Nose spray and hemodynamics

    NextPrevious

    Nose spray and hemodynamics

    Ah, cold and flu season.  It’s that joyous time of year when our department is flooded with miserable people complaining of sinus headaches, rhinorrhea and feeling terrible.  We all know that for most viruses, symptomatic care is the way to go.  A nose spray would be helpful, but what about all of those warning labels that tell you it could be dangerous for patients with hypertension?

    A randomized, double-blind, placebo-controlled trial at Mayo Clinic sought to investigate whether or not a locally applied vasoconstrictor could impact hemodynamics in a meaningful way.  Investigators compared oxymetazoline 0.05%, phenylephrine 0.25%, lidocaine 1% with epinephrine 1:100,000, and 0.9% sodium chloride (placebo) applied to the anterior naris with a cotton pledget and a nose clip for 15 minutes, and found no significant increase in MAP, SBP, DBP or HR when measurements were made every 5 minutes for 30 minutes.  Note that they did not sniff, it was just a topical application ala epistaxis treatment.  The population was small (n=68) and the average age was young (mean age 33.5 years), but the data is reassuring.

    So, next time you treat someone with either a cold or a nosebleed and want to recommend a nose spray, take comfort in the fact that you will probably not tip them into heart failure.

     

    Reference:

    Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial. J Emerg Med. 2018 Sep 5. pii: S0736-4679(18)30659-0. doi: 10.1016/j.jemermed.2018.07.004.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • ED Postpartum Hemorrhage

      So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this…   You deliverRead more

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    • Head Scratcher of a Head CT?

      Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all thoseRead more

    • Central Line Troubleshooting. Beyond the Basics.

      Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease andRead more

    • Narcan Overdose. Too Much of a Good Thing?

      What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote inRead more

    • Health Information Exchange: Quest for the Omni-Chart.

      Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vitalRead more

    • Clinical Decision Support…your daily helper.

      Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision supportRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    NextPrevious