Fentanyl as seen by pharmacists

[Guest guest]

I bought a new nursing drug manual today, and in reading it I ran across a

nice little vignette that explains why some people think that fentanyl should

only be given by certain advanced practitioners.

Here's a little except from the Nursing2007 Drug Handbook published by

Lippincott & Wilkins, page 18, in the section called: Safe drug

administration.

" Misplacing decimals.

Error: A patient in the intensive care unit was to receive the opioid

fentanyl, 12.5 to 25 mcg I.V. every 4 to 6 hours, p.r.n., for pain. Unit stock

consisted o 5-ml ampules of fentanyl 0.05 mg/ml, so each ampule contained 0.25

mg (250 mcg). A nurse preparing a dose confused the volume needed when she

converted from milligrans to micrograms and gave 5 ml, thinking it contained

25 mcg. The patient suffered respiratory arrest but was resuscitatedl

Best practice or prevention: Numerous serious fentanyl errors have been

reported, and a misplaced decimal point caused many of them.

A safer alternative for intermittent dosing is I.V. morphine. Fentanyl

doses are best prepared in the pharmacy rather than in the unit. If a fentanyl

dose must be prepared, refer to dosing charts, follow the facility's protocols,

and ask another nurse to check your calculations. "

This book promotes some absurd statements. One, that a safer alternative for

intermittent dosing is morphine; second, that fentanyl doses are best prepared

in the pharmacy; third, that referring to " dosing charts " and another snurse

will make things right.

It's obvious that the nurse who made the mistake had no clue about how to

figure drug dosages. The clue is that it says that she made the mistake when

" she converted milligrams to micrograms " . That shows that she was using a

formula to try to figure out something that she should have known without having

to resort to paper and pencil or calculator. She obviously had no concept of

what she was doing, so she was just working with abstract numbers.. She

didn't stop to check what the total dose she, or he, was giving in terms of x

mcg/ml, so she didn't have a single clue how much she was giving.

NOW, because of that error, the snursies who wrote that book conclude that

snursies cannot reliably figure drug dosages, and they recommend that the

medication be drawn up by the pharmacy.

Those of us who administer drugs in the field are laughing our heads off over

this. We can figure drug doses in our heads, and we don't need a pharmacist

to draw up our fentanyl dose, thank you very much.

" UH, diapatch, we need to give some fentanyl here. Will you start the

tactical pharmacist to our location? " Dispatch: " , Medic 32, tactical

pharmacy will be dispatched. Can you give a request for them to be working

on? "

Medic 32: " Uh, dispatch, we have a 220 pound man with a dislocated knee, in

severe pain, and we are requesting fentanyl. " Dispatch: " Received. We

will relay to PharmTac 1. "

" PharmTac 1. We're responding. Medic 32, can you confirm the patient's

weight? " Medic 32: Yes, sir, the patient says he weighs about 215 pounds. "

PharmTac 1: " Received. We're calculating the dose at this time and will

arrive at your location in approximately 13 minutes. " Medic 32: " Standing

by. "

Enroute PharmTac 1, staffed by a registered pharamacists and a pharmacy tech,

begins to calculate the dose required for a 215 pound patient. First they

use their slide rule to convert 215 pounds to kilograms, and they arrive at a

metric weight of 97.727273 kilograms. Now, using the recommended dose of

fentanyl in musculoskeletal trauma, they find that----it's not an indication for

use!

PharmTac 1 to Medic 32: " Is your patient a candidate for general

anesthesia, regional anesthesia, postoperative pain, restlessness, tachympea or

delirium, preoperative medication, or to manage persistent, moderate to severe

chronic

pain in opiodtonerant patients who require around the clock opioid analgesics

for an extended time, or to manage breakthrough cancer pain in patients

already receiving and tolerating an opioid? " Medic 32: " Uh, sir, I suppose

our

patient is a candidate for regional anesthesia. " PharmTac 1: " Ten-4. We'

ll be calculating. "

PharmTac 1-Dispatch: " We're on scene with Medic 32. "

On arrival the pharmacist has drawn up a solution of 1.5 mcg fentanyl/kg

which equals 146.5 mcg fentanyl. He asks who will administer it? The

paramedic

answers that he will?

The pharmacist says, NO, only an anesthesologist can adminster fentanyl.

Medic 32--Dispatch: " Um, we need Anesthesia 1 to be sent to this location. "

Dispatch: " , M32, Gas 1 will be dispatched. " Dispatch: " Dispatch

to Gas1, respond to ............for a fentanyl administration. Time out,

2300 hours. "

This couldn't actually happen...............could it?

GG

[Guest guest]

Not really, because you and I are the only ones who still have slide rules.

andy

[Guest guest]

In a message dated 1/23/2007 7:40:11 AM Central Standard Time,

rachfoote@... writes:

Not really, because you and I are the only ones who still have slide rules.

andy

that makes three of us....

Pickett Ortho Trig Log Log hiding in the book case at home...

stolen from my father in a week moment of his when I graduated from

college....which remindes me that I need to dig it out and apply some beeswax to

the

sliders.

ck

[Guest guest]

Gene-

I guess I have been in a cave, but what you describe is a sad indictment for

both the public education system AND nursing education programs as well. I may

be real 'old school', but at least I won't overdose a patient (knock on wood)

through a mathmatic error of the type you describe. Sad that nursing, instead of

correcting the deficiencies, chooses to punt to the pharmacists. Nothing wrong

with pharmacists, but this is a matter of professionalism and pride as both a

nurse for 23 years and a medic for 30.

Larry , RN LP

---------------------------------

The fish are biting.

Get more visitors on your site using Yahoo! Search Marketing.

[Guest guest]

Not really. I still have my Versalog from back in college. I dug it out the

other night because the grandkids were asking " What's a slide rule? " Maybe I

even remember how to use it???

Steve Bowman

rachfoote@... wrote:

Not really, because you and I are the only ones who still have slide

rules.

andy

[Guest guest]

I still have mine..

Actually competed in UIL " Slide Rule " .

Jack

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of STEVE BOWMAN

Sent: Tuesday, January 23, 2007 9:07 AM

To: texasems-l

Subject: Re: Fentanyl as seen by pharmacists

Not really. I still have my Versalog from back in college. I dug it out the

other night because the grandkids were asking " What's a slide rule? " Maybe I

even remember how to use it???

Steve Bowman

rachfoote (AT) aol (DOT) <mailto:rachfoote%40aol.com> com wrote:

Not really, because you and I are the only ones who still have slide rules.

andy

[Guest guest]

Jack:

I would have figured you were in the abacus era.

BEB

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Jack Pitcock

Sent: Tuesday, January 23, 2007 10:48 AM

To: texasems-l

Subject: RE: Fentanyl as seen by pharmacists

I still have mine..

Actually competed in UIL " Slide Rule " .

Jack

_____

From: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

[mailto:texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com]

On

Behalf Of STEVE BOWMAN

Sent: Tuesday, January 23, 2007 9:07 AM

To: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

Subject: Re: Fentanyl as seen by pharmacists

Not really. I still have my Versalog from back in college. I dug it out the

other night because the grandkids were asking " What's a slide rule? " Maybe I

even remember how to use it???

Steve Bowman

rachfoote (AT) aol (DOT) <mailto:rachfoote%40aol.com> com wrote:

Not really, because you and I are the only ones who still have slide rules.

andy

[Guest guest]

I never could get the hang of it. waited around for the 'New Modern'

technology.

jp

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Bledsoe, DO

Sent: Tuesday, January 23, 2007 11:34 AM

To: texasems-l

Subject: RE: Fentanyl as seen by pharmacists

Jack:

I would have figured you were in the abacus era.

BEB

_____

From: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

[mailto:texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com]

On

Behalf Of Jack Pitcock

Sent: Tuesday, January 23, 2007 10:48 AM

To: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

Subject: RE: Fentanyl as seen by pharmacists

I still have mine..

Actually competed in UIL " Slide Rule " .

Jack

_____

From: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

[mailto:texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com]

On

Behalf Of STEVE BOWMAN

Sent: Tuesday, January 23, 2007 9:07 AM

To: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com

Subject: Re: Fentanyl as seen by pharmacists

Not really. I still have my Versalog from back in college. I dug it out the

other night because the grandkids were asking " What's a slide rule? " Maybe I

even remember how to use it???

Steve Bowman

rachfoote (AT) aol (DOT) <mailto:rachfoote%40aol.com> com wrote:

Not really, because you and I are the only ones who still have slide rules.

andy

[Guest guest]

I agree, Larry. I teach my students to do the following: After they have

completed their calculations and had them checked by another medic, if

possible, I ask them to ask themselves, " Does this dose pass the common sense

test? "

If the nurse had asked that question, surely he would have seen that he was

giving the whole vial, and that there were 250 mcgs in the vial.

I once gave a drug calculation quiz in which I asked the students to give 15

mg of morphine using 10mg/1 ml ampules. The answer, of course, 1.5 ml. One

student came up with an answer of 15,000 ml. So I went and got 15 liter

bags of Ringers and piled them on the desk. " This is the amount of morphine

you

decided to give. " Needless to say, the point was made.

Gene G.

>

> Gene-

>

> I guess I have been in a cave, but what you describe is a sad indictment for

> both the public education system AND nursing education programs as well. I

> may be real 'old school', but at least I won't overdose a patient (knock on

> wood) through a mathmatic error of the type you describe. Sad that nursing,

> instead of correcting the deficiencies, chooses to punt to the pharmacists.

> Nothing wrong with pharmacists, but this is a matter of professionalism and

pride

> as both a nurse for 23 years and a medic for 30.

>

> Larry , RN LP

>

> ------------ -------- -------- --

> The fish are biting.

> Get more visitors on your site using Yahoo! Search Marketing.

>

>

[Guest guest]

Well, when you have to give a drug on the ambulance, just call for the

on-call pharmacist to respond Code 3 to your location. She'll put those parts

of

the Epi amp together for you and check it twice to make sure it's the correct

dose. She'll make sure there are no contraindications for administration of

this drug to your coded patient, but it will take a few minutes. Not to

worry. You'll know that your drug administration has been done by a registered

pharmacist.

GG

>

> Same things happening in the hospitals in Amarillo. Drug calculations are

> being taken away from the nurses and given to the pharmacists to calculate (IV

> drips and such). This supposedly due to the increase in overdoses on

> patients.

>

> That is great. Lets not teach our personnel the proper way to calculate or

> get rid of those who cannot do the job properly, lets get someone else to do

> it. Pass the buck. Not my job anymore. I feel so bad that I cannot do for my

> patients what I need to do. That's ok though, my enormous paycheck will soothe

> my soul. NOT!!!!!!

>

> wegandy1938@wegandy wrote:

> I agree, Larry. I teach my students to do the following: After they have

> completed their calculations and had them checked by another medic, if

> possible, I ask them to ask themselves, " Does this dose pass the common

> sense test? "

> If the nurse had asked that question, surely he would have seen that he was

> giving the whole vial, and that there were 250 mcgs in the vial.

>

> I once gave a drug calculation quiz in which I asked the students to give 15

> mg of morphine using 10mg/1 ml ampules. The answer, of course, 1.5 ml. One

> student came up with an answer of 15,000 ml. So I went and got 15 liter

> bags of Ringers and piled them on the desk. " This is the amount of morphine

> you

> decided to give. " Needless to say, the point was made.

>

> Gene G.

>

>

> >

> > Gene-

> >

> > I guess I have been in a cave, but what you describe is a sad indictment

> for

> > both the public education system AND nursing education programs as well. I

> > may be real 'old school', but at least I won't overdose a patient (knock

> on

> > wood) through a mathmatic error of the type you describe. Sad that

> nursing,

> > instead of correcting the deficiencies, chooses to punt to the

> pharmacists.

> > Nothing wrong with pharmacists, but this is a matter of professionalism

> and pride

> > as both a nurse for 23 years and a medic for 30.

> >

> > Larry , RN LP

> >

> > ------------ -------- -------- --

> > The fish are biting.

> > Get more visitors on your site using Yahoo! Search Marketing.

> >

> >

[Guest guest]

Same things happening in the hospitals in Amarillo. Drug calculations are being

taken away from the nurses and given to the pharmacists to calculate (IV drips

and such). This supposedly due to the increase in overdoses on patients.

That is great. Lets not teach our personnel the proper way to calculate or get

rid of those who cannot do the job properly, lets get someone else to do it.

Pass the buck. Not my job anymore. I feel so bad that I cannot do for my

patients what I need to do. That's ok though, my enormous paycheck will soothe

my soul. NOT!!!!!!

wegandy1938@... wrote:

I agree, Larry. I teach my students to do the following: After they

have

completed their calculations and had them checked by another medic, if

possible, I ask them to ask themselves, " Does this dose pass the common sense

test? "

If the nurse had asked that question, surely he would have seen that he was

giving the whole vial, and that there were 250 mcgs in the vial.

I once gave a drug calculation quiz in which I asked the students to give 15

mg of morphine using 10mg/1 ml ampules. The answer, of course, 1.5 ml. One

student came up with an answer of 15,000 ml. So I went and got 15 liter

bags of Ringers and piled them on the desk. " This is the amount of morphine you

decided to give. " Needless to say, the point was made.

Gene G.

>

> Gene-

>

> I guess I have been in a cave, but what you describe is a sad indictment for

> both the public education system AND nursing education programs as well. I

> may be real 'old school', but at least I won't overdose a patient (knock on

> wood) through a mathmatic error of the type you describe. Sad that nursing,

> instead of correcting the deficiencies, chooses to punt to the pharmacists.

> Nothing wrong with pharmacists, but this is a matter of professionalism and

pride

> as both a nurse for 23 years and a medic for 30.

>

> Larry , RN LP

>

> ------------ -------- -------- --

> The fish are biting.

> Get more visitors on your site using Yahoo! Search Marketing.

>

>

[Guest guest]

whats wrong with an abacus? lol

A. Dempsey

EMT-I

DHCS - UHS

Re: Fentanyl as seen by pharmacists

Not really. I still have my Versalog from back in college. I dug

it out the

other night because the grandkids were asking " What's a slide

rule? " Maybe I

even remember how to use it???

Steve Bowman

rachfoote (AT) aol (DOT) <mailto:rachfoote%40aol.com> com wrote:

Not really, because you and I are the only ones who still have

slide rules.

andy

[Guest guest]

Gene,

FYI, there is already a proposed rule, by the FDA, that all non-urgent

medication orders in ED's be reviewed by a pharmacist prior to the

administration of the drug. Needless to say, my comment on this proposed rule

was negative.

Randy

R. (Randy) Loflin, M.D., FACEP

Associate Professor

Medical Director, City of El Paso EMSS

Fentanyl as seen by pharmacists

I bought a new nursing drug manual today, and in reading it I ran across a

nice little vignette that explains why some people think that fentanyl should

only be given by certain advanced practitioners.

Here's a little except from the Nursing2007 Drug Handbook published by

Lippincott & Wilkins, page 18, in the section called: Safe drug

administration.

" Misplacing decimals.

Error: A patient in the intensive care unit was to receive the opioid

fentanyl, 12.5 to 25 mcg I.V. every 4 to 6 hours, p.r.n., for pain. Unit stock

consisted o 5-ml ampules of fentanyl 0.05 mg/ml, so each ampule contained 0.25

mg (250 mcg). A nurse preparing a dose confused the volume needed when she

converted from milligrans to micrograms and gave 5 ml, thinking it contained

25 mcg. The patient suffered respiratory arrest but was resuscitatedl

Best practice or prevention: Numerous serious fentanyl errors have been

reported, and a misplaced decimal point caused many of them.

A safer alternative for intermittent dosing is I.V. morphine. Fentanyl

doses are best prepared in the pharmacy rather than in the unit. If a fentanyl

dose must be prepared, refer to dosing charts, follow the facility's protocols,

and ask another nurse to check your calculations. "

This book promotes some absurd statements. One, that a safer alternative for

intermittent dosing is morphine; second, that fentanyl doses are best prepared

in the pharmacy; third, that referring to " dosing charts " and another snurse

will make things right.

It's obvious that the nurse who made the mistake had no clue about how to

figure drug dosages. The clue is that it says that she made the mistake when

" she converted milligrams to micrograms " . That shows that she was using a

formula to try to figure out something that she should have known without having

to resort to paper and pencil or calculator. She obviously had no concept of

what she was doing, so she was just working with abstract numbers.. She

didn't stop to check what the total dose she, or he, was giving in terms of x

mcg/ml, so she didn't have a single clue how much she was giving.

NOW, because of that error, the snursies who wrote that book conclude that

snursies cannot reliably figure drug dosages, and they recommend that the

medication be drawn up by the pharmacy.

Those of us who administer drugs in the field are laughing our heads off over

this. We can figure drug doses in our heads, and we don't need a pharmacist

to draw up our fentanyl dose, thank you very much.

" UH, diapatch, we need to give some fentanyl here. Will you start the

tactical pharmacist to our location? " Dispatch: " , Medic 32, tactical

pharmacy will be dispatched. Can you give a request for them to be working

on? "

Medic 32: " Uh, dispatch, we have a 220 pound man with a dislocated knee, in

severe pain, and we are requesting fentanyl. " Dispatch: " Received. We

will relay to PharmTac 1. "

" PharmTac 1. We're responding. Medic 32, can you confirm the patient's

weight? " Medic 32: Yes, sir, the patient says he weighs about 215 pounds. "

PharmTac 1: " Received. We're calculating the dose at this time and will

arrive at your location in approximately 13 minutes. " Medic 32: " Standing

by. "

Enroute PharmTac 1, staffed by a registered pharamacists and a pharmacy tech,

begins to calculate the dose required for a 215 pound patient. First they

use their slide rule to convert 215 pounds to kilograms, and they arrive at a

metric weight of 97.727273 kilograms. Now, using the recommended dose of

fentanyl in musculoskeletal trauma, they find that----it's not an indication for

use!

PharmTac 1 to Medic 32: " Is your patient a candidate for general

anesthesia, regional anesthesia, postoperative pain, restlessness, tachympea or

delirium, preoperative medication, or to manage persistent, moderate to severe

chronic

pain in opiodtonerant patients who require around the clock opioid analgesics

for an extended time, or to manage breakthrough cancer pain in patients

already receiving and tolerating an opioid? " Medic 32: " Uh, sir, I suppose

our

patient is a candidate for regional anesthesia. " PharmTac 1: " Ten-4. We'

ll be calculating. "

PharmTac 1-Dispatch: " We're on scene with Medic 32. "

On arrival the pharmacist has drawn up a solution of 1.5 mcg fentanyl/kg

which equals 146.5 mcg fentanyl. He asks who will administer it? The

paramedic

answers that he will?

The pharmacist says, NO, only an anesthesologist can adminster fentanyl.

Medic 32--Dispatch: " Um, we need Anesthesia 1 to be sent to this location. "

Dispatch: " , M32, Gas 1 will be dispatched. " Dispatch: " Dispatch

to Gas1, respond to ............for a fentanyl administration. Time out,

2300 hours. "

This couldn't actually happen...............could it?

GG

[Guest guest]

Sheesh, Randy, what's next? ER Docs have to have an FDA representative in

the room before giving any drug? Are we surrendering to mindless

regulation?

Is this a turf battle between the pharmacists and the medical staff? Who is

thinking about the patient? Nobody so far as I can tell.

Bledsoe just posted quite a few articles showing that patients are not given

adequate pain management under the current rules, either prehospital or in

hospital.

Who is driving this movement to deny patients analgesia? The Republicans?

The Democrats? The Taliban? All of the above?

I must confess that I'm going to ask every patient where he works and what he

or she does. If they are a physician, I'm going to ask them what their

philosophy about pain management is before I give them anything to alleviate

their

pain. If they confess that they are a general surgeon, I'm tempted to say

that " I cannot give you any pain relief because it could mask your symptoms.

Here's a bullet to bite on. " If they work for the government, I'm going to

say, " Sorry. I cannot medicate you. You'll need to get FDA approval before

I can do that. "

Seriously, when is this nonsense going to end? EMS folks don't have the

clout to stop it. Doctors do, but where are they when idiotic proposals like

the one you mention come up. Why don't they step up to the plate and say,

" We're mad as Hell and we're not going to let you do this mindless crap. "

As a good friend and a great physician once said to me, in jest, " Remember

that it's the patient who hurts, not you. " How many physicians hold to that

notion? Too damn many.

We must stop the madness. Fentanyl is a safe and efficacious drug. It has

been given in the prehospital setting for a long time without any significant

problems. It has been given in the ER for a long time without problems.

Now, suddenly, some bunch of Drug Nannies want to upset the apple cart for no

reason and stop people from doing what is good for patients, for no good

reason.

We all must fight this trend.

Randy, let us know how to comment on this proposed rule so that we can

express our opposition to it.

Gene

>

> Gene,

>

> FYI, there is already a proposed rule, by the FDA, that all non-urgent

> medication orders in ED's be reviewed by a pharmacist prior to the

administration

> of the drug. Needless to say, my comment on this proposed rule was negative.

>

> Randy

> R. (Randy) Loflin, M.D., FACEP

> Associate Professor

> Medical Director, City of El Paso EMSS

>

> Fentanyl as seen by pharmacists

>

> I bought a new nursing drug manual today, and in reading it I ran across a

> nice little vignette that explains why some people think that fentanyl

> should

> only be given by certain advanced practitioners.

>

> Here's a little except from the Nursing2007 Drug Handbook published by

> Lippincott & Wilkins, page 18, in the section called: Safe drug

> administration.

>

> " Misplacing decimals.

>

> Error: A patient in the intensive care unit was to receive the opioid

> fentanyl, 12.5 to 25 mcg I.V. every 4 to 6 hours, p.r.n., for pain. Unit

> stock

> consisted o 5-ml ampules of fentanyl 0.05 mg/ml, so each ampule contained

> 0.25

> mg (250 mcg). A nurse preparing a dose confused the volume needed when she

> converted from milligrans to micrograms and gave 5 ml, thinking it contained

> 25 mcg. The patient suffered respiratory arrest but was resuscitatedl

>

> Best practice or prevention: Numerous serious fentanyl errors have been

> reported, and a misplaced decimal point caused many of them.

> A safer alternative for intermittent dosing is I.V. morphine. Fentanyl

> doses are best prepared in the pharmacy rather than in the unit. If a

> fentanyl

> dose must be prepared, refer to dosing charts, follow the facility's

> protocols,

> and ask another nurse to check your calculations.

>

> This book promotes some absurd statements. One, that a safer alternative for

> intermittent dosing is morphine; second, that fentanyl doses are best

> prepared

> in the pharmacy; third, that referring to " dosing charts " and another snurse

> will make things right.

>

> It's obvious that the nurse who made the mistake had no clue about how to

> figure drug dosages. The clue is that it says that she made the mistake when

> " she converted milligrams to micrograms " . That shows that she was using a

> formula to try to figure out something that she should have known without

> having

> to resort to paper and pencil or calculator. She obviously had no concept of

> what she was doing, so she was just working with abstract numbers.. She

> didn't stop to check what the total dose she, or he, was giving in terms of

> x

> mcg/ml, so she didn't have a single clue how much she was giving.

>

> NOW, because of that error, the snursies who wrote that book conclude that

> snursies cannot reliably figure drug dosages, and they recommend that the

> medication be drawn up by the pharmacy.

>

> Those of us who administer drugs in the field are laughing our heads off

> over

> this. We can figure drug doses in our heads, and we don't need a pharmacist

> to draw up our fentanyl dose, thank you very much.

>

> " UH, diapatch, we need to give some fentanyl here. Will you start the

> tactical pharmacist to our location? " Dispatch: " , Medic 32, tactical

> pharmacy will be dispatched. Can you give a request for them to be working

> on? "

> Medic 32: " Uh, dispatch, we have a 220 pound man with a dislocated knee, in

> severe pain, and we are requesting fentanyl. " Dispatch: " Received. We

> will relay to PharmTac 1. "

>

> " PharmTac 1. We're responding. Medic 32, can you confirm the patient's

> weight? " Medic 32: Yes, sir, the patient says he weighs about 215 pounds. "

> PharmTac 1: " Received. We're calculating the dose at this time and will

> arrive at your location in approximately 13 minutes. " Medic 32: " Standing

> by. "

>

> Enroute PharmTac 1, staffed by a registered pharamacists and a pharmacy

> tech,

> begins to calculate the dose required for a 215 pound patient. First they

> use their slide rule to convert 215 pounds to kilograms, and they arrive at

> a

> metric weight of 97.727273 kilograms. Now, using the recommended dose of

> fentanyl in musculoskeletal trauma, they find that----it's not an indication

> for

> use!

>

> PharmTac 1 to Medic 32: " Is your patient a candidate for general

> anesthesia, regional anesthesia, postoperative pain, restlessness, tachympea

> or

> delirium, preoperative medication, or to manage persistent, moderate to

> severe chronic

> pain in opiodtonerant patients who require around the clock opioid

> analgesics

> for an extended time, or to manage breakthrough cancer pain in patients

> already receiving and tolerating an opioid? " Medic 32: " Uh, sir, I suppose

> our

> patient is a candidate for regional anesthesia. " PharmTac 1: " Ten-4. We'

> ll be calculating.

>

> PharmTac 1-Dispatch: " We're on scene with Medic 32. "

>

> On arrival the pharmacist has drawn up a solution of 1.5 mcg fentanyl/kg

> which equals 146.5 mcg fentanyl. He asks who will administer it? The

> paramedic

> answers that he will?

>

> The pharmacist says, NO, only an anesthesologist can adminster fentanyl.

>

> Medic 32--Dispatch: " Um, we need Anesthesia 1 to be sent to this location. "

> Dispatch: " , M32, Gas 1 will be dispatched. " Dispatch: " Dispatch

> to Gas1, respond to ............ to Gas1, respond to ............<wbr>for a

> 2300 hours. "

>

> This couldn't actually happen...... This cou This cou

>

> GG

>

>