It’s time for another video. Today I’ll be showing you how to MacGyver your own atomizer for intranasal and orotracheal drug administration. Shout outs to fellow USask FOAMite Dr. Nadim Lalani (@ERMentor) and Dr. Whit Fisher for the idea behind this one. Today’s video is a modification of the design outlined by Whit Fisher here. For more of my “How To” videos, check out the videos page here or GMEP.org.
The intranasal (IN) route of drug administration is becoming ever more popular, specifically in pediatrics and awake intubations. This PK SMACC Talk video from Italian Valerio Pisano Brasca (His blog is here), who has a much cooler name than me, is a good 6 minute overview on the types of medications and doses that can be used via the intranasal route. Some of the big ones are fentanyl, ketamine, and midazolam. Administering these drugs without intranasally is useful for procedures and pain in children, and could also be used before establishing IV access as well. Another drug that can be given IN is naloxone, useful for your narcotized post-op patients on the ward, and drug users in the ED.
What I like most about the atomizer is that you can effectively deliver topical anesthetics to the posterior oropharynx and have the patient hold it themselves for elective intubations. Rather than stick something in their mouth, the patient or a parent could do it for them.
To test this out, I tried it on myself with 2% lidodan and it did a pretty good job of decreasing my gag reflex. Definitely to the point that I could easily get a MAD back there to spray the cords. A common question is “why not just use a nebulizer”? I’ve tried the nebulized 4% lidocaine for topicalizing the airway, and I find most patients say that it just coats their tongue and inner cheeks, while not actually getting their oropharynx. The atomizer does a much better job of this.
Onto the video. If it’s not working, check the YouTube link here.
Questions and comments on how to improve are always appreciated.
Post written by Chris Bond. Peer reviewed by Nadim Lalani (@ERMentor)