl doesn't dump blood pressure like the other narcotics. That's why it's used in recovery.

In general. It can cause hypotension, it's just less likely to. Also, Fentanyl doesn't make people nauseated, which is what makes it safer for folks more likely to aspirate.

Up Vote Up Vote ×
Specializes in Emergency, Med/Surg.

I love fentanyl. I haven't had a patient c/o nausea, dizziness, or become hypotensive. The only down side is the short half-life means more frequent administration.

Very nice in the ED setting when we don't always know the whole story with our patients.

Up Vote Up Vote ×
+ Join the Discussion