Continuing from Shortage of Lifesaving Drugs Reaches Epic Proportions.
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It’s how to provide the best patientcare while at the same time preventing medical mix-ups when administering drug substitutes, many of which have different potencies than their more commonly used counterparts. Fentanyl, for example, which isused as a substitute for morphine, is 10 times stronger than the opiate. A wrong dose, hospital officials worry, could cause death.[1]
Fentanyl is 100 times as potent per mg (not 10 times), but the packaging is generally single dose packaging. A syringe of fentanyl with 100 mcg is roughly the same strength as a syringe of morphine that contains 10 mg. I would need to get 99 more syringes of fentanyl to give the same dose in milligrams.
In what hospital is this not going to require a trip to the pharmacy? What ambulance company carries 10 mg fentanyl (10,000 mcg fentanyl) on any ambulance?
This 10 mg of morphine –
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Is not the same as this 10 mg of fentanyl –
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Image credit. Click on images to make them larger.
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Hold on. That isn’t 10 mg fentanyl. We need more –
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We still need more –
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We aren’t there yet –
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Just a teensy-weensy bit more –
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There is more than a subtle difference between the one syringe and the 100 syringes. If you missed it, go back and look again. Can you tell the difference between 100 syringes and 1 syringe? Are you sure?
Have carpal tunnel symptoms developed from repeatedly pushing the plunger on these syringes? Is each syringe being followed by a flush? If 2 ml fentanyl is followed by a 10 ml flush, that is 1,200 ml for what should have been 1 ml of morphine. The syringes are the same size, although the fentanyl syringes contain 2 ml each and the morphine syringes contain 1 ml each.
There may be other concentrations available, but 50 mcg/ml is the most common concentration of fentanyl. The variation in concentrations is much more common with morphine. The 10 mg/ml concentration is what I carry, which is 10 mg in one 1 ml syringe (as pictured). Everyone should check the concentration at least once before giving any medication.
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To be continued in Part II.
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Footnotes:
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[1] Shortage of Lifesaving Drugs Reaches Epic Proportions
Beverly Ford Source: Telegram & Gazette (Worchester, MA)
December 21, 2011
EMS World
Article
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I have found that the majority of “medical” articles and press coverage directed toward the general public contain a disgusting amount of misinformation and scare tactics …
I had the family of an intubated patient in the ICU once question whether or not it was safe to use propofol on their loved one, after the whole Michael Jackson debacle.
Apparently we aren’t supposed to be smart enough to figure out something is wrong if you have to use 100 “single dose” cartidges to give 10 mg of fentanyl.
Prehospital RN,
A good source of information about this continual problem can be found at Health News Watchdog blog.
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All people hear is that propofol killed Michael Jackson.
What they do not learn is that the difference between life and death was just the failure to maintain an airway. Even propofol-induced apnea goes away quickly. After that apnea goes away, if the airway is not properly positioned, the respiratory drive may not be enough to overcome whatever positional obstruction exists.
If ex-Dr. Conrad Murray had properly positioned Michael Jackson’s airway this one time, Michael Jackson might still be alive. Or Dr. Murray might have found some other way to incompetently kill Michael Jackson.
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How does anyone employ people who are capable of this kind of thinking – or any other completely inappropriate dosing?
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