Hi, I'm about to start the paramedic portion of my education (2nd year) and I've been reading ahead a bit. I just read that endotracheal admin of drugs is considered parenteral, but not pulmonary. On the surface that doesn't make sense to me, but I haven't learned about endotracheal intubation yet. What am I missing? Why isn't endotracheal pulmonary?
Drug administration route...
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"Parenteral" simply refers to any route for drug administration that does not involve the GI tract. The pulmonary route typically means inhaled medications. Aerosolized medications meant for absorption through the respiratory tract are a slightly different concept than just pushing liquid through an ET tube. Nebulized medications, dry powder inhalers, and MDIs rely on creating fine particulates that (ideally) are absorbed through the respiratory tract with lung and systemic effects.
ETT administered medications were traditionally a route when no other options were available in an attempt to produce some kind of desired systemic effect. I'm not certain what kind of therapeutic levels were ever reached through most drugs delivered through an ETT, but I imagine they were pretty dismal. Keep in mind, I've never seen any drugs given endotracheally. I'm not certain if in hospital care still uses it for certain applications, but it has been entirely supplanted by IO access prehospitally.
ETT administered medications were traditionally a route when no other options were available in an attempt to produce some kind of desired systemic effect. I'm not certain what kind of therapeutic levels were ever reached through most drugs delivered through an ETT, but I imagine they were pretty dismal. Keep in mind, I've never seen any drugs given endotracheally. I'm not certain if in hospital care still uses it for certain applications, but it has been entirely supplanted by IO access prehospitally.
Brandon O
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Nobody was.
MackTheKnife
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Before IO, ETT was used when peripheral access was unavailable as stated above. Our agency used it a few times years ago. Once we got more PM's certified to do EJs and central lines, it went by the wayside. If I remember correctly, it was LANE- Lidocaine, Atropine, Narcan, Epi. I did Lidocaine once.
TransportJockey
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Navel was the acronym. Narcan, atropine, vasopressin, epi, and lido. Now with io the only drug i give that comes near the respiratory tract is IN fent for my pedi patients. Other than duoneb/albuterol
NomadicMedic
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When I learned NAVEL the V used to be for Valium. 
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Tigger
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Is Valium really uncommon on ambulances these days? We have it and use it fairly regularly and the ED is always surprised that we have it.
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I haven't used diazepam or even seen it on the road in years. For acute events it's been largely replaced by lorazepam and midazolam. They are faster and more potent.
TransportJockey
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We carry it. But everyone uses Ativan or versed. Same with local hospitals
Brandon O
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I get the impression diazepam is still more popular for the peds crowd? Don't know why.
TransportJockey
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Only thing i have read is an article about it still working better pr. But i never followed up on that
Tigger
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We also carry midazolam but everyone here seems to prefer diazepam for "skeletal muscle relaxation." People seem to be more likely to go for midazolam for seizures and of course post intubation sedation.
NomadicMedic
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We still carry it here in GA. I haven't used it in forever.
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As far as diazepam goes, I have seen exactly one instance where it controlled seizure activity better than lorazepam. Where I work, we rarely use midaz, and that's usually only for RSI. Lorazepam is our go-to benzo and we use diazepam, usually PO, for skeletal muscle relaxation.
MackTheKnife
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In nursing pharmacology, diazepam is taught as the drug of choice for kiddies. But that is the "book world". Our instructors who work in the EDs say that midazolam is more popular.