P Rehospital P Ain M Anagement

Fentanyl trauma analgesia use in air medical scene transports

“…Additionally, fentanyl's pharmacological profile means it is easier than morphine to titrate, and thus arguably entails less risk of respiratory depression because the more rapidly acting agent can be better dosed to effect (11). The doses of fentanyl reported in available series are well under the range expected to entail significant risk of side effects (e.g., dorsal motor neuron-mediated chest wall rigidity) (16).…”

“…First, we wished to assess the accuracy of an impression that our helicopter EMS program's analgesia provision rates were substantially higher than those reported in the extant (primarily ground EMS) literature. Second, we noticed that, in a 2003 comprehensive review of prehospital pain management, the agent we use -fentanyl -was singled out both for its theoretical advantages and for the paucity of out-of-hospital evidence supporting its use (11). Therefore, we set out to assess and report both our program's general performance with respect to pain assessment and care and our specific experience with safety and efficacy of fentanyl.…”

An Evidence-based Guideline for Prehospital Analgesia in Trauma

“…Generally, patient self-reports of pain are preferred to purely observational assessments by EMS providers and the National Association of EMS Physicians (NAEMSP) recommends that reliable tools be used in the assessment of pain. 15,16 A strong recommendation to "assess pain" was reached by review panel consensus. Based on their collective expertise in prehospital care, their knowledge of patient preferences, and their review of the evidence supporting the other recommendations in this EBG, the panel felt that the recommendation to assess pain was so intuitively sensible that it did not require formal GRADE analysis.…”

Prehospital Trauma Analgesia

“…Another study confirmed opioids' hemodynamic and respiratory safety in 500 consecutive HEMS-transported patients receiving over 1000 doses of fentanyl (31). Other studies of varying size and setting have demonstrated that opioid analgesia (usually morphine) can be administered with no major sequelae detected by monitoring heart rate, blood pressure, oxygen saturation, and (in non-intubated patients) end-tidal carbon dioxide (11,20,28,30,(32)(33)(34)(35)(36)(37).…”

“…Furthermore, it is unlikely that small-aliquot administration of even potent opioids will result in a good examiner's missing an injury of life-or limb-threatening import. In the unusual case where clinicians must have an examination that is "unadulterated," a reversal agent (naloxone) can be employed (28).…”