Just curious what peoples thoughts are for treating an inferior MI with RVI with oxygen, asa and fentanyl as opposed to oxygen, asa, nitro, morphine for an MI without RVI? 

Views: 404

Reply to This

Replies to This Discussion

How about some fluids, too? Many of these people will be hypotensive and bradycardic until you prime the pump.

I agree completely! I am just wondering people's opinions and which analgesic if any used for an inferior

dr-exmedic said:

How about some fluids, too? Many of these people will be hypotensive and bradycardic until you prime the pump.

I've heard of a couple different approaches... One is O2 as needed, ASA, fluid loading, and careful use of NTG (IV preferred), and then fentanyl or morphine as needed.  The other was O2 as needed, ASA, fluid, and morphine (no NTG).  I'm more inclined to take the first approach and use fentanyl, if needed.

 

Fentanyl it is then...or for anyone whose BP has you even slightly concerned.

Kote B said:

I agree completely! I am just wondering people's opinions and which analgesic if any used for an inferior

I agree about the importance of fluids. Ditto ASA and oxygen if the difficulty breathing or low sat. 

IV NTG is much safer than SL NTG. 

Fentanyl is probably a much better idea than morphine. Fentanyl produces less of an effect of blood pressure. Any benefit of morphine due to coronary vasodilation is nothing more than wishful thinking.

Of the 2,315 patients who received fentanyl in the field, 66 patients had a vital sign abnormality. Of those 66 patients, three were excluded because they received a sedative in addition to the fentanyl. There were 46 patients who were excluded because their vital sign abnormalities occurred before the administration of fentanyl. Of the 46 patients who had a vital sign abnormality before the administration of fentanyl, 38 patients’ vital signs improved after the administration of fentanyl, eight patients’ vital signs remained the same, and none worsened.


Safety and effectiveness of fentanyl administration for prehospital pain management.
Kanowitz A, Dunn TM, Kanowitz EM, Dunn WW, Vanbuskirk K.
Prehosp Emerg Care. 2006 Jan-Mar;10(1):1-7.
PMID: 16418084 [PubMed - indexed for MEDLINE]

Free Full Text PDF Download from MSTC.


-

New hypotension (i.e., post-fentanyl SBP < 90 in a patient at least 5 years of age, with pre-fentanyl SBP at least 90) was seen in 28 administrations (2.7% of 1055 administrations, 95% CI 1.8–3.8%).


Overall, in 45 cases (4.3% of 1055), fentanyl was administered to patients who were hypotensive.


In 53% of these cases, hypotension (predictably) remained after the opioid was given—but in 47% of cases in which fentanyl was administered to hypotensive patients, the next SBP exceeded 90.


Fentanyl in the out-of-hospital setting: variables associated with hypotension and hypoxemia.
Krauss WC, Shah S, Shah S, Thomas SH.
J Emerg Med. 2011 Feb;40(2):182-7. Epub 2009 Mar 27.
PMID: 19327928 [PubMed - in process]

Full Text PDF Download at medicalscg.


We do not have enough information to determine what effect fentanyl has on vital signs in patients with hypotension or borderline blood pressures, but we no longer have a good reason for expecting that fentanyl will frequently produce bad vital signs. Fentanyl was much more likely to be followed by an improvement in vital signs.


.

Reply to Discussion

RSS

Follow JEMS

Share This Page Now
Add Friends

JEMS Connect is the social and professional network for emergency medical services, EMS, paramedics, EMT, rescue squad, BLS, ALS and more.

© 2014   Created by JEMS Web Chief.

Badges  |  Report an Issue  |  Terms of Service