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Flashcards in Symptom Relief Protocols Deck (14):
1

Criteria for analgesia in adults

RR > 10 and < 30
SaO2 > 95% on oxygen
BP > 90 systolic
GCS15 and NO signs of head injury
Pain score of >= 5
No allergy to Fentanyl

2

Dosing of fentanyl in adults for analgesia

<= 75 years old:
0.5mcg/kg q5 x 3 doses and then q10

> 75 years old:
0.25mcg/kg (max single dose of 25mcg) q5 x 3 doses and then q10

Max dose is not required; titrate to effect

3

Contraindications for dimenhydrinate in adults

Glaucoma or symptomatic prostate hypertrophy

4

Treatment for apnea post fentanyl administration

Naloxone 0.4mg IV

5

Treatment for over-sedation post fentanyl administration

Incremental administration of Naloxone 0.2mg IV

6

What to do if blood pressure drops below 100 post fentanyl administration

1. Elevate legs (situation permitting)
2. Re-check vital signs
3. If BP remains decreased and lungs are clear, 500cc fluid challenge.
4. Consider a second 500cc fluid challenge if pt remains hypotensive with lungs clear.

7

Criteria for anti-emetic administration.

1. GCS15
2. No current history or signs of medication overdose
3. Patient in discomfort from nausea and/or vomiting
4. Consider other non-pharmacologic methods to relieve nausea (e.g. positioning)

8

Dosing for dimenhydrinate in adults

25mg IV slow push over 2 minutes.
Second dose may be repeated in 15-30m.
Subsequent doses of 25-50mg may be repeated every 6 hours.

9

Adolescent fentanyl dosing

FENTANYL 0.5 mcg/kg IV q 5 minutes x 3 doses, subsequent doses q10 minutes if
analgesia criteria persist

10

Adolescent dimenhydrinate dosing for nausea/vomiting

None

11

Criteria for pediatric analgesia

- Age >= 3
- Respiratory Rate appropriate for age
- Sa02 greater than 95% on oxygen
- Adequate blood pressure appropriate for age and no signs of shock
- GCS 15 and no signs of head injury
- Pain score of 5 or greater on numeric scale, or 3 or greater on Wong-Baker faces scale
- No allergy to FENTANYL

12

Pediatric fentanyl dosing for analgesia

FENTANYL 0.5 mcg/kg IV q 5 minutes x 3 doses, subsequent doses q10 minutes if
analgesia criteria persist

13

In case of respiratory depression in a pediatric patient after fentanyl administration.

NALOXONE 0.01 mg/kg IV, may be repeated every 2 minutes if required

14

In case of hypotension in a pediatric or adolescent patient after fentanyl administration

1. Elevate legs (situation permitting)
2. Re-check vital signs
3. If BP remains decreased and lungs are clear, 10ml/kg (max 500cc) fluid challenge.
4. Consider a second 10ml/kg (max 500cc) fluid challenge if pt remains hypotensive with lungs clear.