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6yo 
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👦" title="Junge" aria-label="Emoji: Junge"> presents to your ED with multiple deep lacs after being attacked by the neighbor& #39;s https://abs.twimg.com/emoji/v2/... draggable="false" alt="🐕" title="Hund" aria-label="Emoji: Hund">... He& #39;s screaming/crying in pain but wont let the RN get near him for an IV, looking at the https://abs.twimg.com/emoji/v2/... draggable="false" alt="💉" title="Spritze" aria-label="Emoji: Spritze"> makes him https://abs.twimg.com/emoji/v2/... draggable="false" alt="😭" title="Laut schreiendes Gesicht" aria-label="Emoji: Laut schreiendes Gesicht"> even harder.
How do you treat the pain?
(Josh)
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How do you treat the pain?
(Josh)
1/...
Consider picking https://abs.twimg.com/emoji/v2/... draggable="false" alt="👃" title="Nase" aria-label="Emoji: Nase">!
How does intranasal drug delivery work?
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Capillary rich respiratory mucosa allows https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> to directly enter the https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">(systemic circulation)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Olfactory mucosal absorption leads to rapid therapeutic levels in the CSF.
Source:[27397490]
2/
How does intranasal drug delivery work?
Source:[27397490]
2/
!How does intranasal drug delivery work?https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Capillary rich respiratory mucosa allows https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> to directly enter the https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">(systemic circulation)https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Olfactory mucosal absorption leads to rapid therapeutic levels in the CSF. Source:[27397490]2/" title="Consider picking https://abs.twimg.com/emoji/v2/... draggable="false" alt="👃" title="Nase" aria-label="Emoji: Nase">!How does intranasal drug delivery work?https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Capillary rich respiratory mucosa allows https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> to directly enter the https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">(systemic circulation)https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Olfactory mucosal absorption leads to rapid therapeutic levels in the CSF. Source:[27397490]2/" class="img-responsive" style="max-width:100%;"/>
A few nerdy PK pearls below:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💎" title="Edelstein" aria-label="Emoji: Edelstein"> Quick onset of action
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💎" title="Edelstein" aria-label="Emoji: Edelstein"> Lipophilic drugs = better absorbed
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💎" title="Edelstein" aria-label="Emoji: Edelstein"> Unionized drugs https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔀" title="Verbogene nach rechts zeigende Pfeile" aria-label="Emoji: Verbogene nach rechts zeigende Pfeile"> BBB more readily than ionized forms
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💎" title="Edelstein" aria-label="Emoji: Edelstein"> IN delivery bypasses GI & first past metabolism, BUT nasal mucosa contains lots of CYP450 enzymes!
PMID:[30449731]
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PMID:[30449731]
3/
Optimal for https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts"> Peds, no IV/IO access
Contraindicated inhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="⛔️" title="Nicht betreten" aria-label="Emoji: Nicht betreten"> Recent vasoconstrictor use (cocaine, oxymetazoline, etc), facial trauma or septal defect
Commonly used INhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> in the ED https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts"> Fentanyl, midazolam, ketamine, naloxone, ketorolac, morphine, TXA
PMID:[28366351][29306421]
4/
Contraindicated in
Commonly used IN
PMID:[28366351][29306421]
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Double-blind RCT (n=80) in peds 3-13yo w/ mod-severe pain d/t limb injuries
PMID:[25447557]
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Double-blind RCT (n=90) in children ages 8-17yo w/ acute extremity injuries
PMID:[30592476]
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Some tips I learned... the hard way https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤦♂️" title="Mann schlägt sich die Hand vors Gesicht" aria-label="Emoji: Mann schlägt sich die Hand vors Gesicht">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> https://abs.twimg.com/emoji/v2/... draggable="false" alt="👀" title="Augen" aria-label="Emoji: Augen"> the kiddo& #39;s https://abs.twimg.com/emoji/v2/... draggable="false" alt="🐽" title="Schweinsnase" aria-label="Emoji: Schweinsnase"> for mucus or boogers. Suction is ur friend https://abs.twimg.com/emoji/v2/... draggable="false" alt="🪠" title="Plunger" aria-label="Emoji: Plunger">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Use high conc. to avoid large volume https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts"> Peds (0.5mL per nostril)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="Fettes weißes Häkchen" aria-label="Emoji: Fettes weißes Häkchen"> Positioning matters! Aim atomizer UP & OUT (point outward to the https://abs.twimg.com/emoji/v2/... draggable="false" alt="👂" title="Ohr" aria-label="Emoji: Ohr">)
Source: http://www.aliem.com/pet-pearls-intranasal-medications">https://www.aliem.com/pet-pearl...
Source: http://www.aliem.com/pet-pearls-intranasal-medications">https://www.aliem.com/pet-pearl...
Inspired by "In the Nose?!" CSHP& #39;19 CE
by Kimberly Won PharmD BCCCP, Kevin Kaucher PharmD BCCCP
#TwitteRx do you have any tips or tricks for effective IN delivery??
Please share any experiences with IN meds you thought worked or did not work........ IN dexmedetomidine anyonehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👀" title="Augen" aria-label="Emoji: Augen">?
#NurseTwitter #FOAMed #MedTwitter #emergencymedicine
Please share any experiences with IN meds you thought worked or did not work........ IN dexmedetomidine anyone
#NurseTwitter #FOAMed #MedTwitter #emergencymedicine
