Which drug should NOT be administered via an endotracheal tube?

Which drug should NOT be administered via an endotracheal tube?

• A. Lidocaine
• B. NaHCO3
• C. Atropine
• D. Naloxone

Answer: (B)

When drugs are given through an endotracheal tube, only a small, specific set of medications are known to be absorbed reliably through the tracheal mucosa. Among common ACLS meds, lidocaine, atropine, and naloxone have formulations and absorption characteristics that make endotracheal administration workable in an emergency when IV access isn’t available. Sodium bicarbonate, however, does not have reliable tracheal absorption and its endotracheal use is not recommended because its effects are unpredictable and it can irritate the airway. In practice, if IV/IO access isn’t achievable, clinicians would avoid bicarbonate via the endotracheal route and instead pursue IV/IO access or other rescue methods.

When drugs are given through an endotracheal tube, only a small, specific set of medications are known to be absorbed reliably through the tracheal mucosa. Among common ACLS meds, lidocaine, atropine, and naloxone have formulations and absorption characteristics that make endotracheal administration workable in an emergency when IV access isn’t available. Sodium bicarbonate, however, does not have reliable tracheal absorption and its endotracheal use is not recommended because its effects are unpredictable and it can irritate the airway. In practice, if IV/IO access isn’t achievable, clinicians would avoid bicarbonate via the endotracheal route and instead pursue IV/IO access or other rescue methods.