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MAD - Mucosal Atomization Device

Procedure:

    1. Aspirate the proper volume of highly concentrated medication required to treat the patient (an extra 0.1 ml of medication should be drawn up to account for the dead space within the atomizer at the end of the procedure.)

    2. Twist off/remove the syringe from the needle/needleless device

    3. Attach the atomizer tip via Luer lock mechanism - it twists into place. Slip Luer is also effective as long as the tip is firmly seated on the syringe tip

    4. Using your free hand to hold the crown of the head stable, place the tip of the atomizer snugly against the nostril aiming slightly up and inward (towards the top of the opposite ear).

    5. Briskly compress the syringe plunger to deliver half of the medication into the nostril.

    6. Move the device over to the opposite nostril and administer the remaining medication into that nostril.sal Atomization Device

    Physiology-Membranes of the nose are in direct contact with the brain and CSF. Therefore, meds absorbed across the membranes directly enter the CSF.

    Amount of drug absorbed
    - IV meds =100%
    - Oral meds 5-10%
    - IN (intra-nasal) vary, very near to 100%
    Factors affecting absorption
    - Vasoconstrictors
    - Epistaxis, nasal congestion, mucous discharge
    - Destruction of mucosa from surgery or past cocaine use
    - Particles 10-50 microns adhere best to the mucosa
    Contraindications
    - Epistaxis, trauma, septal abnormality, nasal congestion, mucous discharge
    - Destruction of nasal mucosa from surgery or past cocaine abuse
    Advantages
    - Avoid needle stick injuries
    - Needle less solution to drug delivery
    - Easy/convenient
    - Nose is a rapid access point
    - Painless
    - Little special training involved
    Medications
    - Narcan (naloxone)
    - Versed (Midazolam)

    Narcan
    - Absorption almost as fast as IV
    - Gradual increase in LOC, respiratory status improves fast or faster due to elimination of IV access delay
    - Not always 100% effective. If needed follow with IV along with reassessment for other causes
    - Narcotic antagonist that reverses the effect of opiate drugs, narcotics/synthetic narcotics: Morphine, Dilaudid, Fentanyl, Demarol, Paragoric, Methadone, Heroin, Percodan, Tylox, Nubain, Stadol, Talwin, Darvon
    - Same indications for IV use
    - Same contraindications for IV use
    - Same precautions for IV use
    Basic Intranasal Medication
    Delivery Materials:

    1. Syringe and needle/needleless device to draw up the medication
    2. Atomizer
    3. Medication of appropriate concentration for nasal medication delivery

    High concentration - Low volume
    Ideal volume 0.2 to 0.3 ml per nostril
    Maximum volume 1 ml per nostril

Certification Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the local EMS System.

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