Zofran (ondansetron)

[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.

 

[guardian528]

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

 

[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.

 

[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.

 

[redcrossemt]

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.

 

[ceej]

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

 

[redcrossemt]

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?

 

[MissMedicCMO]

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.

 

[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.

 

[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.

 

[EricCSU]

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

 

[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.

 

[redcrossemt]

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.

 

[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.

 

[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.

 

[AnthonyM83]

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.

 

[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.

 

[AnthonyM83]

Certainly a valid point

 

[ExpatMedic0]

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

 

[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.