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Fentanyl And Head Injuries Or Neuro Pt


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#1 Canis doo

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Posted 17 January 2009 - 04:10 PM

This is primarily in regards to previous post by some of the moderators; however, I may have inadvertently missed the answer.

When encountering patients with suspected or known intracranial insults or external trauma, what are your protocols or procedures with the use of Fentanyl ??
The reason Im asking is in our protocols for the most part it should be avoided. I feel that I have a good knowledge base on the pharmacodynamic and pharmacokinetics of Fentanyl and have researched many articles that warrant its use in ICPetc. Furthermore, there are just as many that do not advocate its use.?

I understand this is not a unfamiliar topic with any and all drugs/therapies/modalities.
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Jason Howard LP, FP-C
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#2 sutureguy

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Posted 18 January 2009 - 09:26 PM

Bear in mind, this is my opinion on Fentanyl in head injuries. I am confident someone can offer you the cold, hard evidence.

I think it is great! Better than morphine for actual or perceived pain because there is less chance of a histamine response and dropping the patients blood pressure (think secondary brain injury).

I acknowledge some of the side effects are confusion, somnolence, amnesia, etc., however, patients still need pain management. However, if you are planning on aggressive airway management, fentanyl works well with your RSI/ DAI drugs for sedation and paralysis.

Tim
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#3 KingAirNLA

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Posted 18 January 2009 - 10:24 PM

Sorry to answer a question with a question.

If your protocols do not support the use of fentanyl in this pt group what do you use for analgesia?

Our protocols fully support the use of fentanyl in trauma pts and pts with increased ICP for both analgesia and RSI/DAI.
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#4 Will Wingfield

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Posted 19 January 2009 - 01:57 AM

Sorry but I'm lost.... Why wouldn't you use Fentanyl with a head injury? I mean unless you're going back to ground EMS protocols of the 80's and 90's where they didn't want us "masking" neuro symptoms with narcotics, I can't off the top of my head think of a reason not to use fentanyl on a CHI....

WW
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#5 chris

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Posted 19 January 2009 - 03:15 PM

We use Fentanyl for our patients with head injuries.
Chris
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#6 Canis doo

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Posted 19 January 2009 - 10:52 PM

Honestly, I' not sure why he dislikes it. I guess when they do a toxicology screen, they would not be able to tell if I gave fentanyl. Please understand I said "for the most part" meaning, if you perform an action thats not A+B+C then you MUST JUSTIFY IT!!
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Jason Howard LP, FP-C
You have enemies? Good. That means you've stood up for something, sometime in your life. ― Winston S. Churchill

#7 Canis doo

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Posted 19 January 2009 - 11:05 PM

Honestly, I' not sure why he dislikes it. I guess when they do a toxicology screen, they would not be able to tell if I gave fentanyl. B) Please understand I said "for the most part" meaning, if you perform an action thats not A+B+C and in chronological order, you MUST JUSTIFY IT!!.
Since we all know every pt fits into that "MAGIC" protocol, it works out for the best, right !!
I have used multiple variations for inductions, and all prevailed in the best intrest for the pt. I'm just getting tired of explaining why and what of every treatment, especially, STANDARD OF CARE. And for ***sake take the pain away. Thats just cruel !!!!!

Thank you brothers, for your knowledge and support.
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Jason Howard LP, FP-C
You have enemies? Good. That means you've stood up for something, sometime in your life. ― Winston S. Churchill

#8 JLP

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Posted 20 January 2009 - 12:01 AM

"Honestly, I' not sure why he dislikes it. I guess when they do a toxicology screen, they would not be able to tell if I gave fentanyl."

that's just bizarre, man. If your doc thinks the patient was gorked because he took narcs, see if a small dose of narcan improves the patient's mental status. If it doesn't, the narcs weren't the problem, go on to something else. You don't withhold analgesia and sedation from injured patients just to make diagnosis easier. If your doc has some other reason for wanting to know if this person has used narcotics - well, that's clinically "neither here nor there" and is really none of our damn business; we're not cops and if it ain't clinically relevant it shouldn't affect our practice.
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#9 rhd316

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Posted 17 February 2014 - 04:15 PM

Sorry but I'm lost.... Why wouldn't you use Fentanyl with a head injury? I mean unless you're going back to ground EMS protocols of the 80's and 90's where they didn't want us "masking" neuro symptoms with narcotics, I can't off the top of my head think of a reason not to use fentanyl on a CHI....

WW




what does CHI stand for??
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#10 rhd316

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Posted 17 February 2014 - 04:20 PM

can someone tell me the reason why fentanyl should not be given to head injury patients??

also, if you cannot give fentanyl for pain management (head, chest, abdominal pain) what else could you do to relieve/reduce the pain??

Thanks!
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#11 onearmwonder

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Posted 19 March 2014 - 07:14 AM

Pain medication should be given appropriately to all head injury pts. Fentanyl is a great medication for that. It has a relatively quick onset, doesn't last too long, relatively hemo dynamically stable. Can be infused as a drip after initial bolus. Starts to attenuate sympathetic stimulation around 3mcg/kg. Complete attenuation of sympathetic stimulation is around 15mcg/kg depending on PT. Should you use it to blunt sympathetic stimulation in pts with increased ICP? We are not sure. The data doesn't favor it's benefits. A lot of services use it for premedication for RSI in head injury pts or severely hypertensive cardiac pts. Again the evidence isn't there as a benefit. We at the Didficult Airway Course have it in our curriculum, but do not consistently teach it from course to course. We do not have a hard stance on it. I personally do not premedicate my patients prior to RSI. I like to keep things simple in stressful task saturated situations. After intubation I immediately go with liberal pain meds first that are appropriate to hemodynamics. Then a sedative as a bonus with appropriate vent settings and little stimulation.

Matt
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#12 Jwade

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Posted 20 March 2014 - 03:55 AM

what does CHI stand for??



CHI = Closed Head Injury.

We run fentanyl drips in the ICU all the time on head patients.
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John Wade MBA, CCEMT-P, FP-C, RN

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#13 timdhawk

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Posted 05 March 2015 - 05:54 PM

Maybe it has something to do with your medical control MD? When I worked in the ICU we had an anesthisia background intensivist who thought Propfol drips were as good and helpful as straight sulfuric acid because she had one case 15yrs ago of Propofol infusion syndrome.


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