[52bravo]

like to know some thing about lollipop, from you guys.

first how do thay like heat, do thay melt in the s... heat of Iraq?

2nd the dosis the TCCC say 400 mcg, some of you tells my that you use 800 mcg, the paper by dr's Russ S. Kotwal Kevin C. O’Connor, and John B. Holcomb (and et al)A Novel Pain Management Strategy for Combat Casualty Care uses 1600 mcg.
so what to use to give the same effect of 10-20 mg morphine IV/IM in real life? i have look it up in the book it say 800 mcg.

3th not a easy one, how long do it have a effect?, the book say ½ time is 7h, but what in reallife, the paper look at the effect after 5h, and there where still good effect there


A Novel Pain Management Strategy for Combat
Casualty Care
Russ S. Kotwal, MD, MPH
Kevin C. O’Connor, DO
Troy R. Johnson, MD
Dan S. Mosely, MD
David E. Meyer, MS, PT
John B. Holcomb, MD


Study objective: Pain control in trauma patients should be an integral part of the
continuum of care, beginning at the scene with out-of-hospital trauma management,
sustained through the evacuation process, and optimized during hospitalization. This
study evaluates the effectiveness of a novel application of a pain control medication,
currently indicated for the management of chronic and breakthrough cancer pain, in the
reduction of acute pain for wounded Special Operations soldiers in an austere combat
environment.
Methods: Doses (1,600 mg) of oral transmucosal fentanyl citrate were administered by
medical personnel during missions executed in support of Operation Iraqi Freedom from
March 3, 2003, to May 3, 2003. Hemodynamically stable casualties presenting with
isolated, uncomplicated orthopedic injuries or extremity wounds who would not have
otherwise required an intravenous catheter were eligible for treatment and evaluation.
Pretreatment, 15-minute posttreatment, and 5-hour posttreatment pain intensities were
quantified by the verbal 0-to-10 numeric rating scale.
Results: A total of 22 patients, aged 21 to 37 years, met the study criterion. The mean
difference in verbal pain scores (5.77; 95% confidence interval [CI] 5.18 to 6.37) was
found to be statistically significant between the mean pain rating at 0 minutes and the
rating at 15 minutes. However, the mean difference (0.39; 95% CI 0.18 to 0.96) was not
statistically significant between 15 minutes and 5 hours, indicating the sustained action
of the intervention without the need for redosing. One patient experienced an episode of
hypoventilation that resolved readily with administration of naloxone. Other
documented adverse effects were minor and included pruritus (22.7%), nausea (13.6%),
emesis (9.1%), and lightheadedness (9.1%).
Conclusion: Oral transmucosal fentanyl citrate can provide an alternative means of
delivering effective, rapid-onset, and noninvasive pain management in an out-ofhospital,
combat, or austere environment.
[Ann Emerg Med. 2004;44:121-127.]