Contributor: Aaron Lessen, MD

Educational Pearls:

Intranasal medication administration is a convenient, quick, and relatively painless option for pediatric patients
Often used as an initial medication to help control pain in children prior to establishing an IV
Using an atomizer is preferred when administering intranasal medications
The syringe should be angled towards the ipsilateral eye or occiput rather than straight upwards
Do not administer more than 1 mL of fluid per nostril as volumes greater than 1 mL are not sufficiently absorbed
Intranasal medication doses differ from the traditional IV dosages and have a slower onset of action

References

Del Pizzo J, Callahan JM. Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care. 2014;30(7):496-501; quiz 502-494.

Fantacci C, Fabrizio GC, Ferrara P, Franceschi F, Chiaretti A. Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room. Eur Rev Med Pharmacol Sci. 2018;22(1):217-222.

Rech MA, Barbas B, Chaney W, Greenhalgh E, Turck C. When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications. Ann Emerg Med. 2017;70(2):203-211.

Schoolman-Anderson K, Lane RD, Schunk JE, Mecham N, Thomas R, Adelgais K. Pediatric emergency department triage-based pain guideline utilizing intranasal fentanyl: Effect of implementation. Am J Emerg Med. 2018;36(9):1603-1607.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD

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