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Fentanyl With Chest Wall Rigidity


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#1 Jwade

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Posted 21 November 2007 - 07:28 AM

Hey guys,

I just wanted to relay my personal experience these past few days with Fentanyl and Chest Wall Rigidity.

Long story short, I have been really sick for the past two weeks, which have required some heavy narcotic doses, I was prescribed the transdermal Fentanyl patches...After two days of having this on, I woke up and felt really weird, very slow HR, ( for me ) and my chest felt very heavy and was very difficult to take a deep breath..very tight.......

Took the patch off and within a few hours, was back to normal, albeit hurting again...LOL........

SO, I can honestly say it was a very strange experience and gives me a little better insight having personally experienced these symptoms...

Anyone else have any personal experience with this?

Respectfully,
JW
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John Wade MBA, CCEMT-P, FP-C, RN

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#2 EDMEDIC

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Posted 21 November 2007 - 07:36 AM

Very interesting JW. I wasn't aware that you could get those sx's /c a transdermal system. That's the first I've heard of it. Brian EMT-P/CC
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#3 Speed

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Posted 21 November 2007 - 03:29 PM

I've never been under the influence of Fentanyl, but have noticed a lot of the time if I slam it, the patients will have a little extra WOB on inspiration, increased excursion, and a little accessory use. If I dilute it well and push it over a few minutes it doesn't seem to be "as bad" nor such a sharp drop in BP.
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#4 Tym2FLY

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Posted 21 November 2007 - 04:20 PM

You might of had a case of Rigid Chest Wall syndrome. Ask your wife about it, I hear that it is common in the Peds poppulation when they receive a large dose as an induction agent for cardiac surgery. Or heck, you might just not tolerate the medication that well. I had a procedure done last summer where the anesthesiolgist walked me to the OR...it was about 100 feet around some hallways, anyway, he pushed 200mcg of Fentanyl, I stopped, said what was that, he told me to keep walking....he said by the time my head hits the OR table, I will be almost asleep...he was right...and it felt wonderful!!:) ! Thought alittle funny story would make some of yall laugh!
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#5 dmiracco1

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Posted 21 November 2007 - 04:30 PM

I dont remeber where but I did read an article about transdermal fentanyl can cause the same side effects ie chestwall rigidity as well as IV push. Its alot more unlikely that way but it is pssible. Literature says that you usually see it when given IV with 500mcg or more and giving it rapidly. You might can just cut the dose in half.
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#6 BackcountryMedic

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Posted 21 November 2007 - 04:41 PM

JW-

What was the dose?
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#7 Jwade

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Posted 21 November 2007 - 06:33 PM

JW-

What was the dose?



HEy
50 mcg / hr


and I am a lite weight when it comes to meds, so this was more than sufficient, I also had vicodin elixir to supplement for any sharp, sudden pain...


The wife said it was more than likely Rigid Chest Wall syndrome, she took the patch off me and within about 6 hours, was feeling normal again..... Still a very strange sensation...

JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#8 Mike MacKinnon

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Posted 21 November 2007 - 10:10 PM

that is freaky!

glad yer OK. get on messenger so we can chat
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Mike MacKinnon MSN CRNA
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#9 fltpuke

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Posted 22 November 2007 - 11:08 AM

JW,

Interesting....

I had seen this during induction of kids and adults for cardiac surgery; albeit with quite large doses. 1mg of Fentanyl IV will make it hard to mask ventilate some folks until your relaxant kicks in.

Had never heard of it for a transdermal delivery system. Thanks for sharing that with us. Hope you're feeling better.


Jeff G., CRNA, MHS
Ex Flight Type Guy
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Jeff G.
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And a few others that I forgot.


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#10 Flightmedic317

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Posted 29 November 2007 - 10:33 PM

Wow.. very freaky.. i have never heard of it being caused by a transdermal patch since its actions are delayed verses when you give it IVP rapidly, you can cause the same effect. Thats no fun!
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#11 BackcountryMedic

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Posted 22 February 2008 - 01:32 AM

Do you think your chest rigidity had anything to do with this recent recall?

http://backandneck.a...anyl-recall.htm
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#12 Mike Mims

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Posted 22 February 2008 - 01:36 AM

Do you think your chest rigidity had anything to do with this recent recall?

http://backandneck.a...anyl-recall.htm

How many providers chart the lot number when giving meds?
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#13 chris

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Posted 22 February 2008 - 02:38 AM

I have never heard of anyone charting the lot number on Fentanyl.
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#14 fltpuke

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Posted 23 February 2008 - 12:50 AM

Do you think your chest rigidity had anything to do with this recent recall?

http://backandneck.a...anyl-recall.htm


This recall was for inadvertent overdosage. The medium that the Fentanyl was suspended in leaked out and more was in contact with the skin causing more rapid absorption.

Jeff G. CRNA, MHS (EMT-P, CFRN)
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Jeff G.
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And a few others that I forgot.


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#15 BackcountryMedic

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Posted 23 February 2008 - 05:20 AM

This recall was for inadvertent overdosage. The medium that the Fentanyl was suspended in leaked out and more was in contact with the skin causing more rapid absorption.

Jeff G. CRNA, MHS (EMT-P, CFRN)


That's my hypothesis. It seemed odd that JWade would have chest wall rigidity with only a normal 50mcg/hr patch. But, if he got a leaky patch his dose would have been higher and faster and chest wall rigidity wouldn't be unexpected. Otherwise 50mcg/hr in an adult causing the problem is very weird.
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#16 Captainbrack

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Posted 23 February 2008 - 12:55 PM

Not to change the subject, but Mike brought it up. The only time I know of the lot number of a medication being recorded is when Iíve gotten the flu shot or any vaccination. Iíve never recorded the lot number of any medication Iíve given either on transport or a bedside nurse. Is this common practice for any of yaíll?
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Brian Hill RRT,RN
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dell Children's Medical Center of Central Texas
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#17 lems1169

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Posted 24 February 2008 - 01:45 AM

Same...Idon't want to hijack the thread but should it be our practice to chart it (for all the meds we give??!!)
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Serge LeMay

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#18 Jwade

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Posted 24 February 2008 - 07:15 AM

That's my hypothesis. It seemed odd that JWade would have chest wall rigidity with only a normal 50mcg/hr patch. But, if he got a leaky patch his dose would have been higher and faster and chest wall rigidity wouldn't be unexpected. Otherwise 50mcg/hr in an adult causing the problem is very weird.



Great Point.....I still have 10 Fentanyl patches left. I will check the lot numbers when I get home from Utah to see if they are recalled.......I wouldnt think 50mcg/hr would give me chest wall rigidity either, but I can tell you, when i woke up, my HR was LOW, and I could barely inhale and exhale.......Was the weirdest feeling I have ever felt......

JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#19 BackcountryMedic

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Posted 25 February 2008 - 01:25 AM

Great Point.....I still have 10 Fentanyl patches left. I will check the lot numbers when I get home from Utah to see if they are recalled.......I wouldnt think 50mcg/hr would give me chest wall rigidity either, but I can tell you, when i woke up, my HR was LOW, and I could barely inhale and exhale.......Was the weirdest feeling I have ever felt......

JW


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#20 sassyskyrn

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Posted 26 February 2008 - 04:56 AM

This is off of the subject but I sure am curious about the narcotic usage in the "west"....... I currently work in the southeast ( origionally from the northeast ) and within the past year have traveled and worked in Phoenix at multiple facilities...... point being is ......... in the short 6 weeks I spent working out there I saw more narcotic distribution than I have seen in my 18 years in medicine! The only persons on Dilaudid and Fentanyl patches back here are those dying of a terminal illness! I am not saying that you did not "need" it ... I am truly trying to gather some insight...... The ER's that I worked in out there were passing out Dilaudid 2mg IVP like scooby snacks! In the Er I currently work in here Dilaudid is used very judiciously.....Now I will tell you that I see a larger population of young folks on Benzo's here in the south vs. the northeast ( I thought maybe it was that "southern bell" mentality) LOL.... I know there are different trends everywhere but knowing the risk of addiction I was a little perplexed by this...... anyone out there with some insight?
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