When to Pick the Nose: Out-of-Hospital and Emergency Department

Ann Emerg Med · Aug 2017

Review

When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.

The intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. ⋯ The intranasal route appears to be an effective alternative for naloxone in opioid overdose. The literature is less clear on roles for intranasal ketamine and dexmedetomidine.

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- Megan A Rech, Brian Barbas, Whitney Chaney, Elizabeth Greenhalgh, and Charles Turck.
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL; Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL. Electronic address: mrech@lumc.edu.
- Ann Emerg Med. 2017 Aug 1; 70 (2): 203-211.
AbstractThe intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. Intranasal fentanyl demonstrates both safety and efficacy for the management of acute pain. The intranasal route appears to be an effective alternative for naloxone in opioid overdose. The literature is less clear on roles for intranasal ketamine and dexmedetomidine.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.

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