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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