With a Mucosal Atomizing Device (MAD) you can deliver many critical drugs intranasally. All you need is a liquid, concentrated drug that will easily cross the nasal mucosa, and give it via something that will atomize your fluid.

Pictured is a mucosal atomizing device. Small, simple, low-tech. Put it on the end of a luer-lock syringe, and off you go. Deliver Fentanyl, Ketamine, Midazolam, Naloxone and other favourites quickly and easily when you don’t have an i.v. access ready. This could save you by giving a bit of sedation to get proper access in a restless, combative patient. Sedate kids before i.v. cannulation, or sedate them slightly before a mask induction. Give midazolam to seizures. Or give naloxone intranasally to get the heroine OD patient breathing again and give you time to struggle with a proper i.v. access.

It works faster than i.m. injections, and is easier and quicker and often more acceptable and appropriate than an i.o. access. If your hospital doesn’t stock them, carry one in your pocket and save the day.

Read more on this great resource:

A few pointers from that site:

Use a highly concentrated form of the medication to reduce volume and therefore reduce runoff. ¼ to 1/3 ml per nostril would be preferred. 1/2 to 1 ml per nostril is tolerable but there will be some loss as the volume increases. More than one ml per nostril per dose should likely be split and delivered over several cycles separated by 10-15 minutes.

Utilize both nostrils to double the surface area for absorption and halve the volume delivered per nostril

Be knowledgeable of the “dead space” within the delivery device and account for this dead space when calculating the volume you will deliver to the patient

This entry was posted in Anesthesia, Emergency Medicine, Prehospital Medicine. Bookmark the permalink.

One Response to MAD IS GOOD

  1. Thomas D says:

    After using M.A.D. occasionally, I have found that some of the drugs used will sting and burn on the nasal mucosa, which leaves you with no gain as far as kids are concerned.

    However, administering atomised lignocain to the nose first, then your drug of choice, will get you past that little problem.

Leave a Reply to Thomas D Cancel reply

Your email address will not be published. Required fields are marked *