Uncommon Medications Found In Your Drug Box

My old service in Colorado carried Zyprexa.
 
We've got Zyprexa here.
 
Nova1300 said:
Careful with that word. 5HT3 blockers are not indicated for either of the conditions you mention unless they are due to highly emetogenic chemotherapy or PONV. You use them, but off-label. And it's an important distinction to make.

If you want to give zofran to everybody the minute they hit the stretcher, that's fine. It's your paycheck (or taxes)paying for these drugs.

But you are comparing a drug which costs more and is a poor choice as a broad-spectrum antiemetic to a class of drugs that have an established history of efficacy as general antiemetics, are cheaper, easier to replace in times of shortage, can truly be titrated to effect, provide some degree of anxiolysis, and suppresses the CN8 nausea from going backward down the road, which only exacerbates the original cause of the nausea.


If 5HT3 is your drug of preference, then so be it. You won't hurt anyone. But, I'm gonna bet you are far more likely to have puke on your uniform.


Putting Natrecor in an EMS drug box when a good percentage of the critical care community is still unconvinced it has any utility whatsoever, seems a bit absurd. Is there some collection of litterature of which I'm just unaware? Where did this idea even come from?

I have similar feelings on lasix. Giving diuretics to a heart failure patient prior to treating the failing heart results in a volume-depleted patient with wet lungs. And that diuresis tends to drag patients all over the starling curve.
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It's not that 5HT3 blockers are my drug of preference, it's my only option. The only way I can administer phenergan is if the patient is allergic to zofran so unfortunately my hands are tied. I will say that I find it offensive that you'd imply I give zofran to "everybody the minute they hit the stretcher". I'm not sure how you came to that conclusion after I clearly stated what my protocols allow. I'm far from a protocol monkey but at the end of the day I have to follow them and our OLMD physicians aren't big on giving us orders for phenergan over zofran no matter the case you present them.

If there are better drugs which are more effective and are cheaper then why aren't we using them? Why is ondansetron one of the most widely used anti-emetic medications out there? I agree that phenergan is more effective, I'm not arguing that point, but my question still stands...why is zofran one of if not the most common anti-emetic medication administered in the prehospital setting when there are better medications that are apparently cheaper out there?

Also, you are correct, I did more reading on zofran today and have not found anything listing an indication as nausea other than what you noted.
 
Handsome Robb said:
why is zofran one of if not the most common anti-emetic medication administered in the prehospital setting when there are better medications that are apparently cheaper out there?
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Because since the patent ran out and generic forms became available it is quite cheap, and doesn't have any of the side-effects associated with other anti-emetics.

This, this and only this. You have a cheap, fairly effective drug that can be given by ANY route without any of the side effects of other anti-emetics. Very simple and non-thought provoking.

You really shouldn't hold up medications being give prehospitally as a reason for that med being "good" either. With the state of EMS and the overall addiction to fads and shiney object syndrome...not a good idea.
 
I'd say my 8mg vials of atropine. Three of them.
 
Handsome Robb said:
It's not that 5HT3 blockers are my drug of preference, it's my only option. The only way I can administer phenergan is if the patient is allergic to zofran so unfortunately my hands are tied. I will say that I find it offensive that you'd imply I give zofran to "everybody the minute they hit the stretcher". I'm not sure how you came to that conclusion after I clearly stated what my protocols allow. I'm far from a protocol monkey but at the end of the day I have to follow them and our OLMD physicians aren't big on giving us orders for phenergan over zofran no matter the case you present them.

If there are better drugs which are more effective and are cheaper then why aren't we using them? Why is ondansetron one of the most widely used anti-emetic medications out there? I agree that phenergan is more effective, I'm not arguing that point, but my question still stands...why is zofran one of if not the most common anti-emetic medication administered in the prehospital setting when there are better medications that are apparently cheaper out there?

Also, you are correct, I did more reading on zofran today and have not found anything listing an indication as nausea other than what you noted.
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Whoa, sunshine. My implication was never meant to be that you are pushing drugs needlessly. The point of my statement was yes, the medication is generally safe and your could give it out like candy if you wished. Not you personally.

The reason I think it is used is because ER folks have this irrational fear that medics giving the other classes of anti-emetics are gonna result in having to intubate everyone as they roll through the door. Which is ridiculous.

That's my theory, at least.
 
Chewy20 said:
We have a bunch of atropine as well. Only have seen it pushed once since I have been here for a lady with a HR in the 20's.
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My very first call as a cleared paramedic was for a guy in 3rd degree AV block with PVC's and a pulse rate in the 20's. IIRC, I gave him several mg of atropine with no or little effect, and ended up pacing him.
 
Digging through the med box today, we still have Demerol.

No fentanyl, but all the Demerol you can stand. :)

Oh, Romazicon too.
 
Lol yep. I didn't even carry that much when I was on the ground in really rural areas. Not sure why I carry it now though.
 
Remi said:
My very first call as a cleared paramedic was for a guy in 3rd degree AV block with PVC's and a pulse rate in the 20's. IIRC, I gave him several mg of atropine with no or little effect, and ended up pacing him.
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We got her rate to start bouncing around in the 40-50s if I remember correctly. Pacing was the next step, but she was concious and alert the whole time somehow so luckily we didnt need to. No radial pulses, unobtainable manual BP on arrival. Think the ER doc said it turned out to be hyperkalemia.
 
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