Everything you need to know about healthcare, you can learn from Fentanyl. 

Recently, I was preparing to transport a paediatric patient. She was being kept sedated so that the ventilator could do its job - to help ease her breathing. Even with the sedation, the patient was still quite restless and her heart rate was a little higher than I was happy with.
 
I looked across at the patient’s mom and said “I am going to give her something to make sure she is comfortable.”
 
“What are you giving her?” she asked.
 
“Fentanyl. It’s a short acting narcotic,” I explained.
 
“I don’t want her to have that, it’s a bad drug! People die from that!” she implored.
 
The mother’s reaction caught me off guard, so I took a moment with her to clarify. I explained how people taking Fentanyl on the street are often unsure of the amount of drug they are taking; they can die because too much of the drug causes their blood pressure to drop or their lungs to stop breathing. 
 
We discussed how I calculated the dose to determine how much of the drug I planned on giving her daughter; I also explained how I would treat any side effects if they appeared. Together, we looked at the ventilator which was there to help her breathe if she needed more assistance. Mom also saw that her daughter’s blood pressure was constantly monitored, and that IV’s were ready in case her blood pressure dropped.
 
We talked about the physical signs that her daughter may be in pain.  I explained why I thought Fentanyl, being much shorter acting than the other options, was my recommended option for her child.  Ultimately, Mom agreed and her daughter was much more comfortable with some pain relief.
 
Mom thought Fentanyl was a bad drug because she connected it with news reports about the opioid crisis. The truth is, there is no such thing as a good drug or a bad drug, there are only drugs.  Every drug has wanted and unwanted effects.  What is good or bad, is how they are used. For example, I doubt Mom would have reacted as strongly if I suggested giving her daughter some acetaminophen. However, the improper dosing, either deliberate or accidental, of acetaminophen causes over 4,600 hospitalizations per year in Canada.
 
Mom’s conversation about Fentanyl highlights an essential skill for all parents navigating healthcare with their child.
 
Healthcare is basically made up of a cycle of assessments and treatments.  Each of these, whether it is having an X-ray taken, receiving a medication or having surgery, has a unique set of risks and benefits. It is my job, along with everyone else on your child’s healthcare team, to weigh the risks and benefits of each procedure and decide which is best. 
 
It is also my job to make sure you, as legal guardian, are well informed.  Every parent has the right to make an informed decision about the treatment their child receives. The best way to make sure this happens is to ask questions. Those questions should always start with: Why does my child need this? What are the risk and the benefits?
 
Jonathan Lee is a Paediatric Critical Care Paramedic with Ornge.

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