nasal atomizers anyone?

J

joedittfurth

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anybody out there have any insight on nasal atomizers specifically with glucagon
 
What type of insight are you looking for? Onset of action?
 
Nasal neb can be affected by nasal congestion, mucus, dried sections, and broken mucosae (as in drug abuse, or prolonged dehumidified respirations, or dehydration).
 
What about them? We use them for Narcan, Fent, Versed, etc here at my service... but never heard of them used for glucagon
 
Same as above. I know it can be used for glucagon, but have never tried it- nor have I seen it tried. The preparation we have is ready for IM upon mixing, and works well when given that route.
 
just wondering about effectiveness and difference vs iv drugs never gotten to use its as an emt basic silly paramedics always get in the way
 
I don't personally like the MAD. It's not reliable, like has been said many things can negatively affect absorption.

Works great for kids.

With a perfect scenario the onset is supposedly similar to IV. We had a bunch of studies provided to us at work when they started pushing its use but I don't have them in front of me.
 
with any tool, they have their place.

I.E. the seizing patient that you are going to have a hard time getting an IV on. wanna break that seizure. with Valium

Cardiac arrest where narcotic toxicity is the suspected cause

just because you got the NAD dosent mean it fits every patient.
 
unleashedfury said:
with any tool, they have their place.

I.E. the seizing patient that you are going to have a hard time getting an IV on. wanna break that seizure. with Valium

Cardiac arrest where narcotic toxicity is the suspected cause

just because you got the NAD dosent mean it fits every patient.
Click to expand...

Why this one?
 
unleashedfury said:
with any tool, they have their place.

I.E. the seizing patient that you are going to have a hard time getting an IV on. wanna break that seizure. with Valium

Cardiac arrest where narcotic toxicity is the suspected cause

just because you got the NAD dosent mean it fits every patient.
Click to expand...

Intranasal is not a viable route of administration for patients in cardiac arrest. Like IM and SQ IN requires peripheral circulation for the drug which cardiac arrest patients severely lack.
 
I have never gave meds through IN, but have seen it done before and it has not had good reactions except when I saw a medic give it to a kid. So my thoughts are the same as the others, that it has to much complications for the meds to get fully absorbed.
 
If you've never given it, and only seen it one, how can you form an opinion?

I use IN Narcan exclusively now for Opiate ODs. I have had excellent results with it. I find that Versed is hit or miss, depending on the concentration I have in my box. Fentanyl IN works great for kids, but I find IV Fent better for adults.
 
DEmedic said:
If you've never given it, and only seen it one, how can you form an opinion?

I use IN Narcan exclusively now for Opiate ODs. I have had excellent results with it. I find that Versed is hit or miss, depending on the concentration I have in my box. Fentanyl IN works great for kids, but I find IV Fent better for adults.
Click to expand...

I have seen it more then once before and have seen it only really work once, that's what I was saying and yes your right I will have to give it myself in situation to see for myself if I like it or not. Don't have a very strong opinion on it yet. From the medics I have talked to all of them have mixed opinions on it, some like it some don't. So after I use it more I will have more of a opinion about it. The one I actually saw work well was Fent for a kid.:)
 
I use it for fentanyl with kids. That's about it. I've had such varying responses on all other uses, that I typically just go IM when I can't go IV. While it may not be as fast as IN could potentially be, it's more consistent and reliable.

For instance: excited delirium- The thought of no needle and a quick onset is awesome. However, my concentration of versed is only 1:1. 2mg of versed isn't going to do anything for an ED patient. Besides the fact that many of our ED patients are on cocaine, which they commonly like to snort... That whole vasoconstriction thing really hampers absorption through the mucosa. Nope. I'll stick with giving a full dose in the muscle and waiting an extra minute or two.
 
unleashedfury said:
with any tool, they have their place.

I.E. the seizing patient that you are going to have a hard time getting an IV on. wanna break that seizure. with Valium

Cardiac arrest where narcotic toxicity is the suspected cause

just because you got the NAD dosent mean it fits every patient.
Click to expand...

IM benzo is the preferred seizure med route...if there is no IV (rampart study)
and why the narcan during cardiac arrest? Your priority should be compressions and airway
 
DEmedic said:
Really? Why is that? Our IN dose is 1mg.
Click to expand...

If you're looking for equivalence to IM glucagon you need to give 2 mg IN. Studies comparing 1 mg IN, 2 mg IN, and 1 mg IM show that 2 mg is the equivalent dose for the nasal route.

I could only find one of the three studies that included a graph, and it appears 1 mg may well be clinically equivalent. But there have been no studies large enough to say whether the observed differences in 1 mg and 2 mg are actually clinically relevant.



(I added the blue for folks not used to mmol/L as a glucose measurement)
 
Interesting. I'll share that with the guy in our Protocol Revision group. I'm sure they'll just say, "continue to give 1mg IM" however. :)
 
DEmedic said:
Interesting. I'll share that with the guy in our Protocol Revision group. I'm sure they'll just say, "continue to give 1mg IM" however. :)
Click to expand...

Like I said, clinical relevance is perhaps more appropriate for the provider. There are statistical differences in BGL curves between IV D10 and D50, but clinically there is little difference.

I think if you gave 1 mg IN while working on a line, you'd be fine in practice, but given the lower than equivalent dose you may find non-responders.
 
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