Intranasal administration? Just another novelty?

[Rialaigh]

IN Glucagon administration is starting to pop up in local protocols around here, this one was new to me...


It seems that we are finding more ways of administering drugs less effectively. I am all for putting more tools in the "toolbox" that EMS providers carry and I see IN as a viable alternative route when IV/IO access cannot be established (which should...should be never) and the drug cannot be given IM.

Do you (personally, and your service) use Intranasal administration. If so what drugs?

Is it in the protocols but no one uses?

Do you see a viable future for any IN drugs and if so which ones? (especially with the ease of IO kits these days)


Just curious what our more experienced providers (and those in the hospital setting) think on this subject.

 

[Rialaigh]

And I totally had the wrong forum open when I posted, I meant for this to go in the ALS section. If a moderator see's this and deems it worthy of moving I would be very appreciative.

 

[ffemt8978]

And I totally had the wrong forum open when I posted, I meant for this to go in the ALS section. If a moderator see's this and deems it worthy of moving I would be very appreciative.

Done

 

[Tigger]

We have IN Naloxone for all levels. Not always as effective as IV, but if there's no IV access of ALS has an extended response time it's useful. We also have IN Versed and Haldol. Never seen either used but I like the idea of no needles around combative patients.

 

[DesertMedic66]

FFEMT is always helpful

The only medications we have for IN are Narcan and Versed.

 

[Arovetli]

Sure there's a viable future.

It's certainly less invasive than the bone gun.

There can be a little variability as to the absorption of these drugs.

I'm for it. Plenty of circumstances in the field where having needle less drug administration is desirable. Although that doesn't absolve you of the need for a line.

The more resources and tools the better. More pharmacology education is what I would push for.

 

[ffemt8978]

Do you think that with the relatively limited time EMS is in contact with the patient, the reduced effectiveness of an IN medication is a fair trade off between ease of access and other considerations (such as safety with combative patient)?

 

[STXmedic]

We have intranasal fentanyl, versed, narcan, and glucagon.

I initially thought IN was the bee's knees. After much experience with it, I've found that I am more often than not left dissatisfied with the results.

I like it for initial pediatric pain management. I'll consider it if I'm having a hard time getting a line on an actively seizing patient. IN is definitely not my first option (or second if I can help it) for the vast majority of patients.

I do prefer IN administration over shooting it down the tube... :unsure:

 

[chaz90]

I really like IN for Fentanyl administration. I use it when I can before moving the patient, then I follow up with an IV dose later. For seizures or chemical restraints of combative patients, I much prefer IM Versed over IN. As was posted somewhere else here somewhat recently, it seems like any patient that isn't cooperative with you snorts the Versed all over the place. I've had pretty good experience with IN Narcan as well. For that, you just have to be patient long enough for it to work.

 

[Arovetli]

Do you think that with the relatively limited time EMS is in contact with the patient, the reduced effectiveness of an IN medication is a fair trade off between ease of access and other considerations (such as safety with combative patient)?

Definitely.

I like the way you phrased that, "trade off".

I wish we started teaching/thinking like this, a lot of medicine is a trade off of sorts...from managing metabolic derangements to pharmacology...

I think, especially for ems pharmacology, there are too many newer medics that come out not realizing/understanding how the medications work, at least on a basic level...and how administration routes effect that.

Especially with the time/scene/safety constraints EMS is under...IN route is really useful.

 

[the_negro_puppy]

We have IN fentanyl for Paeds. I like it.

 

[Dwindlin]

We have it for Fentanyl, Valium, and Narcan.

Only time I really use it is actively seizing patient. I don't see any good reason to drill these patients initially. Give them a dose IN and get your line once the seizing stops. If it doesn't stop, well then we can talk about an IO.

 

[DrParasite]

as an ignorant EMT, I love the idea of IN narcan, esp for BLS providers. if you give it to someone who didn't OD on opiods, it has few negative side effects (other than wasting ta drug). and if they are a heroin OD, you just stabilized their breathing (and maybe woke them up, with almost always ensure a patent airway).

Is it as effective as IV or IM? no..... however, it is less invasive, and can help save a life if your ALS is unavailable or has an extended response time.

 

[NomadicMedic]

Is it as effective as IV or IM? no..... .

Incorrect.

We found that although IN naloxone had a slower on-set of action than the IV route, the overall time from patient contact to clinical effect was the same.

INTRANASAL NALOXONE IS A VIABLE ALTERNATIVE TO INTRAVENOUS NALOXONE FOR PREHOSPITAL NARCOTIC OVERDOSE Tania Mieke Robertson, MD, Gregory W. Hendey, MD, Geoff Stroh, MD, Marc Shalit, MD

Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose

Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses
Mark A. Merlin DO, EMT-P, Matthew Saybolt BS, Raffi Kapitanyan MD, ScottM.AlterBS,EMT-P,JanosJeges MD, JunfengLiu PhD,SusanCalabrese MICP,Kevin O. Rynn PharmD,Rachael Perritt PharmD,Peter W. Pryor II MD, MPH.