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REVIEW OF INTRANASALLY ADMINISTERED MEDICATIONS FOR USE IN THE EMERGENCY DEPARTMENT

Posted by Dr Ramon REYES, MD on

MEDICAMENTOS ADMINISTRADOS POR VIA INTRANASAL
La vía intranasal es adecuada para administrar (con un atomizador, si es posible) analgésicos, sedantes y antídotos a un paciente agitado o neurológicamente deprimido cuando no es posible conseguir con rapidez un acceso IV. Esta infografía nos recuerda las dosis habituales. Puedes acceder al artículo que le sirvió de base en el siguiente enlace: https://lnkd.in/gUu9TSFk

Teleflex
Belen Moya Gutierrez
Natalia Jimenez Grande
Emergency Staff
Jose Antonio Ortiz Gomez

Review of Intranasally Administered Medications for Use in the Emergency Department

Abby M Bailey 1 , Regan A Baum 1 , Karolyn Horn 1 , Tameka Lewis 2 , Kate Morizio 1 , Amy Schultz 2 , Kyle Weant 3 , Stephanie N Justice 4
Affiliations

Abstract

Background: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter.

Objective: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine.

Discussion: The nasal mucosa is highly vascularized, and the olfactory tissues provide a direct conduit to the central nervous system, bypass first-pass metabolism, and lead to an onset of action similar to IV drug administration. This route of administration has also been shown to decrease delays in drug administration, which can have a profound impact in a variety of emergent scenarios, such as seizures, acutely agitated or combative patients, and trauma management. IN administration of midazolam, lorazepam, flumazenil, dexmedetomidine, ketamine, fentanyl, hydromorphone, butorphanol, naloxone, insulin, and haloperidol has been shown to be a safe, effective alternative to IM or IV administration. As the use of IN medications becomes a more common route of administration in the emergency department setting, and in prehospital and outpatient settings, it is increasingly important for providers to become more familiar with the nuances of this novel route of medication delivery.

Conclusions: IN administration of the reviewed medications has been shown to be a safe and effective alternative to IM or IV administration. Use of IN is becoming more commonplace in the emergency department setting and in prehospital settings.

Keywords: emergency department; intranasal; medication; nasal; prehospital.

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