# Fentanyl

Adult and pediatric analgesia, route-specific doses, and the young-child base-contact requirement.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/fentanyl/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Keep micrograms (mcg) distinct from milligrams (mg).
- Adult injury/burn analgesia requires systolic BP above 90 in the relevant source. Continue airway and ventilation assessment after dosing.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-015 — Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf)
- [SO-T-005 — General Injury and Trauma - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-T-05%20Gen%20Trauma%204-2024_0.pdf)
- [SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-E-05%20Burn%204-2024_0.pdf)
- [SO-P-015 — General Injury and Trauma - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf)

## Use in OCEMS

- Opioid analgesia in applicable painful-injury/burn pathways, and IV treatment of cardiac pain not relieved by nitroglycerin or when nitroglycerin cannot be given.
- Assess pain, perfusion, respiratory status, and mental status before selecting an analgesic.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Pain — IV or IM | 50 mcg; may repeat once after approximately 3 minutes for continued pain. |
| Pain — IN | 100 mcg, divided as 1 mL per nostril with 50 mcg/mL stock; may repeat once after approximately 3 minutes. |
| Cardiac pain | 50 mcg IV; may repeat once after approximately 3 minutes. Follow SO-C-015 and withhold if systolic BP is below 90. |

## Pediatric

- SO-P-015 severe-injury pain: 2 mcg/kg IN/IV/IM, maximum 50 mcg per dose. May repeat once after 3 minutes; total maximum 100 mcg.
- SO-P-015 requires base contact for children age 2 or younger. I-20 uses a “younger than 2” note; retain the condition-specific age-2 contact requirement rather than dropping it.

## Pediatric weight table — Severe injury pain

- Source: SO-P-015. Dose rule: 2 mcg/kg; route: IN/IV/IM.
- 2 mcg/kg IN/IV/IM; maximum 50 mcg per dose. May repeat once after 3 minutes; total maximum 100 mcg.
- Base contact is required for children age 2 or younger. Monitor ventilation, mental status, and blood pressure.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IN/IV/IM | Volume at 50 mcg/mL |
| --- | --- | --- |
| 3 kg | 6 mcg | 0.12 mL |
| 4 kg | 8 mcg | 0.16 mL |
| 5 kg | 10 mcg | 0.2 mL |
| 6 kg | 12 mcg | 0.24 mL |
| 8 kg | 16 mcg | 0.32 mL |
| 10 kg | 20 mcg | 0.4 mL |
| 12 kg | 24 mcg | 0.48 mL |
| 15 kg | 30 mcg | 0.6 mL |
| 20 kg | 40 mcg | 0.8 mL |
| 25 kg | 50 mcg | 1 mL |
| 30 kg | 50 mcg | 1 mL |
| 35 kg | 50 mcg | 1 mL |
| 40 kg | 50 mcg | 1 mL |
| 45 kg | 50 mcg | 1 mL |
| 50 kg | 50 mcg | 1 mL |
| 60 kg | 50 mcg | 1 mL |

## Preparation & reassessment

- Stock listed in I-15 is 100 mcg/2 mL. Confirm concentration and the selected route.
- Document pain before and after treatment, dose times, total dose, blood pressure, and respiratory response.