Field medications · Adult & pediatric guidance · ALS
Fentanyl
Adult and pediatric analgesia, route-specific doses, and the young-child base-contact requirement.
OCEMS source summary · Updated 2026-09-16
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.
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.
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.