This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. To earn your credits, go to www.rapidce.com, or to print and mail a copy, download the test here.
- Explain the physiology of intranasal drug administration.
- List the benefits of intranasal drug administration.
- Identify three methods for intranasal drug delivery.
- Explain the rationale for utilizing the intranasal drug route.
- Identify five drugs that can be safely administered intranasally.
Emergency medical providers across the country use a variety of drugs to help manage patients in the prehospital setting. Depending on each service’s region and level of care, the number of drugs available to a given provider can range from as few as five to as many as 100. As prehospital care grows and expands, medical directors, EMTs, paramedics and managers are all looking for ways to grow the quality of care delivered prior to emergency department arrival. Improving the quality of care does not always mean expanding someone’s scope of practice by adding more interventions and more drugs to a provider’s toolbox. It can also mean finding new ways to deliver current interventions more efficiently and safely. Previously, this has included the transition to needleless intravenous (IV) line med-ports, auto-retracting IV needles, utilization of emergency medical dispatch to eliminate the unnecessary use of lights and sirens, and the ever-changing tweaks to cardiopulmonary (perhaps soon to be called cardiocerebral) resuscitation.
This continuing education article will discuss intranasal drug administration—a delivery route that has not seen widespread EMS utilization, but which offers all levels of EMS providers a safe and effective alternative for drug delivery in a variety of emergency settings.
The idea of intranasal (IN) drug administration is not completely new. An article in the April 2007 issue of EMS Magazine by Rob Curran called for its widespread introduction and use.1 Curran cited then-recent research that suggested IN drug administration was safe and could be nearly as effective as IV administration; however, to date, widespread use has not caught on. While there are a variety of reasons that could be argued, probably the most simple is that EMS as a system can be slow to change. Another reason is that the administration of intranasal drugs is considered off-label, since few drugs have been specifically presented to the FDA for approval via the intranasal route. Remember, though, many drugs used in emergency medicine are considered off-label. Since Curran’s article, more research has been completed on both understanding how IN drug administration works and what drugs are effective via the IN route.
The nasal cavity has two primary functions: olfaction, or sense of smell, and warming, humidifying and filtering the air we breathe. It is the latter function that is important when discussing intranasal drug administration. Inside the nasal cavities are turbinates, which are highly vascular and convoluted passageways lined with a warm, moist mucosal layer. The moist mucosal layer moisturizes air as it passes though the turbinates, and the dense capillary beds allow heat transfer into the air. Additionally, the highly vascular turbinates allow for rapid drug absorption into the bloodstream because the capillaries within the turbinates are specifically designed to allow the rapid shift of fluids (medicines) across the capillary membranes. Turbinates increase the nasal mucosal surface area from what would likely be only a few square inches to over 180 cm2.2