Intranasal drug administration

[letmesleep]

I just had another thought.....any one who uses IN at their place of employment, would you mind letting me know were you work by means of a PM or here? My thought is to access protocols to assist us with our proposal, you help would be awesome.

thanks in advance!

[Doczilla]

Drugs that are feasible to be given IN in the prehospital environment:

versed (midazolam)

valium, though only in concentrated form

fentanyl

morphine

narcan

ketamine

Ativan has relatively inconsistent absorption through mucous membranes, though a pharmacokinetic study of IN ativan looked favorable. Epi is only given IN for local vasoconstriction, such as for a refractory nosebleed or in preparation for a procedure like nasal intubation or NG placement. Lidocaine is only given IN for local anesthetic effect. Neither epi nor lido are absorbed from the nasal mucosa in sufficient quantities to be systemically effective (say, in cardiac arrest), though systemic effects are uncommonly but sometimes seen. Haldol is not yet in widespread use, but there is a tiny pharmacokinetic study, so we may see this sometime in the future if further studies pan out.

Note that the drug has to be a concentrated form, or it will simply run down the back of the throat as liquid rather than clinging to the nasal mucosa and absorbing.

'zilla

[Richard B the EMT]

Here in NYC/NY State, I have never heard of IN meds administration. I have seen my Paramedics administer meds down an ET (now reconnect the BVM, and keep pumping). However, I can not speak about the rest of the state.

I have located what might answer some of your questions, at the New York State Department of Health's site. Link to...

http://w2.health.state.ny.us/query.html?co...p;search=Search

[Shells]

Hey Doczilla,

Have you heard anything about Glucagon IN? There is a local service that has it in their protocol (not my employer's medical control).

[mshow00]

Firedoc,

As far as drugs being able to be given down the tube - valium is no longer being given down the tube as it is oil based so the new acronymn being taught is LEAN (lidocaine, epi, atropine, narcan). I'm not sure if versed could be given via ET tube as I've never given it that way.

You forgot the "O". It is supposed to be either OLEAN / LEANO. Lidocaine, Epi, Atropine, Narcan & Oxygen. :twisted:

[akroeze]

I thought the V was Vasopressin

[firedoc5]

You forgot the "O". It is supposed to be either OLEAN / LEANO. Lidocaine, Epi, Atropine, Narcan & Oxygen. :twisted:

At first I learned the "LEAN" acronym, later to be told the NAVEL one. But I was always sceptical about Valium. I think I've given all of them but Valium that way at one time or another. Actually, I was hesitant to give anything (other than O2) nasally, only when ordered to.

I think Oxygen is a given. I don't think anyone would forget it so it didn't need to be included in an acronym to remember. :wink:

[Doczilla]

Hey Doczilla,

Have you heard anything about Glucagon IN? There is a local service that has it in their protocol (not my employer's medical control).

I have heard of it in the setting of rescue therapy that diabetics can self-administer at home (or a family member can administer) for drops in BGL. I haven't really heard of it much around here in EMS, so I went back to the literature. A Pubmed check revealed some small pharmacokinetic studies that show it may be of benefit (though the form and dosage of the glucagon varies) both in adults and children. Two studies suggested that IN glucagon did not produce as "sustained" a blood sugar level as IM, but one study said the volunteers didn't have as much nausea. All the studies were on healthy volunteers or diabetics, and some had hypoglycemia induced with insulin beforehand. I didn't see any studies on glucagon in emergency patients. The literature on it isn't awe-inspiring, but it makes logical sense. I don't see any harm in it, since glucagon is already a recognized treatment for hypoglycemia, and it may be of benefit.

'zilla

[Doczilla]

My feelings on drugs down the ET tube: not adequately studied, and largely moot now that we have easy to use IO devices. A tool for the tool bag if you left the IOs back at the station accidentally, but otherwise of historical interest only.

'zilla

[fireflymedic]

Doczilla, one other one which I forgot that is quite useful for nasal intubations - neosynephrine which comes in a spray, but is given IN anyway. Though nasal intubations are falling out of favor very quickly with the more widespread use of RSI/DAI in ground services. I believe I've only had one nasal in an 8 year career.