My only concern is the time effort and money they are spending trying to get the green whistle as product INTO emergency departments. I see this as an unsuccessful strategy. There’s just no need there.

To be fair to MVP they are not trying to get the product into emergency departments. Methoxyflurane (the green whistle) is used by first responders such as paramedics as a simple and relatively safe way to administer analgesia quickly. Although it failed as an anaesthetic agant (liver toxicity), methoxyflurane has a good track record in Australia when used in this way and would likely be successful in the US.

Not held.

I sort of agree however it could displace N2O use for reducing dislocations. Maybe some paeds. Still seems niche as I stated in my straw I also think this is essentially a poor use of limited resources. An IV is going in anyway for most patients and cost and familiarity will dictate its also used for analgesia.

Prehospital is different because you often want to basically grab the patient and head off to ED asap faffing with a line could be a waste of time also some initial analgesia may help you get an IV in.

Intranasal fentanyl the main other option has major issues due to being a drug of abuse as you need a really high dose compared to IV (great for diversion) and there have been lots of examples of abuse.

They are in Australia.

I don't think methoxyflurane has a role in emergency departments. I've never seen it used in that setting in Australia. Once you get to ED there are better agents that are more titratable.

Schedule 8 drugs like fentanyl are closely controlled requiring a double sign out and I don't agree that it has a major issue of abuse in Australian emergency departments. Also intranasal fentanyl is generally limited to children.

Well, actually they are. Hence my post!

both the ED s I work in have been approached by reps exploring whether we would like to add it to our Imprest.

I have recently been invited to an education day sponsored by MVP - the sole purpose of which is to convince Emergency staff of the utility of Methoxy inside EDs.

The near universal consensus amongst colleagues is that it doesn’t have a role, we have better options.

Fair call @Chagsy and you can't blame MVP for trying. They've got next to no chance of grabbing any market inside ED's in Australia I would think and your post reinforces my view.

I have seen it used in ED. Don't think it's a big enough market to chase.

Issues with diversion have occurred in the prehospital setting. And IN fentanyl usually paeds but what other option for non needle based instant analgesia? Don't answer it's rhetorical. Point is it's not a great option but it's the only direct competitor.

Also @Shapeshifter just to be pedantic it was kidney failure that stopped its use in anaesthesia ;).

The goal should be to get it on the prehospital protocols for minor trauma, broken bones etc and watch sales accellerate. I think they will get there.

Dentist here,

Surprisingly I first heard of this product at work as one of the clinics I used to work at had it ready in case a patient wanted it for a toothache/pain during treatment.

I've never personally used it but my colleague did mention that it had some positive effects especially for some patients who had extreme phobia of needles. They would instead suck on the green whistle to get through treatment instead of being anaesthetised.

Only downside is that we are working in the mouth so the treatment would have to be constantly halted in order for the patient to suck on the green whistle.

I no longer work at this clinic and it remains the only clinic which had it ready on hand.

Disc: I do own a small amount of shares in MVP as I think the product can gain traction in the US. Perhaps not in the hospital setting but more in the wider community settings eg. Sports stadiums, swimming pools, ambulances etc.

Both liver and kidney toxocity @AlphaAngle !