How liberal are you with antiemetics?

Zofran just became a regular paramedic drug here and was finally made a standing order for 4mg only but before it was a critical care drug only with direct order gotta love VT
 
tah06090 said:
Zofran just became a regular paramedic drug here and was finally made a standing order for 4mg only but before it was a critical care drug only with direct order gotta love VT
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That's kind weird... back home in NM all anti-emetics fall under the intermediate scope
 
Vermont is very restrictive were broken into districts and 3 of the districts up north arent allowed to have paramedics med directors say no and in one of those districts is the largest city in vermont this state drives me crazy ill have my medic in 4 months which i have to take in NH cause VT has no medic programs then im outta here
 
tah06090 said:
Zofran just became a regular paramedic drug here and was finally made a standing order for 4mg only but before it was a critical care drug only with direct order gotta love VT
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it's 4mgIVP BHO here...
 
Thats nothing we gotta call for status epilepticus to get valium its direct order and up until last year adenosine was direct order standing protocol now is give the 6mg then call for repeat doses of the 12mg 12mg
 
alphatrauma said:
I do not (nor does my Medical Director) advocate giving EtOH or drug intoxicated, actively vomiting, patients anti-emetics in the field. I would ask anyone who does to lay out their rationale, as it pertains to medical risk/benefit/positive patient outcomes... not the cleanliness of their rig or uniform.

Hopefully you are forming a differential diagnosis prior to administration.




Which can usually be corrected with IV hydration



Worse reason ever for giving a medication (well, maybe 2nd worse)



Sad thing is, I've seen providers slamming Zofran like it was Adenocard.



x2




I spent a couple years working with primary care physicians in an urgent care setting, and it never ceased to amaze me how people refuse to let their body do it's job. Instant gratification is the order of the day, as busy schedules do not provide the convenience for rest and time to recuperate. And we wonder why it takes so long to get better. Don't get me started on the overuse/misuse of antibiotics.

Back on track... Ask yourself, why is your intoxicated patient vomiting? Alcohol is a POISON (as far as the body is concerned), when the body's ability to metabolize it has been exceeded - toxicity. Will someone PLEASE explain to me how suppressing the the vomit reflex is a good thing in this particular patient. Yes there are exceptions (varicies/caustic substances/bleeding), but these are not the bulk of those presenting. As far as airway is concerned... fowlers/semi-fowlers anyone? I think there may be a suction canister somewhere on the truck.

There are MANY excellent uses for Odanestron/Zofran, but making the poster child for this application an intoxicated patient, is pure lunacy. I will go on record as saying that withholding treatment from a patient who needs it is unacceptable... but so is the other extreme - delivering care/treatment that is unwarranted for the sake of convenience.
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No thank you. I'd rather let it sit and let them sleep it off at the hospital than explain to my medical director/a jury why my unconscious/unresponsive drunk patient aspirated vomit with subsequent sequelae. Airway compromise is a life threat, and not one that I'm willing to accept an increased risk.
 
Fox800 said:
No thank you. I'd rather let it sit and let them sleep it off at the hospital than explain to my medical director/a jury why my unconscious/unresponsive drunk patient aspirated vomit with subsequent sequelae. Airway compromise is a life threat, and not one that I'm willing to accept an increased risk.
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I'd argue that you would have a more difficult time explaining why you didn't intubate... Zofran is the last thing this patient needs.
 
alphatrauma said:
I'd argue that you would have a more difficult time explaining why you didn't intubate... Zofran is the last thing this patient needs.
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Let me rephrase...decreased LOC but will not tolerate an OPA or tube.
 
rfrielly said:
Wonder why?
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Not like the base nurses know much more. We just got zonfran a year ago and it's a BHO. As soon as the nurse hears n/v they automatically give you an order for it, even if you never had the intention of asking for it.
 
No thank you. I'd rather let it sit and let them sleep it off at the hospital than explain to my medical director/a jury why my unconscious/unresponsive drunk patient aspirated vomit with subsequent sequelae. Airway compromise is a life threat, and not one that I'm willing to accept an increased risk
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Let me rephrase...decreased LOC but will not tolerate an OPA or tube.
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So, do ypu mean to say that a vomiting pt with with a decreased LOC will no longer be at risk for aspiration with the simple application of an anti-emetic? In my opinion, if the pt has a decreased LOC, but will not tolerate an OPA, then they still have a gag reflex and can probably be put in the recovery position and if monitored, probably pose little little risk for aspiration.
 
I think that protection of the airway is the number one priority here. If I've got a patient who is actively vomiting and unable to protect their own airway I'm going to intubate. Plain and simple.

Fowler's, Semi-Fowler's, and the classic Recovery Position are great if the patient is conscious enough to manage their own airway, otherwise you'd better have an NG/OG tube down there if you're not going to tube them. Also, you've got a system where you can't intubate? I believe an anti-emetic would be very appropriate.

So....to answer the OP's statement, we only use Zofran in my region. Any time I bring a patient down from the ski slopes, have an inebriated patient on a backboard, or anyone who feels the slightest bit queasy I will throw our 4mg on. If my patient has a hx of nausea with opiates and I'm going to treat with analgesia I will prophylatically treat with 2mg, then provide the other 2 as needed.

By the way...Hi all! Glad to join! :D
 
alphatrauma said:
I'd argue that you would have a more difficult time explaining why you didn't intubate... Zofran is the last thing this patient needs.
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I would venture to say that giving Zofran is a lot less invasive than intubating a patient. If we look at the big picture, you can give Zofran and the patient has less of a risk of aspiration and will sleep it off in the ER or you can intubate and now this patient is most likely going to be admitted to the hospital on a ventilator. Not to mention the risks of intubation on alcoholics. Less go with the FAR less invasive treatment.
 
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