Intranasal Medication Delivery
Objective: Give an intranasal drug with an atomizer and the formulation the protocol lists. Split it between both nostrils. Arrest epinephrine does not go in the nose. The card has the amount.
Why this matters
The nose is a real route for a few EMS drugs. The formulation has to be concentrated enough. The mucosa has to be available.
The route fails when the volume is too large, the atomizer is missing, the nose is full of blood, or the drug was never meant for the nose. Technique is the lesson. The amount stays on the protocol card.
- Use an atomizer. A drip from a syringe into the nostril is not the same delivery.
- Split the volume between both nostrils. If the card says the volume is too large for one spray, follow the card’s second spray or second route.
- Confirm the vial is the intranasal formulation you carry. Arrest epinephrine is not given in the nose.
- Drug, concentration, intranasal, both nostrils.
- The atomizer is on. I am not dripping this.
- This is not the arrest epinephrine.
Clinical sequence
- Choose the route from the protocol, not from convenience. Intranasal is for the drugs and the patients that card lists. It is often used when an intravenous line is not up yet.
- Look at the nose. Heavy bleeding, a lot of mucus, or a destroyed midface means poor absorption. Use the next route the protocol allows.
- Draw the protocol dose from the correct concentration. Attach the atomizer. Brace the head. Aim slightly up and out, not at the septum.
- Give half in each nostril unless the device and the card say otherwise. Compress the syringe briskly so you make a mist.
- Reassess the problem you treated. That is breathing after naloxone, or seizure activity after a benzodiazepine. Be ready for the intravenous or intramuscular dose your protocol uses if nothing changes. Naloxone still follows naloxone use. Support breathing. Do not chase full wakefulness.
Teaching points
- Absorption needs mucosa and a small volume. Drug that runs onto the lip was not absorbed. This page does not set a maximum milliliter. Your device and protocol already did.
- A pediatric volume is easier to overdose if you use the adult concentration. Use the tenfold-error habits.
- Do not use the nose as a reason to skip oxygen or a bag-mask on a patient who is not breathing.
Common errors
- No atomizer, and a stream that hits the septum.
- The entire dose in one nostril, so half of it spills.
- Spraying epinephrine meant for intramuscular or intravenous use because it was the vial in hand.
Practice
One-minute check
With a saline syringe and an atomizer, deliver a split spray on a manikin. Say the drug name and the route out loud before you press. Then name one drug you will not put in the nose.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — Intranasal naloxone and other routes stay on the local formulary.
- Medication rights — Drug, concentration, and route are still checked when the route is the nose.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.