Gravol

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skivail

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How often do you push gravol? I find in my area IM gravol is pushed out like candy.
 
To be honest I had to google it to even know what it was... That said, I do give Benadryl on a regular basis.
 
Here it seems like anyone who even mentions nausea gets gravol prior to transport. I feel like people push it just because they can.
 
So Gravol (dimenhydrinate or Dramamine for those of us in the US) is not a commonly used drug in the US. However, I've never hesitated to use anti-emetics, especially ondansetron (I didn't really hesitate to use promethazine, but I did give a little pause in the elderly population). There's no reason not to treat a VERY unpleasant symptom when you easily can.

My question is why would you NOT treat nausea?
 
Oops I misread uses. In that case I do give Phenergan a lot too. I'd rather not have a patient in distress due to wanting to vomit the entire ride.
 
I probably push Zofran more than I push anything else, including oxygen.* It is a very simple thing that can go a long way towards making people feel better. We may not be able to solve all of their problems, but if we can help the nausea they will be grateful.



* At least 1/2 of the time I use O2 it is because I need to give a neb.
 
I like gravy on my chicken.
 
Has anyone ever seen any QT prolongation side effects from Zofran / Ondansetron? I often hear that as a consideration for our standing comfort orders. Being that zofran is to be given after pheneragen does not resolve it.
 
I have not, from either a provider stand point or a personal one. I spent a week taking ~30mg of Zofran a day and the ER MD never mentioned anything about QT prolongation or any other cardiac issues. I also had a patient that had a poly-pharm OD including Zofran, and the MD wasn't concerned about the Zofran at all. He mentioned something about needing to get into the hundreds of milligrams in order to start running into problems.
 
8jimi8 said:
Has anyone ever seen any QT prolongation side effects from Zofran / Ondansetron? I often hear that as a consideration for our standing comfort orders. Being that zofran is to be given after pheneragen does not resolve it.
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Don't say that, Zofran will go the way of Droperidol :rolleyes:!

Never seen it, but I can't say I've ever looked for it either. In someone with a diagnosed QT issue (which you probably see a lot more of) it's probably worth considering, but for the general population, it's probably not worth worrying about.

I am curious about y'all using promethazine as the front line med, especially in light of the phlebitis concerns and the number of dystonic reactions it causes in the elderly. How does your facility deliver it and any thoughts on why it's first-line?
 
Our standing orders are usually

Phenergan 6.25 mg ivp q4 prn nausea vomiting

Ondansetron 4mg ivp q6 prn for n/v refractory to phenergan


I've never seen any adverse reactions from either of these drugs in IV form.

These have been the standing orders over two network hospitals, that I've worked at in this area.
 
We actually do it reverse... We use 4mg Zofran x2, then 12.5mg Phenergan x2 refractory to Zofran. I'm not a big fan of it, as I've always had much better luck with Phenergan terminating the nausea.
 
skivail said:
Here it seems like anyone who even mentions nausea gets gravol prior to transport. I feel like people push it just because they can.
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That will really depend on which EMS service you are with. At some, people will give it just because they can somewhat justify it. At others, unless you're on a long distance transfer or doing some pretty good vomiting you won't be likely to get it. Where are you riding out?
 
I don't give it very often but do when it is warranted. The hospitals give it before long transports fairly often as well as giving ativan. It seems to work as I haven't had anyone be sick in my unit for a long time. (Knock wood).
 
My service took Phenergan off in favor of Zofran.

If anyone has any complaint of nausea they get Zofran from me.

I know medics that automatically push Zofran any time they give Morphine or Fentanyl, but I prefer that they at least have some complaint of nausea.

As far as Gravol, I'd never heard of it called that way until today. ;)
 
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Medic2409 said:
My service took Phenergan off in favor of Zofran.

If anyone has any complaint of nausea they get Zofran from me.

I know medics that automatically push Zofran any time they give Morphine or Fentanyl, but I prefer that they at least have some complaint of nausea.

As far as Gravol, I'd never heard of it called that way until today. ;)
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I do the same. I have had any nausea issues with morphine yet, if I do I will address them with Zofran. I have only had to give morphine 3 times though in 5 months.
 
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