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If the pt is not intubated yet, high dose fentanyl should be used. Anywhere form 7.0-8.0 mcg/kg of fentanyl should be considered.
7-8 mcg/kg? Is that a typo?
I agree that fentanyl is a better drug for prehospital use. Faster onset, more stable hemodynamic profile, more consistent dose-dependent effects, more titratable. Just better all the way around.
An excellent combo in burn patients is 100mcg of fent, 12-25mg of promethazine, and 1-2mg of versed. This gives an excellent synergistic effect and in an average sized patient you'll almost always get decent analgesia and anxiolysis for a 20-30 minutes or so.
As for the OP's question, it is the histamine release they are afraid of. At least that's the rationale that I've heard before.