Which routes are permitted for fentanyl administration in the severe pain protocol?

• A. IV/IM/IN/IO
• B. Intravenous, Intramuscular, Intranasal, and Intraosseous
• C. PO
• D. Inhalation

Answer: (B)

The concept being tested is which routes are approved for fentanyl in the severe pain protocol. Fentanyl is highly potent with rapid onset, so the protocol allows multiple routes to ensure fast and flexible access to analgesia, even if IV access is difficult.

The permitted routes—intravenous, intramuscular, intranasal, and intraosseous—cover a range of situations: IV for immediate effect, IM when IV isn’t yet available, IN as a quick noninvasive option, and IO when neither IV nor IM access is practical.

Oral fentanyl is not used because it has unreliable and slow absorption, which makes it unsuitable for severe, time-critical pain control. Inhalation isn’t included in this protocol, likely due to variability in dosing and delivery in the EMS setting. So the best answer includes IV, IM, IN, and IO.