# Zofran (ondansetron)



## 82-Alpha599

We just received our new protocols for 2010 and we now have Zofran 4mg IV or IM for nausea/vomiting.  I did my homework on the drug but im just curious what you all think of it, and how to best use it.

Do you use it on the drunk 17 y/o girl who just found out what a yager bomb is all about, is it better IV or IM, push it fast/slow, ...????

any tips are appreciated
Thanks


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## Shishkabob

I've seen Zofran used a few times and I LOVE it, though I've only seen the PO form of it, and it was administered to anyone complaining of nausea/vomiting.



My view on the 17yo girl, if you're giving fluids or other drugs, go IV route.  If you're not going to start an IV, than give IM.


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## Fox800

We've had it for about a year...we can give it IV or IM (pedi is IV only). It's good stuff. And yes I will give it to drunks (being transported) that are vomiting, no problem.


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## Onceamedic

I like to administer it to nauseous patients on the scene.  It saves a lot of time when they don't puke in the rig.

PS..  its a very good drug.


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## 8jimi8

i don't see how a po medication is going to help someone who is vomiting!


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## Fox800

8jimi8 said:


> i don't see how a po medication is going to help someone who is vomiting!



You can get it in a quick-dissolving tab B)


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## rescue99

82-Alpha599 said:


> We just received our new protocols for 2010 and we now have Zofran 4mg IV or IM for nausea/vomiting.  I did my homework on the drug but im just curious what you all think of it, and how to best use it.
> 
> Do you use it on the drunk 17 y/o girl who just found out what a yager bomb is all about, is it better IV or IM, push it fast/slow, ...????
> 
> any tips are appreciated
> Thanks



Sure beats the side effects of compazine! 

No, I would NOT give Zofran to a kid who was drunk. Not a chance! My kid gets stinkin drunk, let him live the whole experience! 

It works well as a slow push for people with N/V due many legitimate causes.


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## Fox800

rescue99 said:


> Sure beats the side effects of compazine!
> 
> No, I would NOT give Zofran to a kid who was drunk. Not a chance! My kid gets stinkin drunk, let him live the whole experience!
> 
> It works well as a slow push for people with N/V due many legitimate causes.



I think this is a matter of "style points". I prefer to save my partner from having to clean up vomit off the stretcher/floor of the patient compartment. And I don't have to smell it on the way. Or get puke on my uniform. But to each their own!


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## 82-Alpha599

cool... sounds like some good stuff  cant wait to try it out.


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## rescue99

82-Alpha599 said:


> cool... sounds like some good stuff  cant wait to try it out.



Hey ya 599..how's down river these days? 

If one person who would otherwise have become an alcoholic doesn't because I refused to make it easy, I believe I've done a humane service. Besides, the drownsiness factor implies an increased airway risk.


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## rescuepoppy

rescue99 said:


> Hey ya 599..how's down river these days?
> 
> If one person who would otherwise have become an alcoholic doesn't because I refused to make it easy, I believe I've done a humane service. Besides, the drownsiness factor implies an increased airway risk.



Aspiration poses an airway risk as well.


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## rescue99

rescuepoppy said:


> Aspiration poses an airway risk as well.



My intended point..


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## Fox800

rescue99 said:


> My intended point..



Errr...methinks that increased risk of vomiting would be more of an aspiration risk versus whatever sedative effects (very minimal to nonexistent) you'd see by administering ondansetron. We switched from promethazine to ondansetron for precisely that reason...it doesn't have the sedative effects that other antiemetic medications produce.

Lower risk of vomiting + less airway woes + less mess to clean up beats teaching a would-be alcoholic a lesson. That would seem to go along with slamming naloxone to piss off an addict.


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## Onceamedic

rescue99 said:


> If one person who would otherwise have become an alcoholic doesn't because I refused to make it easy, I believe I've done a humane service.



I think it is just as valid to assume the patient dives even deeper into the bottle due to the indifference, ignorance and cruelty of those paid to take care of him/her.


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## DV_EMT

zofran is a GREAT drug. It allows a rapid relief of nausea. 

it comes in as as ODT (orally disintegrating tablet) and a MDV (multi dose vial). I've seen it given primarily via 500/1000 mL drip. It can be given IVP but if your gonna go that route... just go PO


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## Fox800

Kaisu said:


> I think it is just as valid to assume the patient dives even deeper into the bottle due to the indifference, ignorance and cruelty of those paid to take care of him/her.



:beerchug:

Treat your patient. Don't "teach them a lesson" by refusing to address their signs/symptoms, i.e. vomiting.


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## 82-Alpha599

rescue99 said:


> Hey ya 599..how's down river these days?



Oh some ol' same ol'


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## rescue99

Fox800 said:


> Errr...methinks that increased risk of vomiting would be more of an aspiration risk versus whatever sedative effects (very minimal to nonexistent) you'd see by administering ondansetron. We switched from promethazine to ondansetron for precisely that reason...it doesn't have the sedative effects that other antiemetic medications produce.
> 
> Lower risk of vomiting + less airway woes + less mess to clean up beats teaching a would-be alcoholic a lesson. That would seem to go along with slamming naloxone to piss off an addict.



Don't agree. The ETOH effect is enough of an LOC/airway risk. I see no reason to exacerbate an existing risk. I know what recovery position, suction and a mop are for. Comes down to choice I suppose.


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## s4l

<3 Zofran in the ER.  Shuts those damn whiny pts up.


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## 82-Alpha599

what is the IV and IM onset of action time?


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## Aidey

Fox800 said:


> Errr...methinks that increased risk of vomiting would be more of an aspiration risk versus whatever sedative effects (very minimal to nonexistent) you'd see by administering ondansetron. We switched from promethazine to ondansetron for precisely that reason...it doesn't have the sedative effects that other antiemetic medications produce.
> 
> Lower risk of vomiting + less airway woes + less mess to clean up beats teaching a would-be alcoholic a lesson. That would seem to go along with slamming naloxone to piss off an addict.



This for me too basically. 

I like having both promethazine and ondansetron available, although we are moving to just ondansetron. Promethazine works on motion sickness where as ondansetron has little effect if any. We routinely transfer pts to a hospital about 5 hours away, and it is nice to be able to treat motion sickness if it develops. Some pts with chronic problems also prefer one over the other at times too.


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## redcrossemt

rescue99 said:


> Don't agree. The ETOH effect is enough of an LOC/airway risk. I see no reason to exacerbate an existing risk. I know what recovery position, suction and a mop are for. Comes down to choice I suppose.



What's an "LOC risk"?

Recovery position and oropharyngeal suction does not totally prevent aspiration, and the very dangerous ARDS and pneumonia that will accompany this patient's long critical care course after aspiration. Zofran may actually prevent the vomitting in the first place, placing the patient at a much decreased rate of mortality and morbidity.

I don't care if the patient is EtOH+ or not. We shouldn't punish our patients by withholding treatment to make them miserable. That is unethical, and creates a huge risk to your patient in this situation.

In as far as the risk of somolence... Clinical trials indicated that 20% of patients taking Zofran experienced drowsiness, compared to 23% of those given a placebo. Compared to the other common option, a sedative anti-histamine called Phenergan, Zofran has a very limited risk of drowsiness. In addition, what is going to happen if your drunk gets sleepy? They can't protect their own airway? Pretty easy for us to fix... just put in a simple airway adjunct.


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## redcrossemt

Aidey said:


> Promethazine works on motion sickness where as ondansetron has little effect if any.



Also, +1 on this.

Phenergan for motion sickness and vertigo.

Zofran for GI related nausea and vomitting.


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## redcrossemt

Oh yeah, and hello 82A599!


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## rescue99

redcrossemt said:


> What's an "LOC risk"?
> 
> Recovery position and oropharyngeal suction does not totally prevent aspiration, and the very dangerous ARDS and pneumonia that will accompany this patient's long critical care course after aspiration. Zofran may actually prevent the vomitting in the first place, placing the patient at a much decreased rate of mortality and morbidity.
> 
> I don't care if the patient is EtOH+ or not. We shouldn't punish our patients by withholding treatment to make them miserable. That is unethical, and creates a huge risk to your patient in this situation.
> 
> In as far as the risk of somolence... Clinical trials indicated that 20% of patients taking Zofran experienced drowsiness, compared to 23% of those given a placebo. Compared to the other common option, a sedative anti-histamine called Phenergan, Zofran has a very limited risk of drowsiness. In addition, what is going to happen if your drunk gets sleepy? They can't protect their own airway? Pretty easy for us to fix... just put in a simple airway adjunct.



We're thinking all drunks are going to be everything except really drunk! There are not too many cases where we have to go as far as tubing to protect the airway albeit, it occasionally does occur. Non drinkers and kids could be in more trouble but honestly, so what if the victim vomits? Under normal conditions we put them in a recovery position which is first line treatment anyway. Barf can be cleaned up. I'm certainly not afraid of a cleaning up a little mess. If my partner is that big a weenie, I'll do it for heaven sake. 

What I am opposed to is introducing drugs into the system of person with an already decreased LOC without a good reason. Especially if its a kid whose immature system typically hasn't had much in the way of drugs yet. It just isn't necessary under most conditions.That fifth of rum sitting in a kid's stomach will do a whole lot more harm than the initial vomiting will. If he/she is still barfing in a few hours, then consider Zofran.


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## redcrossemt

Rescue99, I think what you are saying now is more reasonable than your initial comments indicating that N/V from alcohol intoxication wasn't legitimate, and that we should let them ride it out to teach them a lesson.


As a side note, Zofran has been found to be safe in the pediatric patient. 4mg IM or IV is fine for those patients over 12 y/o. Between 4-12 y/o, 0.1 mg/kg is recommended. With patients younger than 4 y/o, you should consult medical control as I can't find any literature describing safety and efficacy in that population. I do believe that the SEM protocols require medical control for patients under 12 y/o anyway.


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## rescue99

redcrossemt said:


> Rescue99, I think what you are saying now is more reasonable than your initial comments indicating that N/V from alcohol intoxication wasn't legitimate, and that we should let them ride it out to teach them a lesson.
> 
> 
> As a side note, Zofran has been found to be safe in the pediatric patient. 4mg IM or IV is fine for those patients over 12 y/o. Between 4-12 y/o, 0.1 mg/kg is recommended. With patients younger than 4 y/o, you should consult medical control as I can't find any literature describing safety and efficacy in that population. I do believe that the SEM protocols require medical control for patients under 12 y/o anyway.




^_^Unless I write a book, not all thoughts are jotted down at one time. I still have those first thoughts but yes, there are other, more reasonable reasons as well.


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## maxwell

It's really the only anti-emetic I use.  It's safe, fast, effective, and well-tolerated all around.  It is very, very expensive though.  Especially the oral dissolving tablet thingys  "Zofran ODT."

...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.


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## 82-Alpha599

Nice to see you to redx, maybe ill last a little longer this time. Eh?


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## Fox800

maxwell said:


> It's really the only anti-emetic I use.  It's safe, fast, effective, and well-tolerated all around.  It is very, very expensive though.  Especially the oral dissolving tablet thingys  "Zofran ODT."
> 
> ...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.



There are generic versions available now.


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## Medic946

We've been using Zofran for about a year and I love it!! Good for the drunks, doesn't sedate like Phenergan. Use it IV slow push for best results as far as I've seen.


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## motomedic

Used it last night for the first time. Although I was the Engine medic an did not transport, I hear it works well and we give it often due to are lengthy mountain commutes. Cheers


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## m33kr0b

Zofran was my drug of choice when I was doing chemo.


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## CBFPD

maxwell said:


> It's really the only anti-emetic I use.  It's safe, fast, effective, and well-tolerated all around.  It is very, very expensive though.  Especially the oral dissolving tablet thingys  "Zofran ODT."
> 
> ...and I never give anything to my fans of the Carbon-Carbon bond - except for restraints and a mask.


We pay $0.27 per 4mg Ondansetron Orally Disintegrating Tablet. Pretty cheap....


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## SurgeWSE

I love Zofran and will use it with anyone who is complaining of nausea and with pain meds that tend to cause nausea.  Keep in mind, it is prophylaxis for emesis.  The ones that are already puking their guts out when you get there would be better served with Phenergan.


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## SES4

Fantastic drug.  Awesome that a generic is now available as well. 

I had surgery and required both Phenergen and Zofran while hospitalized.  And as stated Phen.= Already Puking, did not do much for me otherwise and knocked me on my butt.  Zofran though allows you to function generally (each person is different and drugs effect each person differently so I try not to make blanket statements).


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## FFMedic75

Although the drunks probably don't deserve it, you or your partner end up cleaning up the inevitable mess.  So yes I give it to drunks as long as they meet the requirements laid out in my protocols.


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## JeJmFs

Love Zofran. We have been using it in our service for a few months. Still have the good ol Phenergan. I have heard several of our medics say that they like Phenergan better and several say they like Zofran better. I personally dont know what is better. We now have protocol to give a 2nd 4mg dose of Zofran if the 1st does not work. I do like Phenergan for long distance transports though.... makes the pt.s sleepy.


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## redcrossemt

Good bump on this thread. I will tell you anecdotally after using Zofran on the truck for a couple months, I really like having it! It has in most cases stopped active vomiting for my patients, and 8mg has been 100% effective in relieving nausea.


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## TheMowingMonk

From what we have been taught about Zofran its unlikely to be effective on nausea caused by EtOH. But from what you guys are saying it sounds like it has been working on EtOH? what have people experianced with it and EtOH?


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## mycrofft

*As of last week we have switched from Tigan to Zofran.*

Tigan was cheaper and worked as well. Potential psych and seizure effects of Zofran remain to be seen.


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## guardian528

TheMowingMonk said:


> From what we have been taught about Zofran its unlikely to be effective on nausea caused by EtOH. But from what you guys are saying it sounds like it has been working on EtOH? what have people experianced with it and EtOH?



i wasn't there, but on halloween night our medics were giving it out to any vomiting drunks brought in, and they reported it working well


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## burninghalogen

I had seen phenergan used multiple times before I became a medic and it always seemed to stopped the puking but the patients seemed to have the sedation effect about them. I work under Cleveland Clinic East protocols as well as other protocols in the northeastern Ohio area and I've used zofran ODT, IM, and IVP. I think ODT is great for a person dry heaving or not actively having alot of vomit, other wise IVP is the best. I have used IM but only in a pinch or when first on scene, The IM worked but, I'd still say go IVP is ossible. Good stuff though all around, great to premedicate with ODT prior to narcotics like morphine cause ya don't need a line, and I guess they are flavored like baby ASA.


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## ceej

Our protocol offers Zofran 4mg IV/IM only after witnessed vomiting. It is also in our Dilaudid/Fentanyl protocol to give before pain meds as a prophylactic for the nausea they may cause.


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## redcrossemt

ceej said:


> Our protocol offers Zofran 4mg IV/IM only after witnessed vomiting. It is also in our Dilaudid/Fentanyl protocol to give before pain meds as a prophylactic for the nausea they may cause.



You give it prophylactically with pain meds, but not for other nausea? Strange. It seems that Zofran works much better *before* the patient vomits.


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## ceej

redcrossemt said:


> You give it prophylactically with pain meds, but not for other nausea? Strange. It seems that Zofran works much better *before* the patient vomits.



That's what I said.

Now ask me how many medics have 'witnessed' vomiting before giving it


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## redcrossemt

ceej said:


> That's what I said.
> 
> Now ask me how many medics have 'witnessed' vomiting before giving it



Nothing against you, but if you have to violate your protocols to do what's in the patient's best interest, your protocols should probably be changed. Violating protocols puts your providers at risk for litigation if Zofran ever does cause a bad reaction in a patient. I don't know what kind of logic there would behind the "they have to puke first" protocol. Maybe something to take to your medical director or medical control authority?


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## MissMedicCMO

82-Alpha599 said:


> We just received our new protocols for 2010 and we now have Zofran 4mg IV or IM for nausea/vomiting.  I did my homework on the drug but im just curious what you all think of it, and how to best use it.
> 
> Do you use it on the drunk 17 y/o girl who just found out what a yager bomb is all about, is it better IV or IM, push it fast/slow, ...????
> 
> any tips are appreciated
> Thanks



We currently use Zofran in our proctols/system.  I like it a lot more then phenergan...Its less harsh and has less of the sleepyness of phenergan. And depending on how much she has been vomitting lol...Our dosage is 4mg IV/IM ONE TIME only dose...unless otherwise ordered by doc...goes great with narcs.


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## FFMedic75

We've been using it for a while.  It is not sedating like Promethazine, so it is possible to use it on drunks without as many concerns, but keep in mind if you can remove some of the Alcohol through vomit that may not be bad.  I personally like Promethazine better if the patient is already actively vomiting.  However the Zofran seems to work better for Nausea and it doesn't put the patient to sleep so you can continue to monitor GCS and such.  You should push Zofran IV over a few minutes because it apparently causes severe headaches if given to fast.


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## rhan101277

We have phenergan and compazine.  We can give compazine 2.5mg IV, but in drug book it doesn't even state an IV dosage.


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## EricCSU

FFMedic75 said:


> We've been using it for a while.  It is not sedating like Promethazine, so it is possible to use it on drunks without as many concerns, but keep in mind if you can remove some of the Alcohol through vomit that may not be bad.  I personally like Promethazine better if the patient is already actively vomiting.  However the Zofran seems to work better for Nausea and it doesn't put the patient to sleep so you can continue to monitor GCS and such.  You should push Zofran IV over a few minutes because it apparently causes severe headaches if given to fast.



It also causes a tachycardia if pushed too fast.  I shoot for about a two minute IV push with Zofran.

I am also disgusted by others who want to "teach drunks a lesson" by witholding an anti-emetic.  What happened to doing what is in your patient's best interest?

Eric


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## stefanickus

i agree with pretty much everyone else. Give the meds on scene and by the time you get them loaded into the truck you should have a lot less cleaning to do. I have had great success using zofran even on drunks.


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## redcrossemt

EricCSU said:


> It also causes a tachycardia if pushed too fast.  I shoot for about a two minute IV push with Zofran.



Tachycardia? I've never seen that before.

The prescribing info says it can cause bradycardia, but not tachycardia.


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## alphatrauma

*Drunks*

... let them puke

Fluid bolus(es) and a barf bag will do nicely.

Unless there are other collateral considerations (absent gag reflex/bleeding/diarrhea/etc), there's nothing cruel about letting a young/healthy inebriated individual do some purging. it's actually quite therapeutic.


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## 18G

I disagree with letting them puke and suffer. Its not my job to inflict that. Who knows what the situation is. Perhaps it is there first time drinking and their friends weren't watching out for them. Perhaps they didnt intend to get that drunk. Or perhaps they are an alcoholic. Regardless it doesnt matter. 

Its our job to alleviate suffering, not punish patients by withholding medicine that can help.


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## AnthonyM83

Fox800 said:


> I think this is a matter of "style points". I prefer to save my partner from having to clean up vomit off the stretcher/floor of the patient compartment. And I don't have to smell it on the way. Or get puke on my uniform. But to each their own!


It's not just a matter of wiping up a little vomit. And not all drunks will stay nicely in recovery position.

Drunks have projective vomited over the cabinets, seats, our uniforms, gurney, themselves. Though it usually can't be helped, it doesn't look great rolling into the ER with a patient with puke all over themselves, stinking up the place and looking like he's not being taken care of. Then, the nurse has to spent time carefully undressing his emetic clothes fuming of alcohol and acid, trying not to get any on him. Then you have to do a full gurney wipe-down, all the little cracks. Same with the ambulance. And worst part being when you finish a full-decon....yet still smell the puke on you.

Yes, it's not usually that bad, but illustrating a point here... better for you, better for patient, better for ER staff, better for a competent image to other patients in the ER/lobby.


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## alphatrauma

Hmmmm, interesting... and I always thought (read:learned) that vomiting was the body's natural defense mechanism against ingested toxins (ie. alcohol). I guess you (un)learn something new every day.


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## AnthonyM83

Certainly a valid point


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## ExpatMedic0

We have been using Zofran here for around 5 years or more. Works great!


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## 18G

Alcohol gets absorbed almost instantly upon entering the stomach. Letting the patient vomit all over the place will unlikely effect the level of alcohol in the body.


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## rescuebill

For all of those who would suggest to just "let them puke, it's just a little clean up, so be a man and clean it up"   I submit for your consideration that it's not just about clean up. 

It is also about possible exposure, and lenght of clean up. While I am cleaning up, I am not available for another call, one which may very well be a legitimate emergency, and one in which my timely interventions can make a difference, but remember I'm stuck at the ER mopping up puke.

And what if I get hit by flying puke, now in addition to cleaning up my truck, I have to change my uniform ( at a minimum ) and possible take a shower, so now I'm out of service even longer, all because I wanted a drunk to learn a lesson which is not my job to teach !

Here's a thought, how's about we treat our PT's, according to our respective protocols and leave our thoughts and feelings about every thing else in the locker before getting on the ambulance


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## alphatrauma

18G said:


> *1.* Alcohol gets absorbed almost instantly upon entering the stomach.





18G said:


> * 2.* Letting the patient vomit all over the place will unlikely effect the level of alcohol in the body.




You are incorrect on both accounts. Alcohol absorption is dependent on how quickly the stomach empties into the small intestine. Many factors can influence this, food being a major one. The presence of food will cause the pyloric sphincter to close, to allow for the proper breakdown of food, thus delaying intestinal absorption. Vomiting can facilitate the emptying of the stomach (read: alcohol), and prevent the absorption of the expelled contents. So what if you have to clean up the back of the truck... big deal if you need to change clothes or stay "out of service" a little longer.

 A strategically placed emesis receptacle IS your friend. 

Wait a minute, what am I thinking... if it's in the protocol to use, I'll just give it.


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## 18G

Actually, alcohol absorption begins as soon as it enters a persons mouth. The mucosa absorbs alcohol and it rapidly transfers across the stomach and small intestine. 

Yes, food effects absorption rate. But if your being called for an "alcohol overdose" (common dispatch around here) and the patient already has a level of alcohol sufficient to cause significant N/V and obtundation, letting them vomit is probably not gonna effect their recovery time. 

Protecting the obtunded patients airway and limiting exposure to the patients emesis is more wise in my opinion. 

Perhaps neither train of thought is actually wrong. It does make sense about eliminating some of the contents of alcohol in the stomach through vomiting, but the patient has already absorbed a lot of the alcohol and having them vomit will not change their condition during the time EMS has the patient. But will make it worse for them and the EMS providers.

I think its more of the mentality surrounding letting the patient be nauseous, vomit, and punish the patient for their action that is bothersome.


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## mycrofft

*Well, we've been using IM and PO Zofran for a little while now.*

Not better than Tigan, much more expensive. Jury is still out about drug interactions, side effects, etc.


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## Alaska Dustoff

*Zofran*

My flight service uses both Zofran & Phenergan. We got a good read from the pharmacy on uses:

1. If they aren't puking yet, Zofran has its greatest effect.
2. Already puking, Phenergan is better. Drug rep for Zofran even says it's less effective once puking starts.

So that's how we use it. All the way up 12mg total PRN. Especially useful for the head-bonk types who start puking as reflex anyway.

If there's a lot of anxiety or agitation along the need for an antiemetic, we like phenergan better, with the sedation effect it provides. A lot of time if I can wipe out the anxiety, the puking center in the brain becomes happier (and my partner is much happier!).


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## javajunkie

*Zofran "Undesired Effects"*

I know for most people Zofran's a godsend, but keep in mind it's still a drug that can have side effects.

I was given IV Zofran after surgery with morphine, and immediately started vomiting.  After 24 hours on Zofran (and nothing else for 12 hours), my mother (RN) finally figured out the Zofran was the problem.  Sure enough -- no Zofran, no emesis!  The morphine never did make me queasy...  I now keep Zofran on my "please don't give me" list and put up with phenergan's drowsiness.


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## TransportJockey

We use Zofran in the ER more than any other anti-emetic. Great drug. And if we're transferring a pt a long distance, we tend to give them benadryl to help with the motion sickness. Seems to work well. The local services carry phenergan only.


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## Alaska Dustoff

*Individual Drug Reactions*

For Java Junkie: As with any medication there can be sensitivities. You may have found yours. You also may have had nausea already, which is a point for phenergan rather than zofran. It's still a great drug for the pre-nausea, pre-vomiting patient. At least folks don't mix atarax with phenergan anymore...


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## alphatrauma

18G said:


> Actually, alcohol absorption begins as soon as it enters a persons mouth. The mucosa absorbs alcohol and it rapidly transfers across the stomach and small intestine.



The amount of alcohol absorbed through the oral mucosa is infinitesimal, compared to the rate of absorption through the small intestine. Roughly 20% is absorbed in the stomach, with a contrasting 80% at the small intestine. 



18G said:


> Yes, food effects absorption rate. But if your being called for an "alcohol overdose" (common dispatch around here) and the patient already has a level of alcohol sufficient to cause significant N/V and obtundation, letting them vomit is probably not gonna effect their recovery time.



Suppressing vomiting with pharmaceuticals (or anything for that matter) is not indicated here. And vomiting WILL affect the recovery time/overall long-term outcome. Why continue to allow alcohol to be introduced into the small intestine, when the body is NATURALLY attempting to get rid of it... other than fulfilling one's own sense of self-importance or getting one's protocol gun off?   




18G said:


> Protecting the obtunded patients airway and limiting exposure to the patients emesis is more wise in my opinion.



Protecting an airway is very important! 

Dodging emesis... not so much




18G said:


> Perhaps neither train of thought is actually wrong. It does make sense about eliminating some of the contents of alcohol in the stomach through vomiting, but the patient has already absorbed a lot of the alcohol and having them vomit will not change their condition during the time EMS has the patient. But will make it worse for them and the EMS providers.



Just because the patient has absorbed a lot, does not mean that we should allow it to continue by suppressing vomiting. Of course there are some who are only concerned about the time they spend with the patient, and could care less about what happens after they clear and return to service. But there are consequences to everything we do, whether some want to acknowledge it or not. 




18G said:


> I think its more of the mentality surrounding letting the patient be nauseous, vomit, and punish the patient for their action that is bothersome.



Punishing a patient is never justified, but ignoring the body's 
natural/therapeutic processes isn't either.


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## Aidey

alphatrauma said:


> Suppressing vomiting with pharmaceuticals (or anything for that matter) is not indicated here. And vomiting WILL affect the recovery time/overall long-term outcome. Why continue to allow alcohol to be introduced into the small intestine, when the body is NATURALLY attempting to get rid of it... other than fulfilling one's own sense of self-importance or getting one's protocol gun off?



I had a discussion with a doc the other day about this and giving pill OD patients Zofran along with their charcoal. He said if we are giving charcoal, he would rather the patient get an anti-emetic and keep the charcoal down than puke it all back up, even if throwing up will remove some of the pills. 





alphatrauma said:


> Punishing a patient is never justified, but ignoring the body's
> natural/therapeutic processes isn't either.



I agree with the body's natural process thing. Some people want to give every single person who has nausea Zofran, and I don't understand why. Sometimes in life a person is going to be sick and nauseous, and they may even throw up. It's a natural reaction. The issue is when a person can't stop throwing up, or you need them to keep something down (like charcoal, or the GI cocktail).


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## Aidey

Double post, oops.


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## PrincessAnika

from a pt standpoint....during PG i was on phenergan for N/V....worked for a couple months, then no more.  got zofran in the ER....once PO, once SIVP - both times worked better than any cocktail i could come up with of phenergan/reglan at home....unfortunately couldn't afford to get a script of zofran, and melting stuff under my tongue usually induces vomiting for me anyway.  but as a pt it worked great!


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