Due to production problems, fentanyl is in extremely short supply. Over the past few weeks the fentanyl inventory reached a critically low level, resulting in many prescribers of fentanyl being asked to consider alternative analgesics or using patient-controlled analgesia PCA) pumps instead of frequent prn injections. The Pharmacy at St. Francis Medical Center was able to procure a drug supply and was able to meet all of the patients’ analgesic needs. The shortage is expected to continue into January. Barring any further manufacturing or distribution problems, adequate supply of fentanyl should remain available.

Reflecting new ACLS guidelines, several adjustments to the medication contents of the code carts will be made effective December 15^{th. Isoproterenol and bretylium will be removed and vasopressin and amiodarone will be added. Vasopressin, administered as a 40 unit IV bolus, will offer an alternative to epinephrine. Amiodarone will be packaged on the carts with a dextrose solution for drug dilution and IV line flush. During a cardiac arrest, amiodarone 300mg should be diluted to 20ml and bolused intravenously over 1-2 minutes. Diazepam (Valium) will be removed based on a Joint Commission recommendation.}