Not Just a Single Squirt: Understanding Nasal Drug Delivery

Paramedics in a rural setting respond to a young man who is unresponsive, barely breathing, has pinpoint pupils and has fresh needle marks along his arm veins. Recognizing this as an opiate overdose they assist ventilations and attempt to administer IV naloxone, but have difficulty starting an IV line.

They heard about nasal naloxone, so they squirt a vial of naloxone into the patient’s nose with a syringe (1 ml of 0.4 mg). It does not have any effect but they manage to establish an IV and administer another 0.4 mg IV. The patient awakens. Based on this experience, they decide nasal naloxone does not work and resist adoption of the concept during future discussions.

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